Aortic valve stenosis remains the most dominant form of valvular heart disease. The aortic valve area below 1.0 cm2 is an assignment to the interventions. The modern senile aortic valve stenosis treatment options are mini-surgical valve replacement (mini-SVR), balloon aortic valvuloplasty (BAV), and transcatheter aortic valve implantation (TAVI). This study aims to inform readers about up-to-date interventions for patients with senile calcific aortic valve stenosis in Ukraine, based on the experience of the Cardiac surgery department in Lviv, Ukraine.

Methods.

From a single-centre retrospective registry (10/2015-02/2022), 204 patients were included. One hundred seven patients underwent mini-SVR, tree BAV, and four – TAVI. Diagnostic modalities used to assess the anatomy of the aortic valve were: ECHO, ECG-gated computer tomography with aortic valve calcic scoring, and Angiography.

Interventional procedure techniques were BAV, TAVI; surgical: mini-SVR via upper ministernotomy or right-sided minithoracotomy.

Results.

Anatomical assessment of the aortic valve in senile aortic valve stenosis was based on the morphology of the aortic valve (bicuspid or tricuspid aortic valve), asymmetrical hypertrophy of the left ventricular outflow tract, and coronary ostia height. The age-related anatomical features were calcium deposits in the leaflet, coronary ostium and mitral annular calcification. Ministernotomy (in 67 cases) and a right-sided minithoracotomy (in 40 cases) were performed to secure the “heart step” without instability of the chest cage with the smaller valve size implantation than was expected before. Preserving the chest cage and avoiding aortic cross-clamp/cardio-pulmonary bypass were advantages of TAVI. Fragile patients expected TAVI risks: aortic root damage, paravalvular leak, moderate aortic insufficient, the risk of atrioventricular block and embolic stroke, and kidney dysfunction.

Conclusions.

Mini-surgical valve replacement and transcatheter aortic valve implantation are accessible procedures in Ukraine for senile calcific aortic valve stenosis treatment.

Computed tomography is the "gold standard" for performing aortic morphometry during preoperative planning in invasive cardiology and cardiac surgery. Predictive modeling of indicators can significantly save resources. The purpose of the study: to make modelling of Valsalva sinuses and coronary artery ostia height parameters depending on age-anthropometric indicators in healthy men based on computed tomography. The material is represented by contrast-enhanced computed tomography images of the aorta and coronary arteries of forty-three men under normal conditions. Methods: morphometric and statistical analyses. A multifactorial correlation-regression analysis was conducted to establish the complex influence of age-anthropometric parameters on sinuses of Valsalva and coronary artery ostia height. The reliability of the obtained indicators was confirmed by Fisher's test (F). Using the Durbin-Watson autocorrelation criterion, the correctness of the built model was proved. In healthy men, weight (direct effect) and body mass index (inverse effect) significantly influenced the height of the lower edge of the right coronary artery ostia. The regression coefficient is R = +0.632, with p<0.001, the standard error of estimation (SEE) is 2.951. The obtained linear equation of the prognostic model: the level of the height of the departure of the lower edge of the right coronary artery ostia = 0.359 x А 1 - 1.099 x А 2 + 16.53. The correctness of the built model was checked using the Durbin-Watson autocorrelation test (2.181). The prognostic model for calculating the height of the left aortic sinus was formed by height and weight indicators (strong direct influence): R = +0.759, p<0.001, SEE = 2.208. The adjusted coefficient of multiple determination was R2 adj = +0.562. The Durbin- Watson autocorrelation criterion was within the normal range (2.241). The linear equation of the prognostic model with the obtained β -coefficients: the level of the height of the left sinus of the aorta = 35.83 x А 1 + 0.033 x А 2 - 42.22. The work of prognostic models for individuals with different anthropometric and age parameters was verified. Thus, a model of the dependence of the indicator of the height of the left sinus of the aorta on height and weight was created; of the height of the deviation of the lower edge of the right coronary artery from weight and body mass index in healthy men based on computed tomography.

The increase in global burden of stroke is hard to overestimate. Every year it continues to be a leading cause of mortality worldwide. Extracranial pathology of the carotid arteries is a major underlying reason of stroke. Given the role of alimentary factors in the development of atherosclerosis of the carotid arteries, possible influence of food additives on the carotid sinus structure is of special interest. Monosodium glutamate is one of the most common food additives that is allowed for consumption in many countries due to it being considered relatively safe. Recent scientific research however points towards the possible adverse effects of monosodium glutamate on the living organism. The aim of this study was to analyze qualitative and quantitative parameters of carotid sinus structural organization of white male albino rats under normal conditions, in the setting of oral monosodium glutamate consumption and after its withdrawal. Carotid sinuses of 30 white male albino rats that had been daily consuming 10 mg/kg of monosodium glutamate for 4 or 8 weeks with subsequent withdrawal for 2 weeks were subjected to qualitative and quantitative analysis at different time-points of the experiment. The data obtained was compared with the results of morphologic and morphometric study of carotid sinuses of 9 rats of the control group. For morphometric analysis, the following parameters were considered: intima thickness, media thickness, adventitia thickness, diameters of the arterioles, venules and capillaries of the carotid sinus vasa vasorum. Summarizing the morphometric analysis results, it is worth noting that, for the duration of 8 weeks of the experiment, steady increase in the thickness of all layers of the vascular wall, but especially intima and adventitia, was observed in the study group. At the same time, the diameter of the arterioles located in the carotid sinus adventitia was decreasing, while venules and capillaries demonstrated invariable increase of their lumen diameter. After 2 weeks of monosodium glutamate withdrawal, the thickness of intima and adventitia continued to increase, while media thickness had somewhat decreased, probably due to fibrosis and dystrophy. The tendency towards narrowing of the arterioles' lumen and widening of the venules and capillaries persisted for at least 2 weeks despite discontinuation of monosodium glutamate. Therefore, systematic consumption of monosodium glutamate may lead to impairment of carotid sinus structural organization, particularly endothelial proliferation, fibrotic and dystrophic changes of media, adventitia thickening as well as microcirculatory vessels damage, that continue to persist despite the food additive withdrawal.