Thromboembolism of pulmonary artery is life-threatening condition due to acute right ventricle failure and cardiogenic shock. System thrombolysis is the main way of reperfusion in massive pulmonary embolism with a very high risk of fatal hemorrhage complications. There is a popular revascularization method in two last decades such as endovascular treatment. It allows to recover the blood flow into occluded pulmonary arteries up to three weeks after confirmed embolism episode and to decrease major bleeding risks. Now trials corroborate the high efficacy and safety of interventional treatment the usage of which would allow to improve prognosis in massive pulmonary embolism.

Objective: to assess the probability of pathogenic effects OF Il-18 (IL18, IL18R1 and IL18RAP) gene polymorphism on the risk of myocardial infarction in patients with stable coronary heart disease.

Materials and methods: the present study was performed with the inclusion of 260 patients with stable coronary heart disease (CHD), residents of the industrial region of Western Siberia. Molecular genetic testing was performed on nine polymorphic sites of il18, IL18R1, IL18RAP genes.

Results: associations of polymorphic sites rs13015714 IL18R1 and rs917997 IL18RAP with risks of myocardial infarction were Determined (OR =1.95 (95% CI =1.06-3.58), p =0.029 and OR =2.01 (95% CI =1.11-3.64), p=0.018).

Conclusion: to confirm the role of polymorphism IL18, IL18R1, IL18RAP in the pathogenesis of atherosclerosis, prospective monitoring of this group of patients is necessary to identify cases of manifestation of clinical signs in persons with adverse prognosis.

Purpose To study the early repolarization pattern (ERP) in patient with nonischemic cardiomyopathies (acute myocarditis and arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C)).

Materials and methods: We analyzed 2 groups of patients: The 1st group — 29 patients with acute myocarditis (21 male, age 48,7±13,5); the 2nd — 51 patients with confirmed diagnose of ARVD/C (27 male, age 33±7). We used the criteria by Macfarlane P.W. et al., 2015 to identify ERP. Also we analyzed the results of endomiocardial biopsy (EMB).

Results: In the 1st group ERP was detected in 13,8% (4) patients), in the 2nd ERP was detected in 17,6% (9) patients. There was no significant difference between frequency of ERP in these groups (p>0.05In the 1st group in all patients was detected inflammation by EMB, myocardial fibrosis was found in 25% (1) patients. In the 2nd group in 22,2% (2) patients with ERP there were no structural abnormalities detected by EMB, and other 78% patients had residual myocytes.

Conclusions. On the example of myocarditis and ARVD/C we demonstrated that the ERP was not studied for all diseases that have a pathogenetic basis for its occurrence. Further prospective studies are necessary to evaluate the relationship with the arrhythmias, including malignant ones.

Background. In arrhythmogenic right ventricular dysplasia (ARVD), repolarization disorders precede structural heart changes.

Objective. The aim of this work was to evaluate repolarization changes in ARVD patients with various degree of electrocardiographic (ECG) changes.

Design and methods. The standard ECG and vectorcardiograms (VCG) of patients with a confirmed ARVD diagnosis (N = 22, 13 men 51 ± 16 years and 9 women 50 ± 12 years), observed in the Medical Centre of V.A. Almazov, were analyzed. The degree of ECG changes was assessed by the number of precordial leads with negative T-wave, the global dispersion of repolarization — on the basis of the maximum interval between the peak and the end of T-wave, the spatial repolarization sequence — by T-vector direction, the action potential duration (APD) — on the basis of Q-Tpeak and Q-Tend intervals.

Results. At no T-wave inversion in precordial leads, the latest repolarization took place in the posterior regions of ventricular base, at T-wave inversion only in the right precordial leads — in the lateral part of the right ventricle, at T-wave inversion in all precordial leads — in the antero-apical parts of the ventricles. Depending on the degree of ECG changes, the duration of repolarization increased in such a way that the shorter APD increased more than the longer ones; the global dispersion of repolarization was not increased.

Conclusion. In ARVD, the increase of repolarization ECG changes is a result of inhomogeneous APD prolongation and the changes in ventricular repolarization sequence (up to it’s inversion), not accompanied with a growth of global dispersion of repolarization.

Background: There are new characteristics of ventricular extrasystole (VE): the QRS interval maximum duration (VEQSI max.) and its fragmentation (fQRS), which are insufficiently studied in patients with ARVD/C.

Objective: To analyze VEQSI max. and fQRS of VE depending on frequency of SCD, syncope, ICD and ICD-shocks in patients with ARVD/C.

Materials and methods: Included 83 patients:(41 m, 30.3±4.1 years): 55 (27 m) with the established (ED), 13 (5 m) — borderline, 15 (9 m) — possible diagnosis of ARVD/C [Marcus F.I., 2010].

Results: Syncope were in 34 patients (41,0%, 19 m): mostly (70,5%, 15 m) in the ED. SCD — in 5 patients (2,4%, 4 m): 80,0% with the ED. ICD was implanted to 31 patients (37,3%, 21 m) in 87,1% ED. ICDshocks- in 15 patients (48,4%,11 m) with the ED. The average VEQSI max was 168,1±23,1ms, significantly higher inED (р<0,05), and in men (р<0,05). FQRS was discovered in ED (10,8%) and possible diagnosis (13,3%), in the leads II, III, V5-V6.

Conclusions: Syncope, SCD, ICD implanting and shocks were occurred more often in patients with the established diagnosis of ARVD/C. VEQSI max. was higher in that group.

А clinical case of treatment of a patient with isolated saccular aneurysm of the aortic arch and aneurysm of the infrarenal aorta of large size is presented. As a сoncomitant pathology, gastric adenocarcinoma was revealed. Multi-stage surgical treatment was performed. The first stage included left-sided carotid-subclavian bypass, the second –TEVAR, the third — EVAR. The final stage was an extended gastrectomy with lymphodissection. No complications were found during the treatment. The technique of operations is described, explanations on the chosen tactics of treatment are given. The conclusion is made about the advantage of endovascular techniques in the treatment of aortic pathology in patients with oncological pathology.

The relevance of the studied problem was caused by high prevalence of drug resistant epilepsy, an increased structural epilepsy detection and extension indications for a surgical treatment.

The purpose of article consisted in a research of the reasons of low efficiency of epilepsy surgical treatment in adult population with a cross-disciplinary approach position.

Material and methods. The leading approach was the retrospective open research of the failure factors at 14 patiens.

Results. It was revealed unsatisfactory result of epilepsy surgical treatment was caused by a complex of the reasons. The disease features have been the main reason for a failure in 100% of cases, additional reasons: irrational pharmacotherapy -in 86%, the surgical reasons — in 36% of cases.

Conclusions. The unsatisfactory result of epilepsy surgical treatment was caused by a complex of the reasons. Cross-disciplinary approach to a problem, improvement of the epilepsy managment, further researches are required.  Materials of article can be useful for the personified approach at surgical treatment of epilepsy.