Myectomy versus alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy

OBJECTIVES: There is very little evidence comparing the safety and efficacy of alcohol septal ablation versus septal myectomy for a septal reduction in patients with hypertrophic obstructive cardiomyopathy. This study aimed to compare the immediate and long-term outcomes of these procedures. METHODS: Following propensity score matching, we retrospectively analysed outcomes in 105 patients who underwent myectomy and 105 who underwent septal ablation between 2011 and 2017 at 2 reference centres. RESULTS: The mean age was 51.9 ± 14.3 and 52.2 ± 14.3 years in the myectomy and ablation groups, respectively (P = 0.855), and postoperative left ventricular outflow tract gradients were 13 (10-19) mmHg vs 16 (12-26) mmHg; P = 0.025. The 1-year prevalence of the New York Heart Association class III-IV was higher in the ablation group (none vs 6.4%; P = 0.041). The 5-year overall survival rate [96.8% (86.3-99.3) after myectomy and 93.5% (85.9-97.1) after ablation; P = 0.103] and cumulative incidence of sudden cardiac death [0% and 1.9% (0.5-7.5), respectively P = 0.797] did not differ between the groups. The cumulative reoperation rate within 5 years was lower after myectomy than after ablation [2.0% (0.5-7.6) vs 14.6% (8.6-24.1); P = 0.003]. Ablation was associated with a higher reoperation risk (subdistributional hazard ratio = 5.9; 95% confidence interval 1.3-26.3, P = 0.020). At follow-up, left ventricular outflow tract gradient [16 (11-20) vs 23 (15-59) mmHg; P < 0.001] and prevalence of 2+ mitral regurgitation (1.1% vs 10.6%; P = 0.016) were lower after myectomy than after ablation. CONCLUSIONS: Both procedures improved functional capacity; however, myectomy better-resolved classes III-IV of heart failure. Septal ablation was associated with higher reoperation rates. Myectomy demonstrated benefits in gradient relief and mitral regurgitation elimination. The results suggest that decreasing rates of myectomy procedures need to be investigated and reconsidered. © The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved

Endometrial morphology in women of reproductive age with PCOS

Background. Polycystic ovary syndrome is the most common endocrine disease in women, affecting various aspects of health. The results of several studies indicate an increased prevalence of hyperplasia or endometrial cancer in women with PCOS, but there are no clinical recommendations on the need for assessing the endometrial condition in PCOS and approaches to predictions. Aim: to determine the frequency and structure of endometrial pathology among reproductive-aged patients with PCOS. Materials and methods. In a cross-sectional survey, we examined 1200 women who are subject to annual preventive examination. The research period was May - December 2017. The diagnosis of PCOS was made according to the consensus criteria adopted in May 2003 in Rotterdam. Participants signed informed consent for the survey. Results. We found 102 women with a verified diagnosis of PCOS. 56 of them completed their participation in the study; the median age was 32.19 ± 5.67 years. All patients underwent a biopsy of the endometrium with immunohistochemical examination. Features of the structure of the endometrium: a normal endometrial characteristic in 24 women (42.9 %), chronic endometritis -18 specimens (58.1 %), abnormal hypoplastic endometrium - 6 (19.4 %), simple endometrial hyperplasia -1 (3.2 %) adenocarcinoma -1 (3.2 %), proliferative endometrium with disorders - 7(22.6 %). Conclusions. In the examined women with PCOS there was a high incidence of histologically confirmed endometrial pathology, in the structure of which chronic endometritis predominates. The foregoing necessitates new research and development of clinical protocols for the timely detection of endometrial pathology in PCOS

A central fragment of ribosomal protein S26 containing the eukaryote-specific motif YxxPKxYxK is a key component of the ribosomal binding site of mRNA region 5′ of the E site codon

The eukaryotic ribosomal protein S26e (rpS26e) lacking eubacterial counterparts is a key component of the ribosomal binding site of mRNA region 5′ of the codon positioned at the exit site. Here, we determined the rpS26e oligopeptide neighboring mRNA on the human 80S ribosome using mRNA analogues bearing perfluorophenyl azide-derivatized nucleotides at designed locations. The protein was cross-linked to mRNA analogues in specific ribosomal complexes, in which the derivatized nucleotide was located at positions −3 to −9. Digestion of cross-linked rpS26e with various specific proteolytic agents followed by identification of the resulting modified oligopeptides made it possible to map the cross-links to fragment 60–71. This fragment contains the motif YxxPKxYxK conserved in eukaryotic but not in archaeal rpS26e. Analysis of X-ray structure of the Tetrahymena thermophila 40S subunit showed that this motif is not implicated in the intraribosomal interactions, implying its involvement in translation process in a eukaryote-specific manner. Comparison of the results obtained with data on positioning of ribosomal ligands on the 40S subunit lead us to suggest that this motif is involved in interaction with both the 5′-untranslated region of mRNA and the initiation factor eIF3 specific for eukaryotes, providing new insights into molecular mechanisms of translation in eukaryotes

First experience of transcatheter implantation of a Russian-made MedLab-CT prosthesis in a patient with dysfunction of biological mitral valve prosthesis

We present a case report of successful transcatheter implantation of a Russian-made cardiac valve prosthesis in a patient with dysfunction of biological mitral valve prosthesis (valve-in-valve). A patient aged 78 years with a high surgical risk and severe heart failure due to mitral valve bioprosthesis dysfunction is described. Fluoroscopyand transesophageal echocardiography-guided transapical implantation of a MedLab-CT prosthesis (23 mm) was made. When a heart rate of 180 beats per minute, a stent prosthesis was implanted. Transcatheter implant valve functioned properly after surgery. The patient was discharged in satisfactory condition

Meshalkin National Medical Research Center

We present three cases of successful transatrial transcatheter valve-in-valve implantation in patients with bioprosthetic mitral valve dysfunction. Patients with a high surgical risk, with severe heart failure due to bioprosthetic mitral valve dysfunction, were implanted with transcatheter prostheses using the transatrial approach.Transesophageal echocardiography and fluoroscopy-guided transcatheter mitral prosthetic valve positioning was performed. With a cardiac pacing at 180 bpm, a transcatheter valve was implanted. The transcatheter valves functioned properly after surgery. The patients were discharged in satisfactory condition

The first experience of implantation of the transcatheter aortal valve prosthesis “MedLab-KT”

Aim. Transcatheter aortic valve replacement in patients with high and extremely high risk has become a routine procedure in many cardiac surgery clinics. Until recently, there were no transcatheter prostheses produced within Russia. This article analyzes the results of applying the first domestic transcatheter aortic valve prosthesis MedLab­KT. Material and methods. In the period from June 2018 to October 2018, 7 operations of transcatheter aortic valve replacement were made using the MedLabKT prosthesis. In all cases, implantation was performed by transapical access.Results. We noted one death. In all cases, paraprosthetic regurgitation was not registrated or was not significant. There are no cases of dislocation of the prosthesis. There were no complications associated with access. In one case, implantation was complicated by myocardial infarction.Conclusion. The first experience of implantation demonstrated the efficacy and safety of using the MedLab­LT prosthesis for transcatheter aortic valve replacement. The analysis of long­term results is required.</jats:p

The Leydig Steroid Cell Tumor in a Postmenopausal Woman with Clinical and Biochemical Hyperandrogenism: A Case Report

Leydig cell tumors (LCTs) refer to tumors of the stroma of the genital strand, which are found mainly in postmenopausal women. The diagnosis of LCTs in postmenopausal women is associated with specific difficulties and is based on the identification of hyperandrogenism with clinical manifestations of virilization, which has an erased picture in postmenopausal women. LCTs require differential diagnosis with other causes of hyperandrogenism. We present the clinical case of a 55-year-old Russian postmenopausal patient with LCTs of the right ovary, significantly increased levels of androgens, and rapidly progressive clinical signs of hyperandrogenism. The patient underwent laparoscopic bilateral salpingo-oophorectomy, and the androgen indices reached average values by the first and third month after surgery. This case demonstrates that LCTs are often benign with a good prognosis and normalization of the clinical and laboratory manifestations of hyperandrogenism after surgical treatment. The type of surgery performed (bilateral salpingo-oophorectomy rather than unilateral) is recommended as the treatment of choice for LCTs in postmenopausal patients.</jats:p

The Leydig Steroid Cell Tumor in a Postmenopausal Woman with Clinical and Biochemical Hyperandrogenism: A Case Report

Leydig cell tumors (LCTs) refer to tumors of the stroma of the genital strand, which are found mainly in postmenopausal women. The diagnosis of LCTs in postmenopausal women is associated with specific difficulties and is based on the identification of hyperandrogenism with clinical manifestations of virilization, which has an erased picture in postmenopausal women. LCTs require differential diagnosis with other causes of hyperandrogenism. We present the clinical case of a 55-year-old Russian postmenopausal patient with LCTs of the right ovary, significantly increased levels of androgens, and rapidly progressive clinical signs of hyperandrogenism. The patient underwent laparoscopic bilateral salpingo-oophorectomy, and the androgen indices reached average values by the first and third month after surgery. This case demonstrates that LCTs are often benign with a good prognosis and normalization of the clinical and laboratory manifestations of hyperandrogenism after surgical treatment. The type of surgery performed (bilateral salpingo-oophorectomy rather than unilateral) is recommended as the treatment of choice for LCTs in postmenopausal patients