Cardiovascular malformations are the most common type of birth defect and result in significant mortality worldwide. The etiology for the majority of these anomalies remains unknown but genetic factors are being recognized as playing an increasingly important role. Advances in our molecular understanding of normal heart development have led to the identification of numerous genes necessary for cardiac morphogenesis. This work has aided the discovery of an increasing number of monogenic causes of human cardiovascular malformations. More recently, studies have identified single nucleotide polymorphisms and submicroscopic copy number abnormalities as having a role in the pathogenesis of congenital heart disease. This review discusses these discoveries and summarizes our increasing understanding of the genetic basis of congenital heart disease. Over the past couple of decades, there has been a greater understanding of the molecular pathways regulating cardiac development. The development of gene targeting technology has led to the generation of a multitude of mouse models with cardiac developmental defects. These studies have led to the identification of numerous transcriptional regulators, signaling molecules and structural genes that are critical for normal cardiac morphogenesis. In addition, multiple genes have been identified that are controlled by these highly conserved molecular pathways.These investigations into the molecular mechanisms of cardiac development have assisted in the identification of genetic etiologies of CHD and provide evidence that many genes may have etiologic roles in human CHD.

Introduction: The paper presents lateresults of surgical correction of the patientswith acquired heart disease.Materials and method: Two hundredfifty one patients had surgical defectcorrection from 2000 to 2016 years. Lateresults were observed in 134 patients. It wasrevealed that subgroup with aortic, mitral andmitral-aortic stenosis and in the subgroupwith aortic insufficiency, systolic functionof the left ventricular was significantlyincreased and heart cavities were positivelyremodeled.Results: Five-year survival rate in subgroupwith initial aortic stenosis and insufficiencywas 100% , in subgroup with initial mitralstenosis - 78.4%, with mitral insufficiency- 75.0%, with mitral-aortic stenosis - 94.1%and with mitral-aortic insufficiency - 49.1%.Conclusion: Risk factors of late mortalityof the patients with valve pathology andsystolic dysfunction of left ventricular aftersurgical correction are: IV NYHA, chronicheart failure, the heart-lung coefficientmore than 65%, high lung hypertension(systolic pressure in pulmonary artery morethan 60 mm.Hg), size of the left ventricularmore than 60 mm and index of end-diastolicvolume of left ventricular more than 110 ml/m2.

Introduction: Cardiovascular diseases are one of the leading causes of mortality and morbidity in Mongolia during last 10 years. Accordingly, increasing number of the procedures cardiac open heart surgeries in Mongolia.The aim is to evaluate of the scientific literature related toestimation of expenditure for open heart surgeries.Method: The literature search strategies were developed to identify published studies. The following literature databases were searched and collected individually: MEDLINE PubMed, Google and abstract books in Mongolian libraries.Result: Analyzed the 28 published literatures which made in estimation of expenditures for open heart surgery. The most of the study were generally focused on the expenses of diagnosis and treatments of open heart surgery. Literature showed that for patients not covered by health insurance, valve replacement surgery typically costs from about $80,000 -$200,000 or more with an average, according to an American Heart Association report, of $164,238, not including the doctor fee. A surgeon fee can add $5,000 or more to the final bill. For example, Dartmouth-Hitchcock Medical Center in New Hampshire charges about $86,500, including doctor fee, after a 30% uninsured discount. St. Mary’s Hospital in Wisconsin charges an average of $107,000, but costs can reach $200,000 or more. AndBaptist Memorial Health Care charges about $75,000 -$140,000, not including doctor fee, but cost can go up to more than $200,000 with major complications. In Russia, total 700,000 people take surgery on annual average each year and on which they spend 10 902 500 000$ annually, it has been stated on Bokeriya.L found that 464 637.840 ruble annually on cardiac surgery coronary angioplasty surgery, 792 237 ruble on coronary heart disease surgery and 9 522 ruble on congenital heart defect repairment surgery. Up to per 15 years old children, 24 288 ruble spend on average. Bokeria et all reported that, expenses of medicine through ABC/VEN analysis, 47 types of medicines of A group(13.1% of total medicines) takes 79.62% of total expenses, 71 types of medicines of B group(19.8% of total medicines) takes 15.36% of total expenses, 242 types of medicines of C group(67.1% of total medicines) takes 5.02% of total expenses. Out of this report, N group’s portion of A group medicines takes 0.79% by VENanalysis. Approximate, all inclusive cost for open heart bypass surgery (CABG ) vary between USD 5500 - USD 7800, depending on the facility & city you chose to get the procedure done in India. D.Tsegeenjav and D.Bat-Undral reported the expenses on open heart surgery in Mongolia, as a result showed that health insurance spend 56 422 656 ₮ (appx 39,100,093$) for 156 numbers of procedures. But real cost expenditure was 440 300 000.00₮. It means health insurance spent 12.6% of total expenditure for procedures. Also health insurance expenditure for CABG and one valve replacement per patient were same as 643 272.00₮, but real expenditures for CABG was 2 000 000.00₮, and for one valve replacement surgery per patient was 5 000 000.00 ₮.Conclution: The scientific literatures showed that many studies related in estimation of expenditure for open heart surgery made in international countries such as Russia, USA, UK and India et all. But we didn’t found the study for estimation of expenditures for open heart surgery by using ABC/VEN analysis in Mongolia.References:1. Health indicators of Mongolia 2002-2012. Report of the state implementing agency.2. Цэгээнжав д, Бат-ундрал д. зүрхний нээлттэй мэс заслûн эмчилгээний зардлûн асуудалд, “авьяслаг шастинчууд 2013” эрдэм шинжилгээний хурлûн эмхэтгэл, х3-4Бокерия л. а.самородская и. в.ßрустовский и др., Oпыт применения авс- и ven-анализа в сердечно- сосудистой хирургии фгбу. Бюллетень нЦссх им. а.н. Бакулева рамн, 2012, ¹1, стр http://lekarius. ru/external/paper/26143. The European health report 2009: health and health system. WHO Library Cataloguing in Publication Data.4. Shear A, Scuffham P, Mollon P. The cost of coronary artery disease in the UK. Br. J. Cardiol. 2004. Vol. 11. P 218-223.5. Htt://health.costhelper.com/valve-replacement.html Heart valve replacement costKey words : Open heart surgery, expenditure

In valve surgery cases among Mongolia, post-arrhythmia is observed that as same as pre-arrhythmia by its kind and prevalence. Which is why post-operation complication, mortality, financial problems are high, also exceeding hospital care. Therefore we aimed to compare pre and post operation arrhythmia in patients who had aortic and mitral valve surgery. In order to compare, we measured pre and post surgery electrocardiogram from total 30 patients with satisfaction. Statistical analyses are completed by SPSS 23 software and the p-value is evaluated as significant when less than 0.05. The average age of patients were 43./±3/. The frequency of pre-surgery arrhythmia were 88.7% hence atrial fibrillation were 62.9%, moreover post-surgery arrhythmia were 80%. There was no statistically significant difference between pre and post surgery arrhythmia (p= 0.9). According to the result, we have concluded that arrhythmia frequency hasn’t been getting lower after valve surgery, consequently needed to improve arrhythmia control, treatment and admit novel methods such as Cox maze IV, and Catheter ablation.