[Prosthetic repair of aortic valve cusps with autopericardium in children. State of the art and prospects]. / Protezirovanie stvorok aortal'nogo klapana autoperikardom u detei. Sovremennoe sostoianie problemy i perspektivy.

According to the results of modern researchers, the main techniques used in congenital pathology of the aortic valve in children include balloon catheter dilatation of the aortic valve, surgical valvuloplasty, the Ross procedure and replacement of the aortic valve with a mechanical prosthesis. Many surgeons point out that these techniques in congenital pathology of the aortic valve yield suboptimal results. This is often due to the lack of a clear-cut definition between surgeons as to what operation should be performed in a particular age group. According to the reports of the majority of researchers, biological prostheses undergo early degeneration and structural changes in paediatric cardiac surgery and yield the worst results. Comparing the main techniques, optimal haemodynamics is observed after the Ross procedure. A disadvantage of this operation is the necessity of repeat intervention on the right ventricular outflow tract, which is required in 20 to 40%. Concomitant surgery of the mitral valve and/or aortic arch during the Ross procedure significantly increases the lethality and the risk of postoperative complications. Compared with an adult cohort of patients, children after prosthetic repair of the aortic valve using a mechanical prosthesis are more often found to have postoperative complications and a higher mortality rate. Yet another problem encountered in paediatric valve surgery is the unavailability of commercial prostheses sized ?19 mm. The duration of the intraoperative parameters for reconstructions of the aortic valve, the Ross procedure, and replacement of the aortic valve by the results of many studies averagely amounts to 74±34 min, 100±56 min, and 129±71 min, respectively. Yet another method which can be used for neocuspidization of the aortic valve in reconstructive surgery of the aortic root in paediatric patients is the use of glutaraldehyde-treated autologous pericardium. In our opinion, given the simplicity of the procedure, duration of the intraoperative parameters, and acceptable initial results reported by some researchers, the Ozaki procedure may be performed in children.

[Three-valve reconstruction with prosthetic repair of the ascending portion of the aorta in elderly patients]. / Trekhklapannaia rekonstruktsiia s protezirovaniem voskhodiashchego otdela aorty u bol'nogo pozhilogo vozrasta.

Elderly and aged patients appear to have a significantly increased risk from a cardiosurgical intervention combining three-valve reconstruction and prosthetic repair of the ascending portion of the aorta. Triple-valve pathology in pronounced mitral insufficiency is often accompanied by concomitant dilatation of the left atrium, i. e., atriomegaly. With the aim to eliminate the syndrome of compression of surrounding tissues and normalize intracardiac haemodynamics, reduction of the left atrium should become an inherent procedure for atriomegaly in patients with multiple-valve pathology.

[Vector mapping of deformation and blood flows in patients with ascending aortic aneurysm]. / Vektornoe kartirovanie deformatsii i potokov krovi u patsientov s anevrizmoi voskhodiashchei aorty.

The authors performed clinical studies based on modelling of an ascending aortic aneurysm in 37 patients and 10 apparently healthy subjects. Echocardiography was carried out in the B-mode using the Vivid E9 device (USA, GE). The linear dimensions of the aorta were assessed at three points - in the immediate vicinity of the valves, in the area of the maximum dilatation and in the area of decreased dilatation with registration of blood flow velocity in the aorta. The aortic walls were contoured with the division of equal intervals into 4 portions in order to obtain longitudinal shear deformation velocity during the cardiac cycle. We worked out a system of assessing the velocity vector fields with the help of transthoracic echocardiography in patients with an ascending aortic aneurysm, based on registration of blood flows, which made it possible to obtain the components of velocity. We also determined an optimal method of assessing turbulence in the aorta taking into account the direction of the vectors. Obtained were the numerical data of aortic wall deformation velocity in the longitudinal direction and calculation of the weighting function with the distinction between pathology and the norm. Based on the deformation, the distance between the registered points, and the movement of the vascular wall, we determined the reference values of blood flow velocity inside the aorta and immediately close to its walls.

The role of N-terminal pro-brain natriuretic peptide in prediction of postoperative atrial fibrillation.

AIM: To analyze prognostic value of different factors in postoperative atrial fibrillation prediction. MATERIAL AND METHODS: Study included 39 patients with coronary artery disease without previous paroxysmal atrial fibrillation. Multiple correlation, logistic regression and ROC-analysis were performed to create predictive model of postoperative atrial fibrillation prognosis. Authors have analyzed most of described in literature preoperative predictors of atrial fibrillation to define the role of different risk factors. Prognostic role of N-terminal pro-brain natriuretic peptide (NT-proBNP) is assessed. RESULTS: We revealed high informativeness of NT-proBNP to predict postoperative atrial fibrillation after on-pump coronary artery bypass grafting.

[Solid lesions of heart valves].

AIM: To analyze clinical-diagnostic and surgical aspects of cardiac valve solid lesions as well as long-term results of surgical treatment. MATERIAL AND METHODS: Clinical, diagnostic and surgical aspects of treatment of 51 patients with tumorous and pseudotumorous lesions of cardiac valves were analyzed. RESULTS AND DISCUSSION: Hospital complications were observed in 17.7% of patients. Mortality rate was 3.9%. 1- and 28-year overall survival was 100% and 94.1% respectively. Quality of life was good, satisfactory and unsatisfactory in 73.5%, 20.4% and 6.1% of cases respectively. CONCLUSION: Timely diagnostics of tumorous and pseudotumorous lesions of cardiac valves is very difficult but possible based on short history, positional dependence of symptoms, embolic events without rhythm disturbances. Additional instrumental methods including TTE, TEE, CT and MRI are necessary to define diagnosis. Intraoperative diagnostics and immediate histological survey are useful to determine volume of surgery in each case. Successful surgical treatment implies urgency, hypothermic perfusion and pharmaco-cold cardioplegia during operation.

[The results of early neurocognitive and neuropsychological testing in patients after ascending aorta and aortic arch surgeries].

It was investigated 30 patients after reconstructive ascending aorta and aortic arch surgeries. Neurocognitive testing was performed 2-3 days before surgery, through 24 hours and 10 days after surgery. Neurocognitive tests included Psychiatric Rating Scale, test "Information-Memory-Consideration Concentration", frontal dysfunction battery and test of clock drawing. Neuropsychological testing was performed by using of hospital scale of anxiety and depression evaluation and Covey scale. The observed moderate decrease of cognitive sphere in 24 hours after surgery has recovered by 10 days of postoperative period. Depressive disorders also were revealed in all stages of postoperative period. Inverse correlation between depressive and intellectual-mental disorders in examined patients was presented. It was suggested introduction of compulsory neurocognitive and psycho-emotional testing for improvement of surgical treatment results.

[Valve-sparing technique for type a aortic dissection with insufficiency of aortic valve].

This article describes clinical experience of surgical treatment of aortic insufficiency in type A aortic dissection using valve-sparing technique. Results of treatment are presented.

[Clinical management of patients with abdominal aortic aneurysms combined with coronary artery disease and multifocal atherosclerosis].

We have analyzed clinical management of 137 patients with atherosclerotic aneurysms of the abdominal aorta combined with coronary artery disease treated during last 10 years in the First Cardiac Surgery Department (Surgery of the Aorta and its Branches) of the Petrovsky National Research Center of Surgery. All patients were subjected to surgery involving both vascular regions: in 130 patients (94.9%) the procedures were staged while 7 patients underwent myocardial revascularization simultaneously with the reconstruction of the abdominal aorta from the minimal access. According to our results staged procedures are safer for patients with atherosclerotic aneurysms of the abdominal aorta combined with coronary artery disease given the organism's limited capacity due to age and comorbidities. Endovascular repair techniques applied both to the coronary arteries and to the abdominal aorta should be always regarded primarily as a gentle form of intervention. In cases where open surgery is required one should try to avoid blood loss, reduce the duration of the procedure and use minimal access surgery when applicable. The overall mortality rate in patients treated for this disorder over the last 10 years was 2.1%.

[Expansion of indications for total replacement of thoracoabdominal aorta].

Experience of surgical treatment of 111 patients with thoracoabdominal aorta aneurysm are presented in the article. All patients were operated in terms 2007 to December 2011 in the department of aortic surgery of acad. B.V. Petrovskogo RSCS of RAMS. All patients were divided into 3 groups. Thoracoabdominal aorta prosthetics from isthmus to bifurcation was performed in 10 patients of the first group. It was done descending thoracic aorta prosthetics in the second group (72 patients). The third group (29 patients) had suprarenal aorta prosthetics. The groups were comparable with respect to initial severity of underlying and concomitant diseases. Hemorrhage was 6242±3040, 2666±1590 and 2962±1547 ml respectively. Liver and renal failure developed in 10, 7 and 24% of cases respectively (p<0.05). Respiratory failure developed in 40, 33 and 27.6% of cases. Mortality was 10, 7 and 13.8% respectively. It was concluded about comparable treatment outcomes regardless of the amount of reconstruction. It is necessary to develop the techniques improving surgical treatment results and decreasing postoperative complications frequency.

[Risk factors and causes of hospital mortality after Bentall-deBono's surgery].

It was done an evaluation of surgical treatment results of 71 patients with aortic arch aneurysm and aortic insufficiency, who were operated routinely. According to data of correlation and multiple regression analysis, chronic obstructive pulmonary disease and kidney disease before operation are significant factors predisposing to death in postoperative period. The authors consider that normalization of lungs and kidneys function before operation improves surgical treatment results in patients of this group.

[Mega aorta: Borst operation or Kouchoukos operation?].

It was done 163 operations on aortic arch in terms 2000 to December 2011. All patients were operated in the department of aortic surgery of acad. B.V. Petrovskogo RSCS of RAMS. 36 operations were performed by using of Borst's technique and 9 operations - by using of Kouchoukos technique in case of extended aneurysms of thoracic aorta. All patients did not differ in the severity of primary state, concomitant diseases and age. Duration of cardiopulmonary bypass and internal organs ischemia were 189±55/190±47 and 55±8/77±20 min respectively. Complication frequency was 27% and 22% in case of cardiovascular failure. Respiratory failure was 16.7% and 33%. Liver and renal failure was observed in 27% and 11% of cases. Encephalopathy was detected 33% and 22% of cases. Mortality was 22% and 11% of cases. It was concluded that Kouchoukos technique is alternative and safe method in thoracic aorta aneurysm treatment.

[Revascularization of the brain in the acute stage of ischemic stroke]. / Revaskuliarizatsiia golovnogo mozga v ostrom periode ishemicheskogo insul'ta.

A literature review on the early surgical revascularization using carotid endarterectomy in the acute stage of ischemic stroke is presented. Special attention is drawn to criteria of patient selection and time of surgery. A history of the problem is given.