Ukrainian Journal of Cardiovascular Surgery

Jubilee XXX All-Ukrainian Congress of Cardiovascular Surgeons

Vasyl V. Lazoryshynets — 2025-06-25

Coronary Artery Bypass Grafting Combined with Mitral Valve Correction via Minimally Invasive Approach: Technique Description and Results

Dmytro Ye. Babliak — 2025-06-25

Aim. To present and analyze the technique of simultaneous coronary artery bypass grafting (CABG) and mitral valve repair or replacement through a minimally invasive approach—left anterior thoracotomy in the 4th intercostal space.

Materials and methods. The study was conducted at the Diagnostic and Treatment Center For Children And Adults Of The Dobrobut Medical Network. Between October 2020 and March 2024, 50 patients with combined mitral valve disease and multivessel coronary artery disease underwent surgery via minimally invasive approaches. Patients were operated on through a 6–8 cm skin incision and a left anterior minithoracotomy in the 4th intercostal space. The procedure involved peripheral cardiopulmonary bypass (CPB), aortic cross-clamping, and cold blood cardioplegia. The mitral valve (MV) was approached through the right atrium and interatrial septum. Conventional techniques were used for MV repair/replacement.

Results. A total of 50 patients were included in the study. The mean age of the group was 65.1 ± 8.8 years, and 16 (34.0 %) patients were classified as NYHA class III-IV. There were no in-hospital deaths, major postoperative cardiac complications, or bleeding complications requiring revision. No conversions to median sternotomy were required. The mean number of distal anastomoses was 2.4 ± 0.9, including 1 ± 0.2 arterial and 1.7 ± 0.6 venous anastomoses. The operative time, aortic cross-clamp time, and cardiopulmonary bypass time were 335.8 ± 49.3 min, 125.7 ± 24.7 min, and 222.04 ± 38.3 min, respectively. The average length of stay in the intensive care unit was 1.5 ± 0.6 days.

Conclusions. This technique allows for simultaneous CABG and mitral valve correction through a single left anterior mini-thoracotomy. The immediate outcomes observed in the first consecutive series of 50 patients demonstrate the safety of this cardiothoracic surgical approach. Further evaluation of the clinical efficacy of this method is warranted, particularly in comparison with similar combined procedures performed through median sternotomy.

Coronary Angioplasty with a Drug-Coated Balloon Catheter in the Treatment of Acute Coronary Syndromes: Medico-Social Perspectives and Challenges of Use in the Setting of Diffuse Coronary Artery Lesions — A Literature Review

Evgen V. Aksenov — 2025-06-25

This literature review explores the role of drug-coated balloon (DCB) angioplasty in the management of acute coronary syndromes (ACS), with a particular focus on patients with diffuse coronary artery disease.

Aim. To conduct a literature review on the benefits of using DCB in the treatment of patients with diffuse coronary artery disease and ACS.

Materials and methods. Unlike traditional drug-eluting stents (DES), DCB technology delivers antiproliferative drugs directly to the lesion site without leaving behind a permanent implant, offering significant advantages such as reduced risk of in-stent restenosis (ISR), lower rates of thrombosis, and shorter required durations of dual antiplatelet therapy (DAPT). These benefits are especially relevant in high-risk populations, including elderly patients, those at high risk of bleeding, or those requiring urgent non-cardiac surgery. The review synthesizes data from key randomized controlled trials (PEPCAD NSTEMI, REVELATION, BASKET-SMALL 2), and meta-analyses.

Results. The review demonstrates the non-inferiority of DCB compared to DES in terms of major cardiovascular outcomes, even in complex settings, such as ST-elevation myocardial infarction (STEMI) and out-of-hospital cardiac arrest (OOHCA). In addition, DCB has proven effective in treating ISR and preserving endothelial function, with evidence of late lumen enlargement and minimal vascular trauma. However, challenges remain, including the need for precise lesion preparation, proper balloon sizing, and operator expertise. Limitations in long-term data and heterogeneity in patient selection across studies highlight the need for further large-scale trials.

Conclusions. DCB angioplasty represents a promising, less invasive strategy in interventional cardiology, particularly in patients with diffuse or high-risk coronary lesions, though widespread adoption will depend on continued research and protocol optimization.

Is There a Place for Surgical Revascularization in Acute Myocardial Infarction?

Olena K. Gogayeva — 2025-06-25

Rapid restoration of coronary blood flow is extremely important in patients with acute myocardial infarction (AMI). Timely reperfusion, performed within the first hours from the onset of angina pectoris, not only improves outcomes but also prevents life-threatening complications. In AMI, preference is given to percutaneous coronary interventions and thrombolytic therapy, while emergency surgical myocardial revascularization is performed for 1.2–5 % of patients.

Aim- to determine the role of surgical myocardial revascularization in AMI according to modern literature.

Materials and methods. Analysis of recent clinical guidelines and literature on surgical treatment of AMI.

Conclusions. In patients with acute MI, emergency surgical myocardial revascularization is possible. The treatment strategy for patients with AMI is selected individually by the Heart Team, based on assessment of pain duration, hemodynamic status, complexity of coronary artery disease, and the presence of mechanical and thrombotic complications. The priority of emergency cardiac surgery increases when stenting of the infarct-related artery is impossible, in cases of multivessel coronary artery disease, large volume of ischemic myocardial damage, or mechanical complications. Further clinical studies are necessary to determine the optimal timing for cardiac surgery in the context of AMI with and without ST-segment elevation.

Choice of Myocardial Revascularization Strategy in Elderly Patients with Non-ST Elevation Acute Coronary Syndrome

Sviatoslav A. Kalashnikov — 2025-06-25

Aim. To identify the differences in clinical and demographic characteristics of elderly patients with non-ST elevation acute coronary syndrome undergoing percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), and to study the factors influencing in-hospital mortality in these patients.

Materials and methods. The study had a retrospective, single-center, observational design. Data from 124 patients aged ≥65 years with a diagnosis of non-ST elevation acute coronary syndrome who underwent revascularization by PCI or CABG were analyzed. Ninety patients (72.6 %) underwent percutaneous coronary intervention (PCI group), and 34 patients (27.4 %) underwent coronary artery bypass grafting (CABG group).

Results. The median age in both groups was 72 years. The ratio of men to women in the PCI group was 54 to 36, and in the CABG group, 26 to 7 (p = 0.04). The median length of hospital stay in the PCI group was 6 (4.0–6.0) days, and in the CABG group, 13 (10.0–14.7) days (p < .001). The ratio of clinical diagnoses of myocardial infarction to unstable angina in the PCI group was 35 to 55, and in the CABG group, 6 to 28 (p = 0.03). The mean SYNTAX score in the PCI group was 24.4 ± 12.5 points, and in the CABG group, 36.2 ± 12.7 points (p < .001). Patients in the PCI group were more likely to have acute coronary occlusion (p=0.018) and less likely to have chronic coronary occlusion (p=0.045), LM stem lesions (p=<.001), or aorto-ostial lesions (p=0.006). No significant difference was found between the groups in clinical manifestations, comorbidities, and interventions. Factors associated with a higher risk of in-hospital mortality were age (p = 0.04), length of hospitalization (p = 0.009), diagnosis of myocardial infarction (p < .001), chronic kidney disease (p < .001), previous stroke (p = 0.003), acute coronary artery occlusion (p = 0.021), and history of CABG surgery (p = 0.013).

Conclusions: Patients aged 65 years and older with non-ST elevation acute coronary syndrome undergoing PCI and CABG differ in gender, diagnosis, type of hospitalization, and anatomical characteristics of coronary artery disease. When choosing a treatment method according to current recommendations, in-hospital mortality in the PCI and CABG groups did not differ. Increasing age, longer hospitalization duration, diagnosis of myocardial infarction, acute coronary occlusion, chronic renal failure, history of stroke, and previous coronary artery bypass graft surgery are factors associated with higher in-hospital mortality, that should be considered when assessing the risks and benefits and choosing a revascularization strategy.

Comparative Analysis of In-Situ Left Internal Mammary Artery and Saphenous Vein Composite Grafts for Left Anterior Descending Artery Revascularization: A Propensity-Matched Study

Parth Bharat Solanki — 2025-06-25

Aim. This study aimed to evaluate the early and mid-term outcomes of a novel strategy using the in-situ left internal mammary artery (LIMA) with a great saphenous vein graft (SVG) to bypass the left anterior descending artery (LAD) in coronary artery bypass grafting (CABG).

Materials and methods. A total of 1,240 patients were included in this retrospective observational study. Using propensity-score matching, 155 patients were assigned to the LIMA + SVG group and 155 to the LIMA − LAD group. Early mortality, postoperative complications, and mid-term major adverse cardiovascular and cerebrovascular events (MACCE) were compared between the two matched groups following the procedure.

Results. No significant differences were observed in early mortality rates between the LIMA + SVG group and the LIMA − LAD group (3.2 % vs. 2.6 %, P=0.69). For mid-term outcomes, the incidence of MACCE was slightly higher in the LIMA + SVG group, but this difference was not statistically significant (14.2 % vs. 12.3 %, hazard ratio = 1.18, 95% CI, 0.38 to 6.72; P=0.73). Computed tomography coronary artery angiography (CTCA) revealed a LIMA + SVG composite graft patency rate of 93 % (72/77) at 25 months post-procedure.

Conclusions. The use of in-situ LIMA with SVG to revascularize LAD was associated with comparable early and mid-term outcomes to using LIMA alone. These findings suggest that the LIMA + SVG composite graft may be a viable alternative strategy when LIMA alone cannot adequately bypass the LAD, particularly in emergency settings.

Features of the Clinical Course of Infective Endocarditis in Children

Oleksandr H. Senko — 2025-06-25

Infective endocarditis (IE) in children is less common than in adults but is associated with a significantly higher mortality rate. At the same time, diagnosis and treatment in young patients are complicated by a higher prevalence of congenital heart defects (CHD). We studied the spectrum of microorganisms and clinical manifestations in children.

Aim. To study the features of the clinical course of infective endocarditis in children.

Materials and methods. A retrospective study of surgical treatment cases of IE in children treated from 1994 to 2023 at the Amosov National Institute of Surgery and Epidemiology was conducted. Clinical manifestations, treatment, complications, outcomes of IE, and the spectrum of etiotropic pathogens were analyzed.

Results. Seventy-one patients underwent surgery from 1994 to 2023, all of whom had intraoperative confirmation of IE and were minors at the time of hospitalization. Among the 71 children, 12 were infants (16.9 %). The distribution according to congenital heart disease was as follows: cyanotic CHD – 10 (14.1 %), non-cyanotic CHD – 37 (52.1 %), without congenital pathology – 24 (33.8 %). The overall hospital mortality rate was 9.8 % (7 out of 71 patients). The distribution of identified pathogens was as follows: in 55 (77.5 %) patients, the pathogen could not be identified; in 13 (18.3 %) cases – gram-positive pathogens; in 1 (1.4 %) case – a gram-negative microorganism; and in 2 (2.8 %) cases, fungi were detected. Nosocomial infection was diagnosed in 16 (22.5 %) children. Cardiac surgery in history was performed in 13 (18.3 %) children.

Conclusions. The treatment of children with IE is complicated by the low rate of pathogen detection among patients with this pathology. The predominant pathogens among those detected are gram-positive microorganisms. Prevention of IE in children at increased risk (presence of CHD, previous heart surgery, intracardiac synthetic materials, and concomitant sources of infection) is essential.

Experience of Surgical Treatment of Mitral Valve Pathology in Children

Hanna V. Maistriuk — 2025-06-25

Isolated congenital mitral pathology occurs with a frequency of 0.5% among all congenital heart defects and is combined with others in 65–82% of cases. Surgical treatment of congenital mitral valve dysfunction still results in a significant mortality rate. In the presence of severe mitral valve pathology and the impossibility of performing valve repair in children of all ages, valve replacement becomes vitally necessary. The goal of mitral valve repair is not only to restore anatomy but, more importantly, to restore functional hemodynamics.

Аim. To analyze the perioperative characteristics of patients and the immediate and long-term results of surgical correction of the mitral valve in pediatric patients.

Materials and methods. Between 2014 and 2024, 135 patients aged 2 months to 18 years with congenital mitral valve anomalies underwent surgical correction (mitral valve repair or replacement) at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. There were 64 male patients (47.4 %) and 71 female patients (52.6 %). The most common congenital heart defects associated with mitral valve anomalies in the study group were: atrioventricular septal defect – 61 cases (45.2 %), hypertrophic cardiomyopathy – 24 (17.8 %), congenital isolated mitral valve disease – 15 (11.1 %), and infective endocarditis of the mitral valve – 10 (7.4 %).

Results and discussion. In the early postoperative period, 4 patients died, resulting in a hospital mortality rate of 3.0 %. In 3 patients (2.2 %), the cause of death was acute heart failure, while in 1 patient (0.7 %) it was respiratory failure due to viral pneumonia. During long-term follow-up, there was one additional death (0.7 %).Mitral valve replacement was required in 6 patients (4.4 %). The mean follow-up duration was 49 ± 16.2 months. Severe residual mitral regurgitation occurred in 4 patients (2.3 %), necessitating reintervention. Moderate mitral regurgitation was observed in 22 patients (17 %), mild in 27 patients (20 %), and minimal in 32 patients (23.7 %). No recurrences were recorded among patients with infective endocarditis during the follow-up period. All patients with associated intracardiac anomalies underwent concomitant surgical correction.

Conclusions. Modern diagnostic techniques enable the early detection of mitral valve anomalies, and contemporary surgical approaches yield favorable outcomes. Mitral valve repair is intended not only to reconstruct anatomical integrity but, more critically, to restore physiological hemodynamic performance. The 10-year reoperation-free rate of 97.1 % highlights the durability of surgical interventions. Reconstructive surgery remains the treatment of choice in pediatric patients, as it is associated with a lower risk of complications compared to valve replacement.

Metabolic Changes in the Myocardium during Adrenaline-Induced Injury and the Effect of Heart Cryoextract on Lactate-Pyruvate Metabolism

Mykola O. Chyzh — 2025-06-25

Metabolic injury to the myocardium during excessive adrenergic stimulation is primarily mediated by overstimulation of β-adrenergic receptors, resulting in a cascade of biochemical and structural changes that lead to myocardial toxicity.

Aim. To investigate the effect of an extract derived from cryopreserved fragments of piglet hearts on glycogenolysis activity in cardiomyocytes, and to evaluate its potential therapeutic efficacy in a model of adrenaline-induced myocardial dystrophy.

Materials and methods. The study was conducted on 84 non-linear male white rats. Adrenaline-induced myocardial dystrophy was modeled using a single subcutaneous injection of 0.18 % adrenaline tartrate at a dose of 5 mg/kg (according to the method of Markova). The experimental group received an intraperitoneal injection of the extract (peptide concentration 0.1 mg/ml, 50 μg per 100 g body weight) daily for 14 days. LDH activity was measured in blood serum using a spectrophotometric method. Lactate and pyruvate concentrations were determined spectrophotometrically in myocardial tissue homogenates collected post-mortem.

Results. In the untreated group, adrenaline administration caused significant metabolic disturbances: increased LDH activity, elevated lactate levels, and reduced pyruvate concentrations, indicating a shift toward anaerobic glycolysis and myocardial hypoxia. Administration of the extract significantly reduced LDH activity and lactate concentrations, while increasing pyruvate levels and restoring the lactate/pyruvate ratio toward physiological values. These findings suggest a restoration of oxidative phosphorylation and improved energy metabolism in cardiomyocytes.

Conclusions. The extract of cryopreserved piglet heart tissue demonstrates therapeutic potential as a metabolic modulator in the context of catecholamine-induced myocardial injury. Its ability to normalize lactate-pyruvate metabolism indicates its promise as a cardioprotective agent for correcting metabolic imbalances in myocardial dystrophy.

Assessment of the Degree of Left Atrial Fibrosis in Patients with Different Forms of Atrial Fibrillation

Eugene O. Perepeka — 2025-06-25

Atrial fibrillation (AF) is the most common type of cardiac arrhythmia, which has a significant impact on the health of patients worldwide. Left atrial fibrosis (LAF) is considered an irreversible form of remodeling that occurs in response to inflammation, stretching, or overload of the left atrium. The prevalence and degree of LAF may be associated with the prognosis and treatment outcomes after catheter ablation.

Aim. To determine whether the degree of left atrial fibrosis is associated with the progression of atrial fibrillation.

Materials and methods. During the period from January 2023 to December 2024, the State Research Institute of Cardiology named after M.M. Amosov National Academy of Medical Sciences of Ukraine performed 58 MRI studies with late contrast enhancement with gadolinium to study the degree of fibrosis of different chambers of the heart. Thirty-six of these patients were diagnosed with AF. In 12 patients, catheter ablation for atrial fibrillation was subsequently performed (radiofrequency, cryoballoon ablation, or pulsed field ablation). In 10, an attempt at electrical cardioversion without catheter intervention was performed.

Results. Among the 34 patients included in the study, 13 (38 %) had paroxysmal AF, 14 (41 %) had persistent AF, and 7 (21 %) had permanent AF. Among the patients with paroxysmal AF, 9 (69 %) had stage I of left atrial fibrosis (LAF), 4 (31 %) had LAF stage II. No patients with LAF stage III-IV were observed in the paroxysmal AF group. In the persistent AF group (n = 14, 41 %), LAF stage I was observed in 4 (29 %) patients, LAF stage II in 8 (57 %), and LAF stage III and IV in 1 (7 %) patient in each group. In the patients with permanent AF (n = 7, 21 %), no patients with LAF stage I were observed. LAF stage II was observed in 4 (57 %) patients, LAF stage III in 2 (28 %), and LAF stage IV in 1 (14 %). The analysis showed a statistically significant decrease in left ventricular ejection fraction in patients with progressive AF. In the paroxysmal group, the mean LVEF was 55.75 ± 11.05 %, while in patients with persistent AF it decreased to 47.46 ± 13.88 %, and in chronic AF it decreased to 36.29 ± 12.08 % (p = 0.018).

Conclusions. According to our results, the degree of fibrosis of the left atrium correlates with the stage of progression of atrial fibrillation.

Left Atrium Function: Can We Really Predict Outcomes After Catheter Ablation for Atrial Fibrillation?

Alina Yu. Tymoshenko — 2025-06-25

Introduction. Atrial fibrillation (AF) is the most common heart rhythm disorder, affecting 1–2 % of the adult population. AF significantly increases the risks of stroke, heart failure, and overall mortality [1]. Catheter ablation (CA) for AF is considered the gold standard for arrhythmia control in patients with ineffective drug therapy. Determining the functional state of the left atrium (LA) is critical for predicting ablation outcomes.

Aim. To evaluate the functional state of the left atrium in patients with AF using speckle tracking echocardiography (STE) and to analyse its prognostic value for catheter ablation results.

Materials and methods. Two-dimensional transthoracic echocardiography with speckle tracking was used to assess the functional state of the LA. For detailed assessment, the LA volume index, LA ejection fraction, and LA strain indicators (reservoir, conduit, and contractile deformation) were measured. Reference values were taken from the HUNT study published in 2023 [17]. Between June and December 2024, 24 patients treated for AF at Amosov NICVS were evaluated at the preoperative stage. The mean LA volume was 81.2 ± 22.0 ml, the mean LA ejection fraction was 49.2 ± 12.9 %, and the LA volume index (LAVI) was 40.0 ± 10.3 ml/m². The mean values of reservoir, conduit, and contractile functions were: LASr 23.0 ± 10.2%, LAScd –13.8 ± 5.5 %, and LASct –9.2 ± 6.1 %, respectively.

Results. In the study group, the reservoir, conduit, and contractile functions of the LA were lower than the reference values reported in the HUNT study. The mean follow-up period was 4.9 months, and the relapse rate was 16.7 % (4 patients).

Conclusions. Assessment of the functional state of the LA using speckle tracking echocardiography may serve as an alternative diagnostic method to predict long-term outcomes after catheter ablation for AF.

Ejection Fraction Decline and Cardiotoxicity Following Anthracycline Chemotherapy: A Risk-Focused Study from an Indonesian Tertiary Care Center

Rizkyastari Onny — 2025-06-25

Background. Anthracycline chemotherapy is a cornerstone of cancer treatment but poses a risk of cardiotoxicity, often presenting as cancer therapy–related cardiac dysfunction (CTRCD). Monitoring left ventricular ejection fraction (LVEF) is essential to detect early cardiac impairment and support safer treatment strategies.

Aim. To assess LVEF changes after six cycles of anthracycline therapy and identify predictive factors associated with CTRCD.

Materials and methods. This observational pre–post study included 74 patients treated with anthracyclines at Dr. Wahidin Sudirohusodo Hospital, Makassar, from 2024 to 2025. LVEF was measured via echocardiographic surveillance before and after treatment. Cardiotoxicity was defined as a ≥10 % decrease in LVEF to ≤50 %. Statistical tools included Wilcoxon signed-rank test, Chi-square, ROC curve analysis, and logistic regression.

Results. The mean LVEF significantly declined from 63.08 % to 56.76 % (p = 0.001). CTRCD occurred in 20.3 % of patients. Risk factors independently associated with cardiotoxicity included age ≥51 years (OR 2.80; p = 0.016) and cumulative anthracycline dose ≥457.5 mg/m² (OR 3.25; p = 0.004). When both factors were present, the risk increased nearly sixfold (OR 5.75; p = 0.001).

Conclusions. CTRCD was observed in one-fifth of patients following anthracycline therapy, with age and dose being significant contributors. These findings support the integration of risk-based echocardiographic surveillance into oncology care to ensure early detection and mitigate long-term cardiac complications.

Clinical Effectiveness of Bilateral Extended ESP Block in Cardiac Surgery Patients with Median Sternotomy under Conditions of Artificial Blood Circulation

Ruslan M. Taran — 2025-06-25

Relevance. Opioid analgesics are always used to provide adequate analgesia, but may carry risks of complications and formation of chronic pain syndrome.

Aim. To evaluate the clinical effectiveness of bilateral extended blockade of the plane of the extensor back muscles (ESPB) as a component of multimodal analgesia in cardiosurgical operations with median sternotomy under conditions of artificial blood circulation.

Materials and methods. A single-center retrospective-prospective observational study included 123 patients who underwent cardiac surgery on the heart with a median sternotomy with artificial blood circulation. The average age of the patients was 60 ± 1.5 years; there were 80 (65%) men and 43 (35%) women. Patients were divided into two groups: group 1 (n=57, 46%) – control, where narcotic analgesics were used for perioperative analgesia; group 2 – research group (n=66, 54%), ESP-block and fentanyl (if necessary).

End points of the study: primary – total dose of narcotic analgesics in the first 48 hours after extubation; secondary – intraoperative consumption of fentanyl, stability of hemodynamic indicators during surgery, dynamics of indicators of acid-base status, glycaemia and blood lactate level, time to extubation of the trachea, intensity of postoperative pain according to the visual-numerical assessment scale (NRPS), the need to prescribe narcotic analgesics, activation and mobility of patients, length of stay in the intensive care unit.

The Statistica package (Stat Soft Statistica v.13.0) and Microsoft Excel 2013 (license 00331-10000-00001-AA4040) were used for statistical data processing.

Results. Total intraoperative fentanyl requirement was lower in group 2 than in group 1 (3 ± 0.05 μg/kg vs. 15 ± 0.05 μg/kg, respectively, p < 0.01). Hemodynamic indicators in both groups at the stages of surgical intervention were within the limits of reference values. However, in group 2, blood pressure and heart rate remained more controlled and stable during the operation (p < 0.01). The lactate level increased in both groups at the end of the operation, but in group 2 it was 1.6 times lower than in group 1 and was within the reference values (2.3 ± 1.3 mmol/L vs. 3.63 ± 1.83 mmol/L, respectively, p < 0.01).

The pain intensity according to the numerical pain rating scale (NRPS) in group 2 was on average 3 times less than in group 1 during 48 hours after surgery (p < 0.01). Narcotic analgesics were prescribed to only 4 (6.06%) patients in group 2, while in group 1, the need to prescribe narcotics was in 49 (80.6%) patients (p < 0.01).

Conclusions. The use of a bilateral extended ESP block in patients with a cardiosurgical profile with median sternotomy under conditions of artificial blood circulation leads to a decrease in the perioperative consumption of fentanyl and the intensity of postoperative pain, which contributes to early extubation of the trachea and shortens the time the patients stay in the intensive care unit.

Hereditary Dilated Cardiomyopathy: A Case Report

Anna A. Zelinska — 2025-06-25

Aim. To conduct a clinical and pathological analysis of a case of hereditary dilated cardiomyopathy with endocardial fibroelastosis.

Materials and methods. A pathological examination was conducted on a 7-month-old child. Macroscopic, microscopic, morphometric, and statistical research methods were applied.

Clinical and Pathological Case. The girl was born from the third pregnancy and third physiological delivery at 38 weeks of gestation, with a birth weight of 2990 g and an Apgar score of 8–9. She was born to parents with a burdened family history — two previous male siblings had died from congenital heart disease, specifically dilated cardiomyopathy, at the ages of 6 years and 3.5 months. Ultrasound examinations of the heart during pregnancy and at 1.5 months of age revealed no abnormalities. At 7 months, the child died of acute heart failure in the context of a viral infection, at which time cardiomyopathy was diagnosed for the first time. Autopsy findings revealed dilation of the left ventricular chamber with endocardial fibroelastosis. Subendocardially, mature wavy connective tissue fibers and young connective tissue elements were found in the interstitium of the deeper myocardial layers, indicating disease progression. This led to myocardial dysfunction associated with cardiomyocyte atrophy.

Conclusions. We present a case of hereditary dilated cardiomyopathy (DCMP) characterized by a combination of left ventricular (LV) dilatation and endocardial fibroelastosis, which mutually accelerated the progression of fibrotic changes in the heart and contributed to sudden death in the context of an acute respiratory viral infection. A key challenge in DCMP is determining its underlying cause—whether genetic abnormalities or immunoinflammatory mechanisms. This case, with the first manifestations of the disease at 7 months of age, highlights the critical need for early diagnosis and genetic screening, particularly in individuals with a burdened family history.