The aim – to determine the efficacy and to perform retrospective study of the results of balloon valvuloplasty in patients of the first year of life with isolated pulmonary artery stenosis.

Material and methods. During the period from January 1, 2007 to December 2014 the balloon valvuloplasty of the pulmonary valve was performed in 238 patients at the Ukrainian Pediatric Cardiology and Cardiac Surgery Center, among them 119 were males and 119 females. The median age of the patients was 42 (0; 365) days, the average weight – 4.60 ±1.81 kg (1.7–11.4 kg). On average, before cath: systolic pressure in the right ventricle was (92.0±24.5) mm Hg; the gradient of systolic pressure on the valve of the pulmonary artery – (69.3±24.9) mm Hg; systolic pressure in the pulmonary artery was – (22.50±8.47) mm Hg.

Results. The procedure was effective in 223 (93.7 %) of 238 patients. Early mortality after balloon valvuloplasty was absent. Complications after balloon valvuloplasty occurred in 4 patients (1.68 %). The result of balloon valvuloplasty was suboptimal in 15 (6.3 %) patients. The mean follow-up period was 5.2±2.1 y (from 2 to 9.7 y). On average: the gradient of systolic pressure at the level of the pulmonary valve decreased from 69.3±24.9 to 20.6±13.4 mm Hg; systolic pressure in the right ventricle – from 92.0±24.5 to 48.2±13.8 mm Hg; the systolic pressure in the pulmonary artery increased from 22.50±8.47 mm Hg up to 27.60±8.65 mm Hg; the level of oxygenation of arterial blood increased from 90.80±9.32 % to 94.30±5.08 %. 29 (12.2 %) patients out of 238 required the repeated cardiac surgical interventions.

Conclusions. Balloon pulmonary valvuloplasty is an effective and safe method of x-ray endovascular treatment of isolated valve stenosis of the pulmonary artery.

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The aim – to determine the predictors of regression of left ventricular hypertrophy (LVH) in patients with critical aortic stenosis (AS) after aortic valve replacement (AVR).

Material and methods. In one-center study, the results of a prospective observation in 119 patients with AS sequentially examined before and 6–12 months after the AVR surgery were analyzed. Among them were 74 (62.2 %) men and 45 (37.8 %) women, median age 63 years (quartiles 56.5–72.0 years). All patients underwent clinical, laboratory and instrumental studies before the operation, including transthoracic echocardiography (TTE) and coronary angiography. Depending on the changes of the left ventricular myocardial mass index (IMM LV) 6–12 months after AVR, all patients were retrospectively divided into two groups: in 52 (43.7 %) patients, the relative decrease in the IMM LV was from 0 to 30 %, and in 67 (56.3 %) – more than 30 % (maximum – 63 %).

Results. Median relative decrease of IMM LV after AVR after 6–12 months was 32.31 % (quartiles 23–40 %). Patients with less dynamics of IMM LV were characterized by a greater frequency of concomitant hypertension, angina pectoris and a large number of hemodynamically significant stenoses of the coronary arteries. The group of patients with large LVH regression was characterized by larger volume of the left atrium, larger IMM LV, lower initial left ventricular ejection fraction (LVEF), higher Tei index, lower MAPSE and systolic wave s, longer corrected QT interval. According to the multivariate analysis, the predictors of more severe LVH regression were the initial IMM LV, LVEF, mitral regurgitation, the duration of the corrected QT interval, and the absence of concomitant multivessel lesions of the coronary arteries. The accuracy of the prediction of the group with weaker dynamics of the IMM LV was 73.3 %, with a pronounced LVH regression – 79.7 %, the overall accuracy of the model was 76.9 %.

Conclusions. The severity of the IMM LV decrease is one of the most important indicators of the long-term effect of AVR in patients with critical AS. Output LVM, LVEF, mitral regurgitation, the duration of the corrected QT interval, and the absence of concomitant multivessel coronary artery lesions are independent predictors of a more favorable dynamics of IMM LV 6–12 months after AVR.

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The aim – to assess exercise capacity of adult patients at late period after aortic valve (AV) replacement with pulmonary autograft (Ross procedure, RP).

Material and methods. Fourty six consecutive adult patients were divided into two groups: group A – 22 patients after RP (NYHA I – group A1, n=8; NYHA II–III – group A2, n=14), group B – 18 healthy adults. Assessment of exercise tolerance was performed using the six-minute walk test and our proposed method of determining the physical work capacity (PWC) in adults with сongenital heart disease. Quality of life was estimated by SF-36.

Results. Distance of six-minute walk test in group A was 429.55±22.22 m; group B – 593.33±7.58 m, Р<0,01. PWC170, PWC170/kg in group A2 (745.7±72.2 kgm/min; 12.0±0.8 kgm/min/kg), in group A1 (1035.0±82.6 kgm/min; 14.1±1.1 kgm/min/kg), were lower compared to group B (1041.4±82.5 kgm/min and 16.5±1,1 kgm/min/kg, Р<0,05, Р<0,01; resp). Maximal oxygen consumption (VO2max) in group A2 (2.5±0.1 l/min) was lower compared to group B (3.0±0.1 l/min, Р<0.05). Conclusions. Assessing exercise capacity should be carried out in all patients after the RP using the six-minute walk test and our proposed method of determining the PWC in adults with сongenital heart disease. Lower exercise capacity at late follow-up period in some patients after RP was characterized by significantly reduced PWC170, VO2max as a result of additional interventions before and after RP and right ventricular dysfunction with good left ventricle function.

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The aim – to evaluate clinical and echocardiographic predictors of the improvement of cardiac systolic function in patients with aortic stenosis (AS) and reduced left ventricular ejection fraction (LVEF) after aortic valve replacement (AVR).

Material and methods. The one-center study analyzed data received from 49 patients with severe aortic stenosis (AS) and left ventricular systolic dysfunction (ejection fraction – LVEF less than 45 %), consecutively selected for isolated aortic valve replacement (AVR). The median age was 60 (lower-upper quartile 53–65) years. Before surgery all patients underwent transthoracic echocardiography (TTE) and coronary angiography. At 6 months after surgery TTE was performed in 48 patients; one patient died during the observation period. Uni- and multivariate logistic regression analyses were performed to identify factors independently associated with most notable increase of LVEF.

Results. Six months after AVR, significant decrease of left ventricular (LV) and left atrial volumes, free ventricular wall thickness and left ventricular mass index was noted, along with improvement of LVEF, other indicators of ventricular contractility (MAPSE, index Tei, wave s) and left ventricular diastolic function parameters. Recovery of LVEF was independent of age, sex, body mass index, heart rate and prevalent concomitant diseases, including arterial hypertension, atrial fibrillation and congestive heart failure. Initial LVEF was the strongest independent predictor of LVEF recovery (β=–0.87; Р<0,001). Mean pressure gradient on aortic valve, tricuspid insufficiency, mitral insufficiency, left ventricular end-diastolic volume index, e′ mean velocity of the mitral valve ring and concomitant diabetes mellitus appeared independently associated with improvement of LVEF as well, with less strength of the relation. Conclusions. Initially low LVEF is the strongest predictor of the significant improvement of left ventricular structure and function in patients with severe AS six months after AVR. AVR is reasonable in patients with AS and a reduced LVEF, having no significant contraindications for cardiac surgery.

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The aim – to estimate effect of gender differences on risk of cardiac and surgical treatment and on follow-up after surgery in adulthood in adults with congenital heart disease (CHD).

Material and methods. Between April 1, 2011 and December 31, 2015, we included 2044 consecutive patients with CHD. For distribution of CHD, there were estimated 11 patient’s groups by nomenclature (more than 40 pts in a group). All patients were divided into groups of surgical/percutaneous intervention and never operated adults with CHD. There were two groups: group 1 – adults after interventions in adulthood (first-time and reoperation), group 2 – adults, without any procedures older than 18 years.

Results. Among 2044 adults with CHD, 1059 (52 %) were males and 985 (48 %) women, the median age 26.23±0.24 (range limits, 18–88) years at the time of inclusion. There were more patients who had surgical/percutaneous intervention (n=1295; 63.4 %), compared to adults without any intervention (n=749; 36.6 %). Overall mortality was 0.34 %. Total seven adults died, including five males (0.47 %) and two women (0.20 %) without significant differences. Female patients had significantly more often arrhythmia history (n=236 women, n=201 male, Р<0.05), significantly higher class of heart failure NYHA > 1 (n=453 women, n=285 men, Р<0.05), which required significantly more often medications (n=660 in women, n=466 in men, Р<0.05). Men smoked more often (n=169 men, n=29 women, Р<0.05). The following CHD were registered significantly more often in women: ASD (n=286), VSD (n=169), PDA (n=106) compared to men (n=145, n=129, n=51, respectively, Р<0.05). On the contrary, men had significantly more often congenital aortic valve malformations (n=318) and coarctation of aorta (n=106), compared to women (n=107, n=59, respectively, Р<0.05). Among patients after cardiac procedures performed during childhood and adulthood, men had significantly more interventions in coarctation of aorta (n=96; 91 %) than women (n=47; 80 %, Р<0.05). Conclusions. Surgery-treated and non-treated adults with congenital heart disease had significant differences regarding risk factors and dominance of separate CHD depending on the gender.

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