Prompt diagnosis of pulmonary embolism (PE) remains challenging, which often results in a delayed or inappropriate treatment of this life-threatening condition. Mobile thrombus in the right cardiac chambers is a neglected cause of PE. It poses an immediate risk to life and is associated with an unfavorable outcome and high mortality. Thrombus residing in the right atrial appendage (RAA) is an underestimated cause of PE, especially in patients with atrial fibrillation. This article reviews achievements and challenges of detection and management of the right atrial thrombus with emphasis on RAA thrombus. The capabilities of transthoracic and transesophageal echocardiography and advantages of three-dimensional and two-dimensional echocardiography are reviewed. Strengths of cardiac magnetic resonance imaging (CMR), computed tomography, and cardiac ventriculography are summarized. We suggest that a targeted search for RAA thrombus is necessary in high-risk patients with PE and atrial fibrillation using transesophageal echocardiography and/or CMR when available independently on the duration of the disease. High-risk patients may also benefit from transthoracic echocardiography with right parasternal approach. The examination of high-risk patients should involve compression ultrasonography of lower extremity veins along with the above-mentioned technologies. Algorithms for RAA thrombus risk assessment and protocols aimed at identification of patients with RAA thrombosis, who will potentially benefit from treatment, are warranted. The development of treatment protocols specific for the diverse populations of patients with right cardiac thrombosis is important.

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Congenital heart disease occurs in the population with a frequency of 8 per 1000 live births. Information on the incidence of various congenital heart defects in newborns in connection with the widespread introduction of prenatal ultrasound diagnostics and an increase in its accuracy allows for planning pregnancy and management of newborns with critical heart defects. The aim of this study wasto retrospectively study the incidence of various congenital heart defects according to echocardiographic studies among newborns in the framework of the experience of one clinic over the period from 2009 to 2019. In the clinic of the Science Research Institute of Cardiology, echocardiographic studies were performed in 34298 children aged 1 day to 17 years, the average age was 3.68 years, the median 2.0 years. The newborns accounted for 4.6% of them (n = 1607). The results of echocardiographic studies were analyzed in 1607 newborns aged from 1 to 27 days. In 247 (15.3%) of the examined no congenital defects were detected, 1360 newborns had various congenital heart diseases. It was found that the most common anomaly in  newborns were interventricular septal defects (37%), more than 60% of all interventricular septal defects were clinically insignificant small muscle defects. It has been shown that the incidence of congenital heart defects in newborns with complex prenatal diagnosis (coarctation of the aorta, double outlet right ventricle) has increased in recent years. A decrease in the incidence of atrioventricular septal defect was observed over the past five years. The possibilities of neonatal cardiac surgery in a particular clinic influenced the structure of the occurrence of individual congenital heart disease due to prenatal pregnancy planning and surgical tactics.

Aim. To evaluate the effect of catheter ablation on left (LA) and right atria (RA) function in patients with atrial fibrillation.Material and methods. The study included 28 patients (14 men and 14 women) aged 33 to 72 years (mean age, 57,7±9,9 years) with paroxysmal (n=23) and persistent AF (n=5). All patients underwent radiofrequency ablation (RFA) with pulmonary vein antrum isolation. Before ablation and 3 days after, transthoracic twodimensional echocardiography was performed in sinus rhythm with an assessment of LA reservoir, conduit and booster pump function and RA peak longitudinal strain.Results. In the studied patients, a significant decrease in the reservoir, conduit and booster pump function of the LA was revealed after RFA, while there was no significant change in RA peak longitudinal strain after catheter ablation. LA reservoir, conduit and booster pump function decreased by 6,45% (p<0,001), 3,59% (p<0,001), 2,85% (p<0,001), respectively, while RA peak longitudinal strain increased by 0,73% (p=0,43).Conclusion. Catheter ablation has a significant damaging effect on the LA tissue, inhibiting the reservoir, pumping and pipeline functions. At the same time, the contractility of the PP in the early postoperative period improves, but not significantly.

Aim. To estimate the efficacy of catheter ablation in patients with type 2 diabetes mellitus (T2D) present with atrial fibrillation and sick sinus syndrome (SSS) undergoing permanent pacemaker implantation.Methods. 56 patients (34 females) with persistent AF and SSS were enrolled in the study. The mean age of patients was 67.7±10.7 years. Dual chamber cardiac pacemaker with remote monitoring function were implanted in all patients. All the patients were assigned to two groups: Group 1 comprised 31 patients aged 67.3±9.6 years, and Group 2 comprised 25 patients aged 72.6±9.9 years, including 22 (39.2%) diabetic patients. 2-3 days after pacemaker implantation, group 1 patients underwent intracardiac electrophysiology study and RFA of the pulmonary vein ostia, mitral isthmus and the left atrial posterior wall. Group 2 patients received antiarrhythmic drug therapy. Results. 3 patients (9%) in Group 1 had recurrent AF within the 6-month follow-up. The efficacy of the RFA for AF was 55% (n = 17) 1 year after the indexed hospitalization. 8 patients had short paroxysmal attacks which gradually lessened and stopped after. 5 patients (21%) in Group 2 did not have any AF paroxysms within the 1-year follow-up (Х2 = 5.52, р = 0.02). All these patients received amiodarone as antiarrhythmic drug therapy, whereas the others had paroxysmal attacks. Frequent attacks in 10 patients (40%) led to a change in antiarrhythmic drug use. Hospital readmission rates for AF were 16% and 52%, respectively (Х2 = 4.15, р = 0.04). The impact of atrial and ventricular stimulation on the development of recurrent AF was statistically insignificant (atrial stimulation – X2 = 0.01, cc = 1, p = 0.90; ventricular stimulation – X2 = 0.15, cc = 1, p = 0.69). None paroxysmal attacks were recorded in 10 diabetic patients (45%) after the RFA within the 1-year follow-up.Conclusion. Catheter ablation for persistent AF and SSS treated with permanent pacemakers is highly effective and safe method. In addition, it is superior to pharmacological approach. The presence of T2D likely did not significantly affect the efficacy of RFA for persistent form of AF.

The paper presents a description of the diagnosis and treatment of takotsubo syndrome in a patient with paroxysmal atrial fibrillation after electrical cardioversion. A case report clearly reflects the need for an integrated diagnostic approach to verify the diagnosis using dynamic echocardiography, electrocardiography, angiographic and tomographic investigations. The complexity of differential diagnosis in this case was an atypical variant of myocardial dysfunction. Follow-up made it possible to track the clinical improvement of the patient and the almost complete normalization of myocardial contractility in terms characteristic of takotsubo syndrome.

Aim. To study the role of molecular biomarkers potentially influencing the formation and progression of heart failure (HF) with preserved ejection fraction (HFpEF) in non-obstructive coronary artery disease (CAD).Material and methods. We examined 48 patients with newly diagnosed HFpEF against the background of non-obstructive CAD. Group 1 (n=31) included patients with class I-II HF and group 2 (n=17) included patients with class III HF; the control group consisted of patients without heart failure (n=17). The content of NT-proBNP and sST2, diastolic dysfunction and coronary flow reserve parameters were assessed.Results. The content of NT-proBNP in patients of group 1 was 45% higher than in group 2 (p<0,001). The mean levels of sST2 did not exceed the reference values and significantly exceeded the control group (p<0,001). Coronary flow reserve (CFR) decreased (p<0,001) depending on the severity of HF. Negative associations of sST2 levels with LVEF, septal e’ and CFR were revealed, as well as NT-proBNP with CFR.Conclusion. HFpEF in non-obstructive CAD is triggered due to progressive impairment of endothelial function, which affects the decrease in coronary and myocardial flow reserves, diastolic function, hyperproduction of humoral factors that initiate perivascular fibrosis and apoptosis of cardiomyocytes.