[Left ventricular ruptures after the mitral valve replacement].

7 cases of left ventricular rupture after the mitral valve replacement, which occurred per 900 operations performed in our clinic, were analyzed. A successful closure of the defect has been managed in 2 cases. In all cases the external closure with liners and patch plasty was used. In two cases the autopsy revealed a transmural myocardial infarction, underdiagnosed preoperatively, which had caused a rupture.

[The diagnosis of coronary failure in patients with aortic and mitral valve defects]. / Diagnostika koronarnoi nedostatochnosti u bol'nykh s aortal'nym i mitral'nym porokami serdtsa.

The incidence of angina pectoris was investigated and the treadmill test was carried out to assess the presence of myocardial ischemia and heart pump function in 238 patients suffering from mitral and aortal heart disease. Comparison with the coronarography readings has demonstrated that the diagnostic value of the painful syndrome in the health status and anamnesis does not exceed 24%. The appearance of an angina pectoris attack in combination with ischemic alterations on the ECG raised the diagnostic value up to 50%. The authors have distinguished a symptom-complex including the development of angina pectoris, appearance of the ischemic signs on the ECG with the integrity of heart pump function, increasing the diagnostic value of the test up to 83-100%. The integrity or insufficiency of heart pump function were shown to allow differentiation between atherosclerotic and relative coronary insufficiency. The conclusion is drawn about the necessity of carrying out the treadmill test according to the program in patients suffering from heart disease with suspected coronary insufficiency.

[Rupture of the posterior wall of the left ventricle after mitral valve prosthesis]. / Razryvy zadnei stenki levogo zheludochka posle protezirovaniia mitral'nogo klapana.

Rupture of the posterior wall of the left ventricle after mitral valve prosthetics is a rare (0.6%) but a dangerous and death-threatening complication. Injury to the fibrous ring in the anatomically hazardous zone (at 4-5 o'clock of an imaginary clock-face) is the most frequent cause of the ruptures. Surgical correction of this complication will be successful only with the use of extracorporeal circulation and repeated cardioplegia. Preservation of the posterior cusp and subvalvular apparatus is a reliable measure preventing rupture of the posterior wall of the left ventricle.

[Causes of mitral valve re-stenosis and the ways of its prevention]. / Prichiny vozniknoveniia restenozov mitral'nogo otverstiia i puti ikh preduprezhdeniia.

The authors evaluated comparatively the results of surgical treatment of mitral stenosis in 203 patients after open mitral commissurotomy (OMC) (their personal experience) and the literature data concerning 168 patients who underwent closed mitral commissurotomy (CMC). The frequency of mitral stenosis recurrences with the use of both methods was determined. OMC was on a par with CMC in safety and exceeded it in efficacy. The frequency of mitral restenosis was considerably lower after OMC than after CMC (p less than 0.05). The authors claim that the main cause of mitral stenosis recurrences is residual stenosis developing in inadequate correction of the anomaly, while the principal preventive measure is OMC which makes it possible to separate the fused commissures completely, remove the subvalvar adhesions, and restore the mobility of the cusps.

[Reoperations of the mitral valve after closed commissurotomy]. / Povtornye operatsii na mitral'nom klapane posle "zakrytoi" komissurotomii.

The authors report on 275 operations performed for the second time after closed commissurotomy. The intervention was undertaken for restenosis of the left venous ostium in 255 and iatrogenic mitral insufficiency in 20 patients. The peculiar features of the clinical picture and diagnosis of these two conditions are discussed in detail. The authors substantiate the indications for closed recommissurotomy and open interventions under conditions of extracorporeal circulation with the performance of plastic valve-preserving operations and replacement of the valve by a prosthesis. From study of the immediate results of reoperations after closed commissurotomy the authors conclude that the method of choice in repeated operations in this pathological condition should be an operation under conditions of extracorporeal circulation which provides the possibility for adequate and radical correction of the anomaly.

[The surgical procedural problems in treating mitral restenosis]. / Problemy khirurgicheskoi taktiki pri lechenii mitral'nogo restenoza.

The paper summaries the experience with 244 operations for mitral restenosis. The methods for surgical treatment of mitral restenosis: closed mitral recommissurotomy, valvuloplasty, and mitral valve prosthesis are comparatively analyzed. Indications and contraindications are defined for relapse. Advantages of reconstructive valve-sparing operations and the necessity of their wide introduction into clinical practice are shown. The paper also gives recommendations how to choose the optimal policy of surgical treatment of mitral restenosis.

[Current approach to the surgical treatment of recurrent mitral valve stenosis]. / Sovremennyi podkhod k khirurgii restenoza mitral'nogo otverstiia.

In the period of 1971-1989, 266 patients with mitral restenosis were operated on: 82 closed mitral recomissurotomies and 184 operations under artificial circulation were performed. Complicated mitral diseases were found in 94% of the patients operated on. The causes of the mitral restenosis are analysed, and the features of its surgical correction together with the short- and long-term results are discussed. Comparison of the closed and open methods of the therapy for mitral stenosis showed that open-heart interventions under artificial circulation are most effective, prevent recurrences, and thus may be considered the operation of choice due to significantly lower hospital mortality rates in the recent five years.