[Diagnostic algorithms and features of clinical course of congenital heart diseases in infants with lung anomalies].

The paper discusses the influence of lung anomalies on the progress of congenital heart diseases (CHD) in infants, as well as diagnostic value of radiography and ultraspeed computed tomography (CT). The four-year experience of the authors includes preoperative examination of 178 infants with CHD (mean age 5.8 +/- 0.6 months, mean weight 5.2 +/- 0.3 kg). Lung anomalies were determined in 24 patients (13.5%) on plain films and in 85 patients (47.8%)--by means of CT. The stenosis of main bronchi in combination with lobar emphysema and lung hypoplasia were found to be the most frequent and severe predictors of respiratory disorders. The obtained data suggest that CT examination may be recommended in infants with CHD for precise diagnostics of associated lung anomalies and further prevention or early management of respiratory complications.

[Nocturnal biting activity of mosquitoes (Diptera, Culicidae) in Volgograd and its environs]. / Nochnaia aktivnost' komarov (Diptera, Cilicidae) v Volgograde i ego okrestnostiakh.

The nocturnal biting activity of mosquitoes was investigated by a Berezansev's bell and bird traps as baits in August 2003. Among 7 man-attacking species, C. modestus, C. pipiens, and Coq. richiardii were most abundant. C. pipens showed two peaks of biting activity at night while both C. modestus and Coq. richiardii displayed one peak of this activity. Bird traps attracted the mosquitoes C. pipiens and C. modestus. The results are discussed in terms of the possible involvement of the above species in the transmission of WNF virus in Volgograd and its environs.

[Interventional radiology in congenital and acquired cardiovascular diseases]. / Interventsionnaia radiologiia pri vrozhdennykh i priobretennykh porokakh serdechno-sosudistoi sistemy.

The paper outlines the present-day achievements in interventional radiology in cardiovascular diseases: balloon valvuloplasty in cardiac diseases (isolated pulmonary arterial stenosis, aortic and mitral stenosis), balloon vasodilatation (peripheral pulmonary arterial stenosis, aortic coarctation), embolization of the vessels and pathological communications, atrioseptostomy, transcatheter closure of atrial septal defects.

[Comparative assessment of hemodynamic parameters in ventricular septal defect, obtained by Doppler echocardiography and catheterization of cardiac cavities]. / Sravnitel'naia otsenka pokazatelei gemodinamiki pri DMZhP, poluchennykh s pomoshch'iu doppleroékhokardiografii i kateterizatsii polosteí serdtsa.

The study was undertaken to assess hemodynamic parameters by Doppler echocardiography in patients with ventricular septal defect (VSD) and pulmonary hypertension. Seventy-two patients aged 5 months to 9 years (mean 2.5 years) who had isolated VSD were examined. The authors conclude that it is possible and necessary to assess hemodynamics in the lesser circulation by using Doppler echocardiography. The method permits monitoring the time course of changes in the right heart, which makes it possible to follow the natural history of disease without applying invasive studies.

[The X-ray diagnosis of congenital absence of the pericardium]. / Rentgenodiagnostika vrozhdennogo otsutstviia perikarda.

The X-ray signs of such a rare abnormality as the congenital absence of the pericardium are presented. The results of examinations and follow-up of 4 patients with this abnormality are analyzed. The patients underwent X-ray, echocardiographic studies, cardiac catheterization and angiography. The diagnosis of the absence of pericardium was confirmed at surgery and in one case at autopsy.

[Potentialities of digital low-dose x-ray apparatus in the diagnosis of heart and lung diseases]. / Vozmozhnosti tsifernoí malodozovoí rentgenovskoí ustanovki v diagnostike zabolevanií serdtsa i legkikh.

The paper presents experience in clinically testing a digital low-dose X-ray apparatus. X-ray studies were performed in 169 patients: 140 with cardiovascular abnormalities and 19 with lung diseases. The findings show the high quality of images of thoracic aorta and lung structures. The radiation dose received during an examination is many times lower than at routine X-ray study and fluorography, which makes it possible to use the apparatus in mass surveys of contingents at risk for tuberculosis.

[Spiral computed tomography in the diagnosis of pathology of the vascular bed]. / Spiral'naia komp'iuternaia tomografiia v diagnostike patologii sosudistogo rusla.

The paper presents experience with spiral computed tomography used in the examination of 1000 patients. It analyzes the potentialities of CT angiography for the diagnosis of abnormality of the vascular bed. It is concluded that the use of the new method of X-ray contrast diagnosis is promising and expedient in clinical cardiovascular surgical care.

[Significance of intravascular ultrasound studies in the evaluation of the vascular lumen and wall in interventional radiological procedures]. / Znachenie vnutrisosudistogo ul'trazvukovogo issledovaniia v otsenke sostoianiia prosveta i stenki sosudov pri interventsionnykh radiologicheskikh protsedur.

The paper analyzes the first experience with intravascular ultrasound study (IUSS) in 9 patients at the Cardiosurgery Center. It presents the potentialities of IUSS during interventional radiological procedures. It is concluded that there are benefits and trends of the technique in the exploration of various vascular beds.

[Digital subtraction angiography in the diagnosis of Fallot 's tetralogy]. / Digital'naia subtraktsionnaia angiografiia v diagnostike tetrady Fallo.

The authors analyze the efficacy of digital subtraction angiography (DSA) in the diagnosis of Fallot's tetralogy (FT); this method helps simplify and cut down the scope of investigations but does not deteriorate their informative value. DSA findings in 120 patients with TF are analyzed. The study was confined to right ventriculography in the majority of cases, which permitted clear-cut imaging of the anatomical details of the defect due to computer processing of the image. Morphometrical parameters were used to make assessment of involvement of the pulmonary artery system more objective: the ratio of the width of various portions of the pulmonary artery system to the width of descending aorta and the pulmonary arterial index characterizing the area of section of both pulmonary arteries in relation to body surface. The quality of imaging the stenoses and hypoplasia in the pulmonary artery system was high, meeting the requirements of present-day surgery. Moreover, DSA helps diagnose other anatomical particulars of TF and the concomitant defects and abnormalities, left ventricular hypoplasia and the type of right aortic arch among other things. The advantages of DSA in the diagnosis of TF are a lesser volume of catheterization, reduced number of sessions and of the dose of contrast agent infused at each session, better imaging of the anatomical details of the defect and of concomitant defects and abnormalities. All this permit examinations on an outpatient basis.

[Pulmonary sling in a patient with anomalous intrathoracic heart displacement (diagnosis and surgical treatment)]. / Lëgochnaia petlia u bolnogo s anomaliei vnutrigrudnogo raspolozheniia serdtsa (diagnostika i khirurgicheskoe lechenie).

The pulmonary sling is the origin of the left pulmonary artery from the right one, this is a rare abnormality giving a marked clinical picture. The paper presents a case of solely rare combination of the pulmonary of the pulmonary sling with abnormal cardiac placement--dextroversion. A three-year-old child underwent explorative thoracotomy for erroneously diagnosed mediastinal cyst. The thoracotomy revealed a suspected pulmonary sling. To make an accurate diagnosis, a comprehensive study (chest X-ray with esophageal contrasting, tracheobronchography, echocardiography, digital subtraction angiography) was performed. Echocardiography clearly showed the absence of bifurcation of the pulmonary trunk and the origin of the left pulmonary artery from the right one proved to be most informative, as evidenced by colour Doppler mapping. The paper deals with the specific features of surgical treatment of this pathology (the patient was successfully operated on through lateral sternotomy by using extracorporeal circulation). The good functional result of the operation was confirmed by echocardiography and angiography.

[Annuloplasty of the tricuspid valve with a controllable semi-ring under the control of transesophageal echocardiography]. / Annuloplastika trikuspidal'nogo klapana reguliruemym polukol'tsom pod kontrolem chrespishchevodnoi ékhokardiografii.

The paper analyzes the first clinical experience with a novel procedure of tricuspid annuloplasty with a controllable semiring under the control of transesophageal echocardiography in 6 patients with tricuspid dysfunction and those with mitral and tricuspid valvular diseases. The application of intraoperative transesophageal echocardiography makes it possible to control both the degree of mitral regurgitation and the severity of right atrioventricular stenosis. This echocardiography may serve a method for plastic correction of the tricuspid valve.

[Anatomic and hemodynamic comparisons in patients with aorta and pulmonary artery arising from the right ventricle]. / Anatomo-gemodinamicheskie sopostavleniia u bol'nykh s otkhozhdeniem aorty i legochnoi arterii ot pravogo zheludochka serdtsa.

The anatomy and hemodynamics were compared in 59 patients with aorta and pulmonary artery origin from the right ventricle. The patients' age was from 3 months to 23.5 years. The pathophysiology of the patients' circulation was determined by many factors, the most important factors were the following: the anatomic type of the malformation, the presence or absence of pulmonary and aortic stenoses and other concurrent congenital heart malformations. The oxygen saturation of the arterial blood was associated with the direction of physiological blood flows in the right ventricle. The most "successful" anatomic and hemodynamic variants of the malformation were types A and B, in which there was no higher blood oxygen saturation in the pulmonary artery as compared to the level of blood oxygenation in the aorta despite the presence or absence of pulmonary stenosis and the site of great vessels. Type C with the inverse site of great arteries is the less "successful" anatomic and hemodynamic variant.

[Classification of aortic and pulmonary artery origin from right ventricle]. / Klassifikatsia otkhozhdenia aorty i legochnoi arterii ot pravogo zheludochka.

An original systematics of origin of the aorta and pulmonary artery from the right ventricle (OAPA RV) is suggested on the basis of examination of 63 heart specimens with the anomaly. Two main variants of OAPA RV are distinguished: (1) with and (2) without a formed infundibular septum (IS). Types A and DA belong to the first variant, types B, C, D, and DC to the second variant. Type A is characterized by drainage of the left ventricular (LV) outflow tract (OT) into the subaortic conus. Type DA differs from type A by the existence of an auxiliary opening between the ventricles due to a deficiency of tissue of the posterior (sinus part) of the septum. Type B is characterized by the absence (or marked hypoplasia) of the septum of the conus (SC). The LV OT in this case drains under both (aortic and pulmonary) coni. In type C the LV OT opens into the subpulmonary conus. In distinction from type C, type DC has an auxiliary defect in the sinus part of the interventricular septum (IVS). Type D is characterized by complete obturation of the exit and the absence of a defect in the sinus part of the IVS (type D1: OAPA RV with an intact IVS) or with a sinus defect in the IVS-DIVS (type D2: OAPA RV with noncommitted DIVS). According to the presence or absence of stenosis of the pulmonary artery (PA) or aorta, 4 subtypes are distinguished: (1) without stenosis; (2) with stenosis of PA; (3) with aortic stenosis; (4) with combined aortic and pulmonary stenosis.

[Right aortic arch with a retro-esophageal diverticulum (embryology, anatomy, classification, clinical picture, diagnosis and surgical treatment)]. / Pravostoronniaia duga aorty s retroézofageal'nym divertikulom (émbriologiia, anatomiia, klassifikatsiia, klinika, diagnostika i khirurgicheskoe lechenie).

Five clinical cases (adult patients) are discussed in illustration of the problems of embryology, anatomy, clinical picture, and X-ray and angiographic diagnosis of a rare anomaly, right arch of the aorta (RAA) with retro-esophageal diverticulum of the aorta. According to I. J. Garti's classification, type C RAA was determined in 4 patients and type B RAA in one patient. The vascular ring around the esophagus and trachea was manifested clinically by mild respiratory disorders in 2 and marked dysphagia in all 5 patients, which required surgical correction. Four patients were operated on through a left posterolateral thoracotomy in the fourth-fifth intercostal space, one patient through a bilateral approach with division of the sternum on the level of the third intercostal space. The clinical effect of the operation was good in all patients. The indications for and the tactics of surgical treatment are discussed.

[Angiocardiographic diagnosis of the position of the interventricular septal defect in a case of double outlet of the great vessels from the right ventricle]. / Angiokardiograficheskaia diagnostika polozheniia defekta mezhzheludochkovoi peregorodki pri dvoinom otkhozhdenii magistral'nykh sosudov ot pravogo zheludochka.

The paper is devoted to analysis of the results of angiocardiographic investigation of 237 patients with a double deflection of great vessels (DDGV) from the right ventricle (RV) (the patients ranged in age from 3 months to 23.5 years) to study the potentialities of the method in the diagnosis of a defect position of the interventricular septum (DIVS). Angiographic investigation permitted a sufficiently accurate determination of a DIVS position in DDGV from the RV. Of paramount importance for determining a DIVS position is the establishment of the interrelationships of the latter with the infundibular septum and the openings of major arteries. For diagnosis of a DIVS position one should necessarily use left and right ventriculography both in standard and axial projections.

Angiocardiographic diagnosis of ventricular septal defect localization in double outlet right ventricle.

Children with double outlet right ventricle, aged 3 months to 23.5 years, were examined to assess the possibility of angiocardiographic diagnosis of defect localization. It was found angiocardiography allows satisfactory localization of the defect in question. To be able localize the defect, it is critical to determine the interaction between the defect and the conus septum, and the origin of large arteries. To establish the diagnosis of ventricular septal defect, right and left ventriculography in standard and axial projections must be performed.

[Angiocardiography in the diagnosis of interventricular septum defects in a double displacement of great vessels from the right ventricle]. / Angiokardiograficheskaia diagnostika polozheniia defekta mezhzheludochkovoi peregorodki pri dvoinom otkhozhdenii magistralnykh sosudov ot pravogo zheludochka.

The paper is devoted to analysis of the results of angiocardiographic investigation of 237 patients with a double deflection of great vessels (DDGV) from the right ventricle (RV) (the patients ranged in age from 3 months to 23.5 years) to study the potentialities of the method in the diagnosis of a defect position of the interventricular septum (DIVS). Angiographic investigation permitted a sufficiently accurate determination of a DIVS position in DDGV from the RV. Of paramount importance for determining a DIVS position is the establishment of the interrelationships of the latter with the infundibular septum and the openings of major arteries. For diagnosis of a DIVS position one should necessarily use left and right ventriculography both in standard and axial projections.

[Vascular ring: classification, clinical aspects, diagnosis and principles of surgical treatment]. / Sosudistoe kol'tso: klassifikatsiia, klinika, diagnostika i printsipy khirurgicheskogo lecheniia.

In the period between 1978 and 1989 operations were conducted on 56 patients with symptoms of the vascular ring (VR). The diagnosis of the disease was established on grounds of the clinical picture and the results of esophagography and angiocardiography. Double arch of the aorta (DAA) was recognized in 28 patients, anomalies of the right arch of the aorta (RAA) with VR formation in 25, and anomalies of the left arch of the aorta (LAA) in 3 patients. In 29 patients VR was combined with another congenital heart disease (CHD): with Fallot's tetralogy (FT) in 9 patients, with ventricular septal defect (VSD) in 4, and with coarctation of aorta (CA) in one patient. RAA anomalies were combined with FT in 6, with VSD in 4, and with CA in one patient. LAA anomalies were combined with VSD in 3 and with CA in one patient. VR separation was carried out through left anterior posterolateral thoracotomy in 91% of cases and through right thoracotomy in the remaining cases. In combination of VR with CHD the VR was corrected in one stage and then the CHD was corrected under extracorporeal circulation. Combination of RAA with FT allowed anastomosis with the use of a divided proximal stump of the left arch of the aorta to be established in 6 cases. In the group of 56 patients one died from hemorrhage during the operation. The late-term results are good.