Sinus of Valsalva aneurysm (SVA) is an uncommon and mostly congenital cardiac anomaly which predominantly affects Asian males [1]. Congenital SVA is caused by deficiency of normal elastic tissue between aortic media and the annulus fibrosus (abnormal bulbus cordis development) [2]. Ventricular septal defect (VSD), aortic regurgitation (AR), and bicuspid aortic valve (BAV) are frequent concomitant lesions in this SVA type. Acquired SVA can result from previous cardiac surgery, endocarditis, syphilis, atherosclerosis, or chest injury [3]. SVA arises from the right sinus of Valsalva in 80-85% cases, from the non-coronary sinus in 5-15%, and rarely from the left sinus. Despite being generally asymptomatic, SVA can compress adjacent structures, resulting in acute

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Objective. To share the experience of endovascular interventions in pregnant women and women in labor, gained by national team “obstetric cardiology”. Materials and methods. The algorithm of medical support was presented, including the cases of cardiosurgical interventions performance , for pregnant women with critically severe pathology of the heart, which was based on actual recommendations and own experience. Into the clinic of Amosov National Institute of Cardiovascular Surgery during 6.5 yrs (12.2013 - 05.2020) 145 women-patients were admitted to hospital, in 79 of them cardiosurgical intervention was done. Endovascular cardiosurgical operations were performed in 36 patients, and the hybrid - in 2. Urgent and emergency endovascular interventions were performed in 17 women-patients with various terms of pregnancy (15 - 35 weeks) and in 2 women in labor. Conditionally-elective cardiosurgical interventions were performed in 17 women-patients on various terms of pregnancy (as a rule, in II trimester) and in 2 women in labor. In 34 patients the interventions were performed with fetus in utero. Early and late maternal mortality was absent. One «programmed» loss of the fetus have occurred on 12-th week of pregnancy with the inborn heart failure. Modern views on impact of ionized radiation and contrast substances on fetus were presented, and the methods of lowering of their potential harm. Conclusion. There was trusted, that while applying strict indications for performance of endovascular interventions during pregnancy, these methods of diagnosis and treatment are more secure in comparison with «open» operative interventions and may be performed under supervision of experienced multidisciplinary team, taking into account the pregnancy term and the fetus defense.

The paper describes the experience of percutaneous transapical access (PTA) usage for performing transcatheter structural interventions in 7 patients. Four patients had paravalvular insufficiency of the prosthetic mitral valve, one patient had a reshunt of ventricular septal defect and a pseudoaneurysm in the area of fibrous mitral-aortic continuity. Two patients underwent PTA for diagnostic examination. The visualization methods, planning algorithm, and technique of the procedure have been described. The overall efficiency was 100%, the degree of paravalvular leak was reduced in all treatment procedures. The main reported complication was hemothorax in two cases. In one case, the occluder migrated from the paravalvular fistula channel into the left atrial cavity with subsequent endovascular extraction. The aim. This study was designed to evaluate modern outlooks about the use of PTA during interventions, enhance the available data and extrapolate the authors’ own experience with the development of their own conclusions and recommendations. Materials and methods. To differentiate structural pathology, the initial selection of patients was performed according to the findings of transthoracic and transesophageal ultrasound. The next step in planning of PTA is analysis of computed tomography (CT) data with 3D reconstruction. PTA and subsequent interventions were performed in the hybrid catheterization laboratory after evaluation of CT data, guided by transesophageal echocardiography (TEE), and with the establishment of optimal angles of the angiograph arc for the best fluoroscopic imaging. Besides, in order to avoid trauma of left anterior descending coronary artery, selective angiography was performed. Surgical team support was essential in all cases. Results. The overall efficiency was 100%, reduction of the degree of paravalvular leak was achieved in all treatment procedures. The main reported complication was hemothorax in two cases. In one case, the occluder migrated from the paravalvular fistula channel into the left atrial cavity with subsequent endovascular extraction. Discussion. The subject of our research was PTA for structural interventions. Available data of the world literature shows that this technology has been developed since the end of the last century. The main complications that can be encountered during the intervention by PTA were: hemothorax; hemopericardium/tamponade; rupture of the coronary artery; pneumothorax; arrhythmia; death. In four out of five cases, we used a Lifetech HeartR PDA occluder to close the puncture site of the left ventricular apex. In the fifth case, LifeTech mVSD occluder was used. Conclusions. Correction of structural pathology by routine use of PTA requires a comprehensive approach to the diagnosis of this pathology using transthoracic and transesophageal echocardiography, contrast-enhanced CT and 3D reconstruction. Support of a multidisciplinary team to provide transition to conventional cardiac surgery access in case of periprocedural complications is mandatory. Due to the emergence of specialized implants, as well as the development of imaging techniques, PTA requires attention and further study.