[Use of extracorporeal membrane oxygenation for pulmonary haemorrhage after pulmonary endarterectomy]. / Primenenie ékstrakorporal'noi membrannoi oksigenatsii pri legochnom krovotechenii posle legochnoi éndarteréktomii.

Pulmonary haemorrhage is one of the most severe complications of pulmonary endarterectomy. To the most effective methods of combating this potentially fatal complication belongs extracorporeal membrane oxygenation (ECMO). In this article we describe a clinical case report regarding intraoperative use of central veno-arterial ECMO for pulmonary haemorrhage following thromboendarterectomy from the pulmonary arteries. According to the data of some authors, long-term ECMO support (for more than 4 days) may lead to such severe consequences as rethrombosis of pulmonary arteries and impairment of cerebral circulation. In our case we managed to avoid such complications, taking into consideration that the duration of ECMO amounted to 21 days. Resulting from the carried out comprehensive therapeutic measures by the time of discharge from hospital, a significant decrease in pulmonary artery pressure was achieved, with events of residual pulmonary hypertension.

[Diverticula and Congenital Aneurysms of the Left Ventricle: Anatomical Features, Pathophysiology, Clinical Presentation and Treatment Strategy].

Congenital aneurysms and diverticula of the left ventricle represent a rare group of anomalies in the spectrum of congenital heart disease. Although natural histories of these anomalies are considerably different and characterized by different rates of lifethreatening events, similarity of their clinical presentation and diagnostic criteria do not allow to differentiate this anomalies at routine examination. Data on etiology, methods of diagnosis and treatment published by various authors is controversial. In this review we present relevant aspects of etiology, pathophysiology and treatment strategy of patients with left ventricular diverticula and congenital aneurysms.

Endoventriculoplasty of the Left Ventricle for Congenital Diverticulum.

Congenital left ventricular diverticulum is an extremely rare heart defect. Here, we report a case of successful endoventriculoplasty using a Dacron patch in an infant who was followed up for one year.

[Surgical treatment of aortic arch malformations in infants under cardiopulmonary bypass].

AIM: To evaluate long-term results and the causes of complications in congenital obstructive pathology of the aortic arch. MATERIAL AND METHODS: Retrospective study enrolled 62 patients aged 55 ± 14 days who underwent aortic arch surgery under cardiopulmonary bypass. It was compared two methods of aortic archplasty: use of xenopericardial material in group 1 and Rajasinghe's autoplastic method in group 2. RESULTS: Follow-up was 42 ± 14 months. In the long-term recoarctation occurred in 7 (13.7%) cases including 6 (18.75%) patients in group 1 and one (3.3%) patient in group 2. Residual hypertension was observed in 12 (23.5%) cases including 10 (37%) patients in group 1 and 2 (8.3%) patients in group 2. Six (50%) patients receive antihypertensive therapy, 5 (41.6%) patients who receive antihypertensive drugs have persistent increase of blood pressure without evidence of anatomic aortic obstruction. Hypertensive response to functional tests was observed in one patient. CONCLUSIONS: Aortic arch reconstruction using autoplasty is associated with lower risk of recoarctationand residual hypertension compared with xenopericardial patch application.

[The flow cytometry in diagnostic of sepsis in children of first year of life with congenital heart disease and operated in conditions of artificial circulation].

The study was organized to evaluate sensitivity and specificity of CD64 index and relative amount of HLA-DR+ monocytes in diagnostic of sepsis in children of first year of life after surgery correction if congenital heart disease in conditions of artificial circulation. To detect CD64 index the kit Leuko64 (Beckman Coulter USA) was applied. The relative amount of HLA-DR+ monocytes was measured by flow cytofluorimeter Navios (Beckman Coulter, USA) using combination of monoclonal antibodies CD14-APC, HLA-DR-PacificBlue, CD45-KrOr. The results of study established that CD64 index in the group with confirmed or supposed sepsis consisted 2.29 (1.96:3.32) that statistically is reliably higher (p = 0.001) than in group without sepsis. The study established no statistically reliable differences in concentration of C-reactive protein in blood serum (p-0.123), absolute amount of leukocytes in peripheral blood (p = 0.128), relative amount of HLA-DR+ monocytes (p = 0.789). It is demonstrated that value of CD64 index higher than 2.00 increases the risk of development of sepsis up to 9.4 times and can be used as a diagnostic criterion of sepsis (AUC = 0.895) with sensitivity up to 80% and specificity up to 90%. The negative prognostic significance of CD64 index and content of procalcitonin in relation to development of sepsis in children of first year of life operated in conditions of artificial circulation amounted to 74% and 76% and 77% and 64% in case of positive prognostic significance correspondingly.

[Treatment of reperfusion renal lesion after surgical management of chronic post-embolic pulmonary hypertension by means of extracorporeal membrane oxygenation (ECMO)].

Thromboendarterectomy from the branches of the pulmonary artery is a conventionally accepted approach to treatment for pulmonary hypertension in chronic pulmonary embolism. A frequently encountered complication associated with this operation is the development in the postoperative period of the reperfusion syndrome as a potential cause of fatal respiratory failure. Taking into consideration that the reperfusion syndrome is a reversible process, waiting measures of support may save the patient's life. The present article deals with a case report concerning successive surgical management of a female patient suffering from chronic recurrent pulmonary thromboembolism accompanied by high pulmonary hypertension complicated by severe respiratory insufficiency in the early postoperative period, thus requiring long-term use of veno-venous extracorporeal membrane oxygenation (ECMO). The clinical case described in the article shows that veno-venous ECMO may be employed to save patients presenting with reperfusion syndrome following thromboendarterectomy from the branches of the pulmonary artery. The method of connecting ECMO namely in the veno-venous option in this particular case was determined by fact that the patient had no cardiac insufficiency. Numerous studies conducted hitherto have also confirmed that using ECMO in the veno-venous variant is accompanied and followed by a lower incidence rate of complications as compared with that of the veno-arterial variant. The results of our case report strongly suggest that timely use of ECMO in the composition of rehabilitation measures during restoration of the compromised lungs may become an effective strategy aimed at improving survival of patients after successful thromboendarterectomy from the pulmonary artery branches.

Reverse subclavian flap repair and maintenance of antegrade blood flow within the left subclavian artery in neonates with aortic coarctation and distal arch hypoplasia.

Surgical palliation for aortic coarctation with aortic arch hypoplasia in neonates and infants has been used in the clinic as the most beneficial treatment for this disorder. This technique allows the correction of aortic coarctation by the use of "extended" anastomosis without cardiopulmonary bypass, which expands the hypoplastic distal aortic arch via the use of a reverse subclavian flap repair. This technique maintains antegrade blood flow within the left subclavian artery.

[Treatment of a patient with a ruptured infectious aneurysm of the aortic arch].

Described in the article is a clinical case report concerning surgical treatment of a 65-year-old male patient presenting with a ruptured infectious aortic arch aneurysm. He was subjected to an operation consisting in prosthetic repair of the ascending portion of the aorta and aortic arch with a homograft under conditions of artificial circulation, deep hypothermia, and antegrade cerebral perfusion.

[Experience with intra-aortic balloon pumping preventively used in patients with a low left ventricular ejection fraction, operated on under extracorporeal circulation].

One hundred and fifty-six patients with coronary heart disease and a low (less than 30%) left ventricular ejection fraction (EF), operated on under extracorporeal circulation and preventive intra-aortic balloon pumping (IABP) were examined. The latter was found to promote the maintenance of stable hemodynamic parameters during and after surgery. Postoperative acute heart failure developed in 101 (64.7%) patients. Mortality was 9.6% (15 patients), in 9 cases death occurred after acute heart failure. There were no intra- and postoperative cases of lower extremity ischemia. Thus, preventive IABP is a safe and effective procedure in patients with low myocardial contractility (EF less than 30%), operated on under extracorporeal circulation.