Anara Abbay

Patient safety remains a major challenge in cardiac surgery, where cardiopulmonary bypass carries risks of residual structural lesions, hemodynamic instability, embolic events, and unrecognized technical complications. This review examines intraoperative transesophageal echocardiography as a patient-safety intervention across the pre-bypass, bypass, and post-bypass phases of adult cardiac surgery, drawing on observational studies, registry analyses, and professional society guidance. Before cardiopulmonary bypass, transesophageal echocardiography establishes baseline ventricular and valvular function, identifies previously unrecognized pathology, and may guide cannulation and operative planning. During bypass, it supports ventricular decompression, myocardial protection, cannula assessment, and the detection and clearance of intracardiac air. After bypass, it evaluates the adequacy of surgical repair and identifies residual valvular lesions, ventricular dysfunction, ischemia, intracardiac air, and aortic complications while immediate corrective intervention remains possible. Although associated changes in surgical or anesthetic management are consistently reported, their frequency varies according to procedure type, patient risk, institutional practice, and study design. Furthermore, management change is a process outcome and does not, by itself, establish improvement in patient-centered outcomes. Serious complications related to transesophageal echocardiography are uncommon, but safe use requires appropriate patient selection, contraindication screening, careful probe manipulation, standardized examination and communication, and operator competence. A phase-based approach may help surgical teams connect imaging findings with time-sensitive hazards and corrective actions. Further prospective evidence is needed to identify the procedures and patient-risk profiles in which routine rather than selective intraoperative transesophageal echocardiography provides clinically meaningful benefit.

Background: Clinical and survival data on pulmonary arterial hypertension (PAH) from Central Asia remain limited. This study aimed to characterize the clinical profile, survival outcomes, and prognostic value of baseline COMPERA 2.0 risk stratification in patients with PAH in Kazakhstan. Methods: This retrospective observational study included 206 adult patients with right heart catheterization-confirmed PAH hospitalized at the largest pulmonary hypertension referral center in Kazakhstan between 2020 and 2024. Patients were categorized into idiopathic PAH (IPAH), congenital heart disease-associated PAH (CHD-PAH), and other PAH subgroups. Kaplan–Meier survival was assessed from the index hospitalization, and Cox regression used patients with complete data for the variables included in each model. The multivariable model included 182 patients (39 deaths). Baseline risk stratification was assessed retrospectively using the COMPERA 2.0 four-strata model. Results: Etiological groups comprised 121 (58.7%) with IPAH, 73 (35.4%) with CHD-PAH, and 12 (5.8%) with other forms of PAH. The mean age was 39.5 ± 13.7 years, and 80.6% were female. At baseline, 62.6% were classified as WHO functional class III–IV. Overall survival did not differ significantly according to PAH etiology (log-rank p = 0.407). Baseline COMPERA 2.0 four-strata risk stratification differentiated survival (log-rank p < 0.001). In multivariable Cox regression analysis, baseline COMPERA 2.0 four-strata risk category remained associated with mortality (overall p = 0.006), with an adjusted HR of 4.67 (95% CI 1.22–17.86) for high-risk versus low-risk patients. Higher tricuspid annular plane systolic excursion (TAPSE) was independently associated with lower mortality hazard (HR 0.89 per mm increase, 95% CI 0.8–0.99; p = 0.026). Conclusions: In this hospitalized, single-center cohort from Kazakhstan, patients were predominantly young women with advanced functional impairment at baseline. Baseline COMPERA 2.0 four-strata risk assessment and lower TAPSE were associated with mortality after multivariable adjustment. These findings support multidimensional risk assessment in patients with PAH and highlight the need for prospective regional PAH registries.

Introduction: Pregnancy in women with unrepaired single-ventricle physiology is rare and associated with substantial maternal and foetal risk. Evidence regarding pregnancy outcomes in this population remains limited. Case description: We report three successful pregnancies in two women with unrepaired double-inlet left ventricle, transposition of the great arteries and valvular/sub-valvular pulmonary stenosis. Both women were classified as modified World Health Organization class IV and received multidisciplinary care throughout pregnancy. Despite complex congenital heart disease, systemic ventricular function and oxygen saturation remained stable. All three pregnancies resulted in live births. However, foetal growth restriction, oligohydramnios, placental insufficiency, prematurity and prolonged neonatal hospitalisation occurred in all pregnancies. One patient successfully completed two consecutive pregnancies without maternal cardiovascular deterioration. Discussion: Pulmonary outflow obstruction, relatively preserved oxygen saturation and stable systemic ventricular function may have contributed to maternal haemodynamic stability. However, substantial foetal and neonatal morbidity in all three pregnancies underscores that favourable maternal outcomes do not establish pregnancy safety in this population. Conclusion: Carefully selected women with unrepaired single-ventricle physiology and balanced circulation may tolerate pregnancy better than expected, although foetal complications remain common. Multidisciplinary management in specialised congenital heart disease centres is essential.

Introduction: Cardiovascular diseases (CVDs) remain the leading cause of mortality and disability in Central Asia. This study analyzes trends in CVD burden across nine countries from 1990 to 2021, identifies major subtypes, explores sex and country-level disparities, and forecasts trends through 2050. Methods: We used data from the Global Burden of Disease (GBD) 2021 study to assess age-standardized death rates (ASDRs) and age-standardized disability-adjusted life years (ASYRs) for CVDs and their subtypes in Armenia, Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Mongolia, Tajikistan, Turkmenistan, and Uzbekistan. Forecasts were generated using GBD reference and alternative risk-reduction scenarios. Results: In 2021, the average ASDR for CVDs in the region was 436.1 per 100,000 population, nearly twice that for respiratory infections and tuberculosis. Ischemic heart disease (IHD) and stroke accounted for 89% of total CVD deaths. Turkmenistan reported the highest ASDR (552.2 per 100,000), while Armenia reported the lowest (314.8 per 100,000). Kazakhstan had the highest stroke-related ASDR at 163.0 per 100,000. Men experienced 1.5 times higher ASDR (538.2 vs. 365.7 per 100,000) and ASYR (10966.6 vs. 6807.5 per 100,000) than women. While most countries reduced ASDRs from 1990 to 2021, Uzbekistan showed a 0.7% increase. Forecasts project a regional decline in ASDR by 2050 in both improved-risk-factor and reference scenarios. Conclusion: CVDs remain the dominant health burden in Central Asia. Evidence-based prevention, improved hypertension control, and health system strengthening are essential to achieving future gains and reducing premature cardiovascular mortality.

Background: Rapid identification of patients at risk of contrast-associated acute kidney injury (AKI) is essential in acute settings such as acute myocardial infarction and ischemic stroke. Point-of-care (POC) creatinine testing provides immediate assessment of kidney function; however, its reliability for clinical risk stratification relative to standard laboratory measurements remains uncertain. This study evaluated the agreement between laboratory- and POC creatinine-based risk stratification and their association with subsequent AKI after contrast angiography. Methods: In this prospective observational study, 295 adults undergoing contrast-enhanced angiography for acute myocardial infarction or acute ischemic stroke were enrolled. Serum creatinine was measured using both standard laboratory methods and a POC device before contrast administration. Estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI 2021 equation, and predicted risk of post-contrast AKI was assessed using the Mehran risk score. AKI was defined according to KDIGO criteria (≥1.5-fold increase from baseline or ≥26.5 µmol/L increase within 7 days). Agreement between laboratory- and POC-derived risk categories was evaluated using weighted Cohen’s kappa. Results: The median age was 64 years (interquartile range 57–70), and 66.8% of participants were male. Based on laboratory measurements obtained in the hospital central laboratory, categories were low in 8.8%, moderate in 37.3%, high in 25.4%, and very high in 28.5% of patients. Among patients with available follow-up creatinine measurements (n = 127), CA-AKI occurred in 11.0% (14/127). Agreement between laboratory- and POC-based risk classifications was near-perfect (κ = 0.97, 95% CI 0.95–0.98). The correlation between laboratory and POC creatinine values was moderate (r = 0.63, p < 0.001). Conclusion: POC creatinine–based Mehran risk stratification shows excellent diagnostic agreement with laboratory-based assessment for identifying patients at risk of post-contrast AKI. POC testing may facilitate rapid bedside risk assessment in patients undergoing angiography for acute myocardial infarction or ischemic stroke without compromising risk classification reliability.

Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is a potentially curable cause of pulmonary hypertension, yet data from Central Asia, including Kazakhstan, remain scarce. We aimed to characterize real-world management strategies and outcomes of patients with CTEPH treated within a national referral program. Methods: We conducted a retrospective analysis of consecutive adult patients diagnosed with CTEPH between 2018 and 2024 at the sole national CTEPH referral center in Kazakhstan. Clinical characteristics, imaging findings, and invasive hemodynamic data were compared between patients undergoing pulmonary endarterectomy (PEA) and those receiving medical therapy alone. Pre- and post-operative changes were assessed in a subgroup of surgical patients, and long-term survival was evaluated. Results: A total of 110 patients were included (mean age 54 ± 12 years; 58% male), of whom 56 (50.9%) underwent PEA. The median delay from symptom onset to referral was 24 months. No significant differences in baseline hemodynamic parameters were observed between surgical and medical groups. Among patients with available paired data, PEA was associated with substantial improvements in pulmonary hemodynamics, right-heart function, exercise capacity, and biomarkers of cardiac stress. Over a median follow-up of 39 months, survival was numerically higher in the surgical group, although this difference did not reach statistical significance. The estimated nationally diagnosed catheter-confirmed CTEPH detection rate was low, whereas the annual number of PEA procedures increased over time. Conclusion: Outcomes of PEA in Kazakhstan fall within the ranges reported in international surgical series. These findings highlight the need for earlier diagnosis, structured post-pulmonary embolism surveillance, and centralized multidisciplinary care to improve access to curative treatment in emerging healthcare systems. The observed nationally diagnosed detection rates likely underestimate the true population burden of CTEPH.

Aortopathy encompasses a spectrum of aortic aneurysms and dissections and represents a major cause of cardiovascular morbidity during pregnancy, particularly in women with heritable connective tissue disorders such as Marfan syndrome. Evidence guiding the management of severe aortopathy diagnosed in early pregnancy remains limited. We report the case of a pregnant woman with previously undiagnosed Marfan syndrome who presented at 10 weeks’ gestation with decompensated heart failure due to severe aortic regurgitation and a massive aortic root aneurysm. Transthoracic echocardiography revealed marked dilatation of the aortic root and ascending aorta, accompanied by left ventricular dilatation and systolic dysfunction. Following multidisciplinary evaluation, urgent surgical intervention was deemed necessary because of prohibitive maternal risk. The patient successfully underwent aortic root and valve replacement during the first trimester. Postoperatively, cardiac function improved, and the pregnancy was continued without major cardiovascular complications, ultimately resulting in the delivery of a healthy neonate. This case highlights the complexity of managing severe Marfan-associated aortopathy diagnosed during early pregnancy and demonstrates that life-saving aortic surgery may be considered in carefully selected patients when maternal risk is extreme, emphasizing the importance of individualized, multidisciplinary decision-making.

Background: According to the National infectious disease monitoring report, there is a fluctuating pattern of incidence of chickenpox in the country, but there are no studies reporting the epidemiological situation in Kazakhstan. There is a discernable association of varicella epidemiology with climate, particularly temperature dependency. We aimed to analyze the incidence and seasonality of chickenpox in the absence of universal varicella vaccination in Kazakhstan. Material and methods: A retrospective analysis of the long-term dynamics of chickenpox was carried out, and data he state report

Background: Vaccine-preventable diseases such as pertussis, measles, and influenza remain among the most significant medical and socioeconomic issues in Kazakhstan, despite significant vaccination achievements. Thus, here we aimed to analyze the long-term dynamics and provide information on the current epidemiology of pertussis, measles, and influenza in Kazakhstan. Methods: A retrospective analysis of the long-term dynamics of infectious diseases was carried out using the data from the statistical collections for 2010-2020 and the Unified Payment System from 2014 to 2020. Results: During the 2010-2020 years, the long-term dynamics show an unequal distribution of pertussis, measles, and influenza-related morbidity. In comparison with earlier years, registration of infectious disease was the highest in 2019 and 2020. The incidence cases among registered infectious diseases in 2019 were: pertussis-147, measles-13,326, and in 2020: influenza-2,678. High incidence rates have been documented in Pavlodar, North Kazakhstan, Mangystau regions, and the cities of Shymkent and Nur-Sultan. The incidence varies depending on the seasonality: pertussis (summer-autumn), measles (winter-spring), and influenza (mostly in winter). Conclusion: The findings highlight the importance of focusing more on the characteristics of the epidemic process of vaccine-preventable diseases in order to assess the effectiveness of implemented measures and verify new routes in strengthening the epidemiological surveillance system.

Background: Persistent hyperlipidemia is a major cause of cardiovascular morbidity in patients with nephrotic and non-nephrotic patients. Low-density lipoprotein-apheresis (LDL-apheresis) was shown to rapidly remove lipid structures. The current study aimed to compare the initial lipid profiles in patients with nephrotic syndrome and non-nephrotic hyperlipidemia as well as to evaluate the lipid profile of each group following a single treatment with LDL-apheresis. Methods: This is an open-label observational cross-sectional study of patients treated with LDL-apheresis including ten patients with nephrotic syndrome and thirteen patients with non-nephrotic hyperlipidemia who were either resistant and/or intolerant of lipid lowering therapy, with normal kidney function. Routine blood tests with full traditional lipid profile (Total cholesterol-(TC), Low-density lipoprotein (LDL), High-density lipoprotein (HDL), Triglycerides-(TG)) were determined before and after 12-hours following a single LDL-apheresis procedure. Results: Both groups were comparable by sex and age with more males than female in both groups. Baseline lipid profile was different between the two groups with nephrotic syndrome patients having significantly higher TC (p=0.05), LDL (p<0.001) and HDL (p<0.02) than those with non-nephrotic hyperlipidemia. A single treatment with LDL-apheresis resulted in significant improvements in the lipid profile of both groups including TC, HDL, LDL and TG, however HDL not significantly reduced in patients with nephrotic syndrome. Conclusion: Resistant nephrotic syndrome patients have a more severe and persistent hyperlipidemia than patients with non-nephrotic hyperlipidemia. The current study shows that LDL-apheresis is a safe and effective alternative to those who cannot tolerate or resistant to conventional treatments.