Coronary vasomotor disorders are a common cause of angina pectoris without obstructive lesion of the coronary arteries (CA). Over the past decade, various non-invasive and invasive diagnostic methods have made it possible to comprehensively assess coronary vasomotor function and determine the endotypes of epicardial and microvascular dysfunction, which is important for stratification of cardiovascular risk and individualization of patient treatment. The basis for the diagnosis of the complex interaction of vasodilation and vasoconstriction of various parts of the coronary bed is a comprehensive intracoronary functional testing, which is recommended if the angina symptoms are persisting against the background of angiographically unchanged or moderately stenosed, blood flow non-limiting coronary arteries. The established parameters characterizing adequate vasodilation are coronary blood flow reserve and microvascular resistance. Increased vasoconstriction potential is diagnosed by intracoronary provocation test with acetylcholine, which allows verification of epicardial and/or microvascular vasospasm. The article discusses standardized criteria, non-invasive imaging methods and modern invasive examination algorithms used in the diagnosis of microvascular and vasospastic angina.

The article presents the results of aortic valve replacement with artificial prosthetic heart valves. The study comprised 422 patients after aortic valve replacement with mechanical bicuspid valve prostheses of 19, 21, and 23 mm. The valves used were «Planiks-E», MedIng-2, Carbomedics, ATS Medtronic, St. Jude Medical. Hospital and long-term results are analyzed directly depending on the type-size of the AMHV used. There was a significant decrease in the peak and average transvalvular gradient on the all aortic valves (p < 0.0015), as well as an increase in the effective orifice area (EOA) of the aortic valve. EOA of the prosthesis “Planiks E” was not significantly different from that of its foreign equivalents. The EOA of St.Jude Medical prostheses was significantly larger compared to the Sorin Carbomedics prostheses (p > 0.005). The peak and mean gradients were different significantly (p = 0.007 and p < 0.05). The highest maximum systolic gradient was observed with Sorin Carbomedics prostheses. The phenomenon of prosthesis-patient mismatch of moderate degree in the early postoperative period was observed in 30.3% of patients, and in 4.1% it was severe. For “Planiks-E” prostheses, severe PPM was observed in 3.2% of patients. “Planiks-E” and ATS Medtronic prostheses were less common related to moderate PPM, in 27.80% and 28.60% correspondently. Overall hospital mortality was 3.4%. The risk of developing moderate PPN was 1.66 (95% CI 1.087 – 2.539, p = 0.19). The follow-up period mediana was 3.4 (2.12÷5.93) years. There were no significant differences in survival between patients without or with different PPM degrees (log-rank test, p = 0.539). Among “Planiks-E” the five-year survival rate was 87%.The PPN phenomenon did not significantly affect long-term survival. The heart valve prosthesis “Planiks-E” is comparable in its hemodynamic parameters to similar imported prostheses, the risk of moderate PPN being significantly lower.

Background. Considering the change in the pathogenetic vector towards the studying of comorbidity, becomes crucial the search for biological predictors providing a more precise assessment of cardiovascular risk in specific subgroups of patients with moderate, unusual or undetectable risk levels (for example, in patients with background acute surgical diseases of the abdominal cavity).
Aim. Evaluation of some rheological and biochemical parameters in patients with acute calculous cholecystitis.
Material and methods. The main group consisted of patients with acute calculous cholecystitis, which were administered cardioprotective therapy (acetylsalicylic acid and atorvastatin) and who carried out urgent cholecystectomy (OKT group). The first comparison group was formed of patients who underwent urgent cholecystectomy, but did not took cardioprotective therapy (OK group). The second comparison group was formed of patients which were used cardioprotective therapy, but who did not perform cholecystectomy (KT group).
Results and discussion. In accordance the study, the following initial data were obtained (Me (25th; 75th percentiles)): HSCRP, mg/l – 9.6 (3.8;15) and 21.11 (4.90;18.20), p > 0.05; homocysteine, mmol/l 12.6 (8.6;16.3) and 9.04 (6.80;10.00), p < 0.05; ICAM-1, ng/ml – 420 (298;482) and 564.27 (280.00;920.00), p > 0.05; MMR-9, ng/ml 119.2(116;1430) and 991.36 (690;1450), p > 0.05, in the OKT and KT groups, respectively. The following data were obtained on an outpatient basis: HSCRP – 1.6 (0.88;3.56) and 5.94 (1.87;9.63), p < 0.05; MMP-9 – 108.5 (84.4;575) and 800.90 (465.00;1310.00), p < 0.05; ICAM-1 – 434.5 (340;580) and 277.75 (240.00;306.00), p < 0.05; homocysteine 14.9 (12.9;19.2) and 15.51 (14.10;18.25), p > 0.05, in the OKT and KT groups, respectively.
Conclusion. The absence of surgical treatment of acute calculous cholecystitis resulted in to significantly higher concentrations of markers of inflammation such as HSCRP, matrix metalloproteinase-9 and lowered levels of the intercellular adhesion molecule – ICAM-1. Thus, conservative management of patients with acute calculous cholecystitis was accompanied with higher concentrations of biomarkers of inflammation and atherosclerotic plaque vulnerability by the end of 30 days of follow-up.

The article analyzes the relative risk (RR) of death from myocardial infarction (MI) in women in the ecological zones of the Republic of Dagestan (RD). An epidemiological study of all female deaths from MI in RD in 2011–2020 was carried out taking into account their residence in cities and rural areas of various ecological zones. The analysis of the RR of mortality by altitude belts indicates that the foothills and mountains of RD are areas of increased risk of death from MI for the female population, while on the plains the same indicator is insignificantly lower. The highest mortality rate from MI among women was recorded in the south of the mountainous ecological zone (8.1 cases per 100,000 female population) with an RR of 1.3.
Aim: analysis of the relative risk (RR) of death from myocardial infarction (MI) among women of ecological zones of the Republic of Dagestan (RD).
Materials and methods: An epidemiological study of all female deaths from MI in RD in 2011–2020 was carried out taking into account their residence in cities and rural areas of various ecological zones.
Results: An analysis of the RR of mortality in the high-altitude zones indicates that the foothills and mountains of the Republic of Dagestan are areas of increased risk of death from MI among female population. However, in the plain the same indicator is insignificantly lower. The highest mortality rate from MI among women was registered in the south of the mountain ecological zone (EZ) (9.1 cases per 100,000 female population) with RR 1.4. These data can be considered evidence of the effect on the risk of death from myocardial infarction among the female population from the southern mountainous areas with a sharply continental climate, characterized by high-altitude hypoxia, affecting the oxygen supply processes in the myocardium.
Conclusion: The areas of increased RR of mortality from myocardial infarction among the female population of rural areas include the high-mountainous regions of the southern mountains of the Republic of Dagestan.

Aim. To analyze long-term results of the use of minimally invasive epicardial video-assisted radiofrequency ablation (RFA) of the pulmonary veins (PV) in patients with various forms of isolated atrial fibrillation (AF).
Materials and methods. Since February 2011 to December 2014, 22 patients (male/female – 21/1) with paroxysmal / persistent / long-standing persistent idiopathic form of AF were operated on the basis of the Republican Scientific and Practical Center “Cardiology”, 7 (31.8%) / 9 (41%) / 6 (27.2%) cases respectively. Mean age was 48.33 ± 9.37 (31–66) years old. The average duration of the history of AF before the operation was 58.6 ± 32.5 months. RFA was performed through a bilateral mini-thoracotomy approach using video endoscopy with the application of bipolar irrigated Gemini X ablative clamp electrodes. All patients underwent bilateral antral RFA isolation of the PVs. In 100% of patients it was possible to achieve a conduction block from the PV collectors.
Results. During the hospital period, there were not no lethal cases, conversions to sternotomy, and neurological complications. The long-term period was studied in 100% of patients, the average follow-up period was 7.4+0.5 years. The final rhythm was assessed using Holter monitoring in 3, 6, and 12 months after surgery, then annually. In 6 (28%) cases in patients with initial non-paroxysmal AF, endocardial RFA of the isthmus of the right atrium or PV orifices was performed at different times after surgery due to the presence of atrial flutter (4/19%) or AF (2/9.5%). Implantation of the pacemaker was required in 2 cases (9.0%).
The effectiveness of bipolar antral RFA isolation of the PV using the Gemini X device, depending on the initial form of AF in the long-term period: paroxysmal – 100%, persistent – 66.7%, long-term persistent – 33.3%.
Conclusion. Epicardial minimally invasive bipolar antral PV isolation is a highly effective treatment for paroxysmal AF. In non-paroxysmal forms of AF, it is necessary to expand isolation of arrhythmogenic zones in the atria.

Background. Reperfusion injury occurs after revascularization of the coronary artery in patients with myocardial infarction (MI) significantly contributing to the development of chronic heart failure. This article describes the results of studying the effectiveness of one of the promising cardioprotection strategies aimed at limiting reperfusion injury.
Materials and methods. Patients with acute anterior MI with ST elevation (STEMI) (n = 87) were included in an open-label prospective randomized controlled trial. Intervention group (IG) patients underwent primary percutaneous coronary intervention (PPCI) and remote ischemic preconditioning in combination with delayed postconditioning (RIPerPostC) (n = 43). Control group patients (CG) underwent only standard PPCI (n = 44). Event-free survival was estimated by Kaplan-Meier curves.
Results. A comparative analysis of the frequency of the composite endpoint (re-hospitalizations for the underlying disease, repeated MI and death from cardiac causes) by the 36th month of follow-up had shown that the proportion of patients who reached the endpoint was significantly higher in the CG: 45.5% vs 20.9% in the IG (p = 0.015). According to the results of the log-rank test, there are statistically significant differences in the event-free survival of the analyzed groups (LR = 1.99, p = 0.047). The Kaplan-Meier curves of the CG and IG during the first 12 months after AMI did not differ visually in height and slope, which indicated the absence of intergroup differences in the cumulative functions of event-free survival during the indicated observation period. After 12 months, there was a discrepancy between the Kaplan-Meier curves due to the fact that the survival rate continued to decrease rapidly only in the CG. According to the survival function, in 25% of CG patients, adverse events occurred within the first 13 months after AMI. Taking into account censored observations, the cumulative proportion of patients without major clinical events 36 months after AMI in the IG was 74% versus 38% in the CG.
Conclusion. In patients with STEMI the DIPerPostC method in combination with PPCI has a positive effect on patient survival over 36 months in comparison with isolated PPCI. The highest number of adverse events occurred during the period from 12 to 36 months of observation in the CG.

Objectives: to study and compare the clinical and echocardiographic characteristics of patients with functional (secondary) tricuspid insufficiency, depending on its etiology and depending on the surgical methods used in surgical practice for its correction.
Materials and methods: clinical and hemodynamic assessment of a population of patients with non-rheumatic tricuspid valve insufficiency (functional) in chronic forms of coronary heart disease (CHD) or dilated cardiomyopathy (DCMP) was performed. The study included 792 patients who underwent correction of non-rheumatic tricuspid valve insufficiency (functional) during a period 2011–2020: 642 participants with coronary artery disease, 150 participants with DCMP. Clinical and echocardiographic parameters were assessed. Results: In the analyzed patient population, in-hospital mortality after surgery in patients with CAD was significantly higher than in patients with DCMP, which can be explained by a number of factors, including the more severe nature of the pathology in patients with CAD (in the study, patients with multiple coronary arteries lesions and a high functional class of angina prevailed in the group of coronary artery disease), and a larger scale of surgical intervention. In patients with DCMP, a more significant dilatation of the right ventricular cavity and a significantly higher increase of right ventricle volumes were noted. At the same time, despite more significant remodeling of the left (LV) and right ventricles (RV), the level of systolic and mean pulmonary artery pressure did not differ significantly between patients with CAD and DCMP. There was no significant difference in the levels of dilatation and volume of the right atrium between patients with CHD and DCMP. Patients with DCMP showed more severe dilatation of the tricuspid valve annulus and the area of its orifice. However, when assessing the magnitude of the degree of severity of the functional tricuspid valve insufficiency, no significant differences were noted in almost all parameters, depending on the etiology. Despite a comparable volume of regurgitation and the degree of tricuspid valve insufficiency, patients with DCMP had a significantly more severe changed geometry of the tricuspid valve annulus. Ring plasty techniques were used in patients with more pronounced LV remodeling and severe LV systolic dysfunction. This, most likely, caused a more significant overload of the pulmonary circulation, causing a higher level of pulmonary hypertension and volume overload of the right heart. In patients with CHD, suture repair methods were more often used, and in patients with DCMP, ring methods of annuloplasty of the tricuspid valve were used more often. At the same time, regardless of the etiology, ring annuloplasty techniques were used with more severe functional insufficiency of the TV in patients with a significantly more significant decrease in right ventricular contractility.
Conclusion: in the study population, hospital mortality was higher in the CHD group than in the DCMP group. In DCMP, a more pronounced dilatation of the tricuspid valve annulus and the area of its opening were observed, however, the degree of severity of the functional insufficiency of the tricuspid valve in all respects does not depend on the etiology. In patients with DCMP, there is a significantly more pronounced violation of the geometry of the tricuspid valve annulus. In patients with coronary heart disease, suture repair methods are more often used, and in patients with DCMP, ring methods of annuloplasty of the tricuspid valve are used. Both in CHD and DCMP, ring plasty of tricuspid valve were used in cases of more severe functional insufficiency in patients with a significantly more decreased contractility of the left and right ventricles.

This scientific review is devoted to the assessment of the role and effects of statin therapy in the treatment of patients with heart failure (HF). The article overviews the possibilities of using new medications with a profound lipid-lowering effect in patients with HF, belonging to the class of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9). The results of our own research are also presented, the purpose of which was to study the association of statin therapy with the state of the coronary arteries (CA) in the long-term period after heart transplantation (HT).
Materials and methods. The data of 75 patients after HT were analyzed. Coronary angiography and intravascular ultrasound were performed to assess coronary artery (CA) damage. The degree of coronary artery disease was determined according to the Stanford classification. In the dynamics of observation, biochemical parameters of blood were assessed.
Results and discussion. 7 years (84 months) after HT, patients were divided in 3 groups: 1st with no significant damage to the coronary arteries (n = 38); 2nd with significant damage to the CA (n = 20); 3rd with angiographically significant stenosis of the coronary artery (n = 17). Within 12 months after HT, the groups were comparable in terms of the dose of atorvastatin taken by patients (from 5 to 20 mg). By the 12th month of therapy, the median dose of the medication was significantly lower (5 (5; 10) mg) in group 3 than in groups 1 (20 (10; 40) mg, p = 0.046) and 2 (20 (20; 40) mg, p = 0.008). The dose reduction of the lipid-lowering drug was due to a decrease in the concentration of LDL-C. After 36 months there was a steady increase in the level of LDL-C cholesterol in the blood in group 3. In groups 1 and 2, there were no significant fluctuations in the concentration of LDL cholesterol within the period from 6 to 84 months after HT.
Conclusions. In order to prevent the development and progression of coronary artery disease in the long-term period after HT, more aggressive statin therapy is required (at least 20 mg of atorvastatin, even after reaching the target LDL-C level). For patients at high risk of developing coronary heart disease and intolerant to more traditional lipid-lowering treatments, PCSK9 should be considered as a promising alternative.

Aim. To study early and long-term clinical outcomes in patients with unstable angina (UA) and coronary artery stenting based on the results of a seven-year follow-up.
Materials and Methods. The study included 165 patients with UA and coronary artery stenting. The average age of patients was 59.04±10.34 years; the number of male patients was 129 (78.2%). The risk by the GRACE scale was 96.9±17.46 points. The average number of affected coronary arteries was 2.23±1.07 per person, the average number of implanted stents was 2.10±1.45 per person, the average length of the stented area was 43.12±25.6 mm. Everolimus- or sirolimus-eluting stents were used. All patients were assessed for troponin I, myeloperoxidase, and C-reactive protein; platelet, plasma, and vascular hemostasis were evaluated. The patients underwent echocardiography, coronary angiography. The follow-up period was 7±1.6 years.
Results. During a 7-year follow-up period, with endovascular treat ment strategy and double antithrombotic therapy with clopidogrel 75 mg and acetylsalicylic acid 75 mg repeated UA developed in 91 (55.2%) pts and myocardial infarction was registered in 21 (12.7%) pts. Cardiovascular mortality was 7.3%. Independent stent thrombosis risk predictors included AUC ADR test ≥ 77.5 U, troponin I ≥ 0.90 ng/ml, total length of the stented area ≥ 60 mm. Independent predictors of the development of restenosis/neoatherosclerosis included: more than 4 implanted stents per patient (RR 1.440; 95% CI 1.233-1.681), the total length of the stented area ≥ 60 mm (RR 1.532; 95% CI 1.245-1.884), homocysteine ≥ 14 µmol/l (RR 1.479; 95% CI 1.168-1.876), myeloperoxidase ≥ 300 pmol/l (RR 1.351; 95% CI 1.102-1.656), with risk factors including a history of coronary heart disease for more than 5 years (RR 13.011; 95% CI 4.226-40.050), diabetes mellitus (RR 1.367; 95% CI 1.136-1.647).
Conclusion. The number of early and long-term coronary events in patients with unstable angina and coronary artery stenting was estimated. Predictors of stent thrombosis, restenosis and the formation of new atherosclerotic plaques outside the stenting zone were identified.

The aim of the study was to assess the cardiovascular status of large-for-gestational-age (LGA) and small-for-gestational-age (SGA) full-term newborns.
A survey of 192 newborns was carried out on the basis of the Republican Scientific and Practical Center “Mother and Child”. Group 1 (Gr1) consisted of 54 large-for-gestational-age newborns, group 2 (Gr2) – 43 small-for-gestational-age newborns, group 3 (Gr3) – 95 newborns with physical development corresponding to gestational age (appropriate for gestational age). Echocardiographic parameters were compared between study groups, as corrected to body surface area.
Morphometric assessment of heart structures in the course of Echo-CG in Gr1 patients showed a statistically significant thickening of the heart walls with predominant localization in the posterior wall of the left ventricle (LV) and interventricular septum (IVS). Significant differences were found in all derivatives of echocardiographic indicators in the examined groups of newborns. In Gr2, signs of diastolic myocardial dysfunction were revealed reflecting an impairment of the age-related evolution of myocardial relaxation processes. The intragroup analyses of LGA and SGA neonates (subgrouped according to the birth weight percentile) revealed no statistically significant differences in the direct and derived echocardiographic parameters analyzed. The frequency of detection of open foramen ovale (PFO), IVS thickness of 5.0 mm and more in LGA newborns had greater as compared with the group of conditionally healthy infants (р = 0.038, р = 0.001). Fetal communications in SGA newborns occurred significantly more often (PFO – р = 0.031, patent ductus arteriosus – р = 0.026) than in newborns with normal weight.
LGA and SGA newborns are characterized by the specific cardiovascular status. The revealed changes make it possible to assign infants with large and small birth weight to the risk group for the development of cardiovascular pathology, which requires dynamic observation as well as therapeutic and prophylactic measures.

Materials and methods. Over the period of 2013 to 2018, endovascular correction of long (more than 25 mm) coronary artery lesions was performed on 80 patients in RSPC “Cardiology”, Minsk. Randomly the patients were divided into 2 groups: experimental group (EG) (n = 40) – endovascular correction with bioresorbable everolimus-eluting vascular scaffold Absorb BVS, and control group (CG) (n = 40) – endovascular correction with everolimus-eluting metallic stent Xience V/ Xience Pro. During further observations we estimated the development of death outcomes (from any reasons and from heart diseases), cases of acute myocardial infarction, incidence of revascularization due to target lesion patency failure, as well as a combined endpoint (all death cases + cases of acute myocardial infarction+ revascularization due to target lesion patency failure). The information about the presence or absence of negative outcomes was collected during the observation via a telephone contact with the patient or their relatives.
Results. In the mean long-term observational period of 86.5 months (interquartile range from 77.0 to 93.0 months) after percutaneous intervention (PCI) total death cases were registered in 7.5% cases for the experimental group and in 5% cases for the control group (CG) (p = 1.00). The combined endpoint (death + myocardial infarction + target lesion revascularization) was registered in 17.5% cases for EG and in 15% cases for CG (p = 1.00). Kaplan-Meier analysis did not reveal statistical significance between the study groups (p = 0.78).
Conclusion. Long lesion correction with biodegradable vascular scaffolds shows similar long-term clinical results in comparison with everolimus-eluting stents. The combined endpoint risk (all death cases + myocardial infarction + revascularization due to target lesion failure) statistically did not differ in long-term period between both groups.

Lung cancer is a medical and social problem. Pulmonary function parameters that were obtained from spirometry had a statistically significant influence on the overall survival of patients with non-small cell lung cancer.
Aim of study: to establish the role of indicators characterizing the severity of airway obstruction in patients with non-small cell lung cancer stages I-III and to assess its effect on the survival of patients after surgical treatment.
Material of study: the study included 303 patients with non-small cell lung cancer (NSCLC) in stages I-III, who had been receiving treatment at the Minsk City Clinical Cancer Center from 2000 to 2018, the patients’ indicators of respiratory failure being determined and long-term results of treatment being monitored.
Results and conclusion: after surgical treatment, the 5-year overall survival (OS) rate of patients with NSCLC in the absence of bronchial obstruction was 42.4%, and in case of bronchial obstruction of the III^rd-IV^th degree, the 5-year OS was 14.8% (p = 0.006).

Aim. To determine the risk factors for postcardiotomy syndrome of low cardiac output in patients after on-pump coronary artery bypass grafting.
Methods. The study included 157 patients who underwent on-pump coronary artery bypass grafting. Intraoperatively and in the early postoperative period, 25 patients developed postcardiotomy low cardiac output syndrome (PLCOS), which was refractory to drug therapy and followed by mechanical circulatory support (MCS). 132 patients did not develop PLCOS and did not require MCS (comparison group).
Results. A retrospective, observational case-control study was carried out. Based on a univariate analysis, risk factors for the development of PLCOS were identified: preoperative left ventrical ejection fraction (LVEF) (B-mode) < 45%, OR = 4.7 (95% CI 1.9–11.5, p = 0.001), open heart surgery during the acute period of myocardial infarction (10 days) OR = 20.5 (95% CI 3.8-109, p = 0.001), aorta reclumping OR = 5.8 (95% CI 1.1 – 30.9, p = 0.049), dysfunction of coronary bypass grafts detected by bypass imaging in the early postoperative period OR = 54.7 (95% CI 13.6-219, p = 0.001).
Conclusions. Postcardiotomy syndrome of low cardiac output is a severe complication after open-heart surgery, leading to multiple organ failure due to systemic hypoperfusion of organs and tissues and is characterized by a high hospital mortality rate of up to 80%. Mechanical support of blood circulation (MCS) in this case is the only method of treatment for this cohort of patients.

The damage to humanity and global healthcare done by the COVID-19 pandemic is hard to overestimate. According to the World Health Organization (WHO), there were more than 500 million confirmed cases of SARS-CoV-2 infection, more than 6 million of which were fatal. The high incidence of arterial thrombosis and venous thromboembolic complications despite the ongoing antithrombotic therapy, often leading to death in patients with new coronavirus infection SARS-CoV-2, indicates the need for profound study of the pathogenetic aspects of procoagulant status and a more rational personalized approach in prophylactic measures in this category of patients. Special interest is the development of thrombotic complications in COVID-19 convalescents.
This article presents a clinical case of a 43-year-old man with no cardiovascular history who suffered viral myocarditis with thrombus formation in the heart cavities, thrombosis of deep veins of the lower extremities and consequent pulmonary thromboembolism, all of which developed within a month after coronavirus infection. In the article authors discuss the leading pathophysiological mechanisms that potentially could propagate the development of thrombosis and thromboembolic complications in patients with COVID-19.

Coronavirus disease 2019 (COVID-19) refers to viral respiratory infections and is the predisposing factor for the development of venous and arterial thrombotic events due to a pronounced inflammatory response, platelet activation, endothelial dysfunction and stasis. Recent studies have confirmed an extremely high incidence of thromboembolic events, especially in the group of patients with severe coronavirus pneumonia. There have been an increasing number of reports of peripheral arterial thrombosis as well. Most cases of arterial thrombosis are noted in critically ill patients in intensive care units. At the same time, acute limb ischemia often occurred in the absence of serious comorbid conditions and was accompanied by high rates of amputations and deaths.
Herein we report the results of management of 14 patients with severe SARS-CoV-2 infection and acute lower limb ischemia. Our own series of clinical observations shows that open thrombectomy and standard parenteral anticoagulation are ineffective in more than one third of cases. The pathogenesis mechanisms of COVID-19-associated arterial thrombosis should be further investigated in order to develop an optimal therapeutic strategy.

Transcatheter pulmonary valve implantation (TPVI) is a relatively new method of treating patients with right ventricular outflow tract (RVOT) dysfunction after surgical treatment of congenital heart defects. Since its introduction in 2000 by Bonhoeffer, more than ten thousand of such procedures have been performed worldwide. Currently two types of valves are available in the Republic of Belarus: Melody TPVMedtronic and Edwards Sapien. TPVI is safe and effective in the majority of patients with RVOT dysfunction and in some selected patients with patched RVOT. The low complication rate and the reduced number of open-chest re-interventions over a patient’s lifetime are among the main advantages of the procedure. The article presents a literature review, and summarizes the experience and results of TPVI performed on 24 patients in the Republican Centre of Pediatric Surgery.

Rhabdomyolysis is a condition characterized by the primary (mechanical) or the secondary (metabolic) damage to skeletal muscles, resulting in cell death and massive release of potentially toxic substances into the general circulation. Alertness to this complex pathological condition is very low among primary care physicians. Most often, traumatologists-orthopedists and resuscitators deal with the clinical picture of rhabdomyolysis. However, an in-depth analysis of literature data on the etiopathogenesis of this process implies a wide range of specialties, who need knowledge of the clinical picture of the development of rhabdomyolysis as well as of therapeutic specifics and prevention to manage this specific contingent patient. At the end of 2021, the clinical consensus of the intensive care committee of the American Association for the Surgery of Trauma (AAST) took place, which resulted in the formulation of recommendations for the management of patients with rhabdomyolysis. The document reviews and compiles knowledge of the causes of muscle fiber breakdown, diagnosis, treatment, and outcomes of acute rhabdomyolysis in critically ill patients.