[Modern trends in development of surgical and endovascular treatment of patients with arterial pathology]. / Sovremennye tendentsii razvitiia khirurgicheskogo i éndovaskuliarnogo lecheniia bol'nykh s arterial'noi patologiei.

The last decade has seen distinct dynamics of the worldwide growth of the number of endovascular interventions and a decrease in the number of 'open' surgical operations for pathology of the aorta and peripheral arteries. The world trends of treatment of patients presenting with pathology of the aorta and peripheral arteries are indicative of a steadily growing amount of operations, most of which are performed in an endovascular manner. In the Russian Federation, the past decade has also witnessed a noticeable jump of the amounts of endovascular interventions. Thus, the number of operations from 2008 to 2017 increased from 15 094 to 37 109 (2.5-fold). Nevertheless, in Russia there is a significant lag in both the total amount and the ratio of the performed surgical and endovascular operations in patients with pathology of the aorta and peripheral arteries. The article analyses the world and Russian trends in the development of surgical and endovascular treatment of patients with pathology of the aorta and peripheral arteries.

[Hybrid approach to treatment of a patient with a thoracoabdominal aortic aneurysm]. / Gibridnyi podkhod k lecheniiu patsienta s anevrizmoi torakoabdominal'nogo otdela aorty.

Described in the article is a clinical case report concerning staged management of a patient presenting with a thoracoabdominal aortic aneurysm. The first stage consisted in complete lower debranching with prosthetic repair of all visceral arteries and the right renal artery. The second stage was endovascular repair of the aortic aneurysm. The chosen approach made it possible to avoid clamping of the thoracic portion of the aorta, which favourably contributed to a decrease in the traumatic nature of the operative procedure, simultaneously preserving the radicality of treatment after the two-stage intervention.

[Stenting in obstructive pathology of pulmonary artery in patients with various forms of congenital heart failure].

A total of 124 stents were implanted to 91 patients with various forms of congenital heart failure for the resolution of obstruction of 111 segments in pulmonary arteries. All these patients were treated in A. N. Bakulev Research Centre of Cardiovascular Surgery in the period from 1994 to 2007. Analysis of observations in early and late postoperative periods indicates that the efficiency of stenting of obstructed pulmonary arteries was 96.4% and the restenosis rate in the follow-up period 3.9%. It is concluded that stenting of pulmonary arteries is an effective and safe method for the management of obstruction problems. In the majority of patients it allows to avoid surgical intervention on pulmonary arteries.

[Hybrid surgical palliation for hypoplastic left heart syndrome in newborn infants].

Hybrid surgery for the treatment of hypoplastic left heart syndrome was undertaken in 19 newborn infants from December 2007 to January 2009. An original method was used with the approach from posterolateral thoracotomy bypassing pulmonary arteries from the transverse pericardial sinus. The survival rate was 84%.

[Immediate and remote results of stenting of left coronary artery trunk in patients with ischemic heart disease].

The aim of this investigation was assessment of efficacy of stenting in patients with ischemic heart disease with lesions of left coronary artery (LCA) trunk. In the A.N. Bakulev Scientific Center of Cardiovascular Surgery between June 1997 and March 2005 stenting of LCA trunk was carried out in 50 patients (33 with stable effort angina and 17 with acute coronary syndrome). Immediate success rate was 100% in patients with stable angina. In a group of patients with acute coronary syndrome angiographic success rate was 100%. Total lethality in this group was (3 cases) 17.7%. In remote period (6 to 60 months) 33 of 39 patients were examined and recurrence of angina was noted in 7 of them (21.1%). Control angiography was carried out in 16 patients and restenosis of LCA was revealed in 18.75% of cases. The authors believe that stenting of LCA trunk is an effective and safe method of treatment of patients with stable angina and sufficiently safe method in patients with acute coronary syndrome. Roentgenoendovascular treatment may serve as an alternative to aortocoronary bypass surgery especially in isolated lesions of LCA trunk. Application of stents with drug coating allows to cardinally improve long term results of stenting.

[Acute coronary syndrome and cell technologies].

The authors researched into the possibility of autologous bone marrow stem cell (MSC) application in patients with acute myocardial infarction (AMI). 10 patients with AMI received cell therapy after giving an informed consent. ECG and EchoCG revealed myocardial infarction (MI) in the basin of the anterior interventricular branch (AIB) of the left coronary artery (LCA) in 4 patients, in the basin of the circumflex branch (CB) of the LCA--in 3 patients, and in the basin of the right coronary artery (RCA)--in 3 patients. Patients older than 70, patients with acute heart failure and those who developed AMI more than 48 hours ago, were excluded from the study. All the patients were male, aged 56.3 +/- 5.2 years, mean time from pain onset to the performance of myocardial revascularization was 11.4 +/- 7.2 hours. Marrow mononuclear fraction was introduced into the infarction-related artery on the 5th-7th day after primary angioplasty and stenting. Marrow sampling and cell material introduction did not cause any complications. All the patients were re-studied 1 month after the MSC transplantation. All the patients' condition improved; no complications or side effects of the interventions were observed. Left ventricle ejection fraction increased from 42.9% to 51.4%; the average number of asynergic segments was 5.3 +/- 0.7 before the intervention and decreased to 2.6 +/- 0.7 (p < 0.01) afterwards. Systolic velocity before the intervention was 2.5 cm/sec, and after the procedure it increased to 4.6 cm/sec in the segments submitted to isolated revascularization and to 6.1 cm/sec--in segments where the intervention was accompanied by the introduction of MSC (p < 0.01). Contrast EchoCG demonstrated an increase of myocardial perfusion in the area of cell therapy. The chief results of the study are as follows: 1) autologous MSC transplantation in patients with acute coronary syndrome is a safe and well-tolerated procedure; 2) myocardial revascularization in combination with MSC introduction in AMI area improves total and local contractile myocardial function and normalizes diastolic filling process in the LV; 3) cell therapy improves the myocardial perfusion.

[Short- and long-term effects of internal carotid arteries stenting in high-risk patients].

The efficacy of endovascular treatment of internal carotid arteries (ICA) stenosis (20 patients) has been compared to that of conventional carotid endarterectomy (25 control cases). ICA stenting was performed in case of stenosis, narrowing arteries to > or = 60% in "symptomatic" patients and to > or = 80% in "asymptomatic" ones. Angiographic indices revealed favorable outcome after stenting in 100%. Mean extent of residual stenosis was 8.3 +/- 0.8%. Significant complications (stroke/fatal outcome) after 22 procedures developed in 3 (13.6%) cases. Mortality was estimated as 4.5%. Taking stroke and fatal cases into account, the interventions were successful in 86.4% cases. The duration of follow-up study was from 1 to 48 months, with 1 case resulting in death and 2--in development of acute disturbance of cerebral blood circulation of contralateral ICA. Short- and long-term results of the intervention did not significantly differ between the study and control groups thus indicating ICA stenting as an alternative to carotid endarterectomy procedure.

[Characteristics of coronary artery lesions in patients with painless myocardial ischemia]. / Osobennosti porazheniia koronarnogo rusla u bol'nykh s bezbolevoi ishemiei miokarda.

AIM: To assess extent and localization of coronary artery lesions in patients with painless myocardial ischemia. MATERIAL AND METHODS: Tredmill stress-echocardiograghy, Holter ECG monitoring and coronary angiography were carried out in 59 male patients (age 30-72, mean 54.5 years) with either angina pectoris or painless ischemia. RESULTS: Among patients with painless ischemia 50% had 2-vessel disease, mostly with right coronary artery involvement (87.5%) and there was no case of left main stenosis. Patients with angina were characterized by significantly higher index of obstruction (p<0.005) and often had multivessel coronary artery disease (48.8%). CONCLUSION: Patients with effort angina compared with those with painless ischemia had more extensive and severe coronary artery involvement while the latter more often had right coronary artery stenoses.

[Dynamics of parameters of variability of processes of repolarization after transluminal balloon angioplasty in patients with ischemic heart disease]. / Dinamika pokazatelei variabel'nosti protsessov repoliarizatsii do i posle operatsii transliuminal'noi ballonnoi angioplastiki u bol'nykh ishemicheskoi bolezn'iu serdtsa.

AIM: To study dynamics of processes of repolarization after transluminal balloon angioplasty in patients with ischemic heart disease. MATERIAL AND METHODS: ECG, Holter ECG monitoring, analysis of parameters of variability of processes of repolarization, echocardiography and treadmill stress echocardiography were carried out in 28 ischemic heart disease patients aged 51.3+/-8.1 years prior to percutaneous coronary intervention, before discharge and in 4.1+/-2.1 months after procedure. Coronary angiography was repeated after intervention when restenosis was suspected because of positive stress echo. RESULTS: Number of vessels with significant stenoses was 1.8+/-0.1, number of implanted stents - 2.0+/-0.2. Analysis of parameters of variability of processes of repolarization at rest and after exercise revealed significant increases of maximal value of QT (MQT(c)) and of its dispersion (QT(cd)). In 3-5 days after procedure significant lowering of these parameters occurred. Development of restenosis during follow-up (in 6 patients, 21.4%) was associated with repeated increases of MQT(c) and QT(cd). CONCLUSION: MQT(c) and QT(cd) are sensitive to myocardial ischemia and can be used as supplementary markers of myocardial ischemia during exercise tests in patients with ischemic heart disease.

Results of hospital bypass angiography in patients with coronary artery disease undergoing arterial and vein myocardial revascularization.

This paper analyzes the results of 94 coronary artery bypass grafts accomplished at the Department of Surgical Treatment of Concomitant Lesions of Coronary and Peripheral Arteries, A.N. Bakulev SCCVS, RAMS, in patients with coronary artery disease (CAD) provided control hospital bypass angiography over the period 1998 to 2002. Control bypass angiography revealed thrombosis of 11.7% of vein and of 1.5% of arterial grafts. The main causes of vein graft thromboses were: bypass grafting of small coronary arteries, that of the coronary arteries with so-called 'immature' stenoses, and mediastinitis. The data presented herein evidence that hospital arterial bypass graft provides for a considerably higher percentage of competence versus vein bypass graft. Hospital bypass angiography is essentially safe while its findings allow to make a detailed analysis of complications whereby upgrading the efficacy of operations.

[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.

[Catheter therapy of congenital cardiovascular defects]. / Kateternaia terapiia vrozhdennykh porokov serdtsa i sosudov.

The authors analyze the experience gained in catheter operations performed at their Department over the recent 28 years. A total of 500 balloon (Rashkind) and 35 knife (Park) atrioseptostomies were performed in critical patients with different "blue" congenital diseases over this period. An immediate hemodynamic effect at the operation table was attained in 95% of patients. Transluminal balloon valvuloplasty (TLBVP) was performed in 372 patients with valvular stenosis of the pulmonary artery. The results of this operation depend on the patient's age, anatomy of the defect, and correct choice of the diameter of balloon catheter. This intervention is particularly effective in patients aged under 1. In patients with combined valvular and infundibular stenosis the results of TLBVP depend on the severity of stenosis and age of patient. An attempt at TLBVP of congenital aortal stenosis was undertaken in 67 patients. Valvuloplasty was carried out in 57 patients. The operation was effective in 13 (62%) out of 21 patients aged under 1. The mortality in this group was 5.5%. Balloon valvuloplasty of the pulmonary artery was carried out in 71 patients with cyanotic congenital heart diseases. The intervention helped eliminate the critical state, rise the systolic pressure in the pulmonary artery, improve blood saturation with oxygen, and evade the operation for creation of a systemic-pulmonary anastomosis. Isolated and postoperative stenoses of pulmonary arteries were removed in 65 patients. Six Johnson and Johnson stents were effectively implanted to 3 patients with rigid postoperative stenoses; in 32 patients transluminal balloon angioplasty (TLBAP) for coarctation and recoarctation of the aorta brought about a satisfactory immediate hemodynamic effect. TLBAP of Blalock-Taussig's stenosed anastomosis were performed in 60 patients with various cyanotic congenital heart diseases. Its results were good in 39 (65%) patients, satisfactory in 19 (31.7%), and unsatisfactory in only 2 (3%) cases. Of the novel endocardial interventions, dilatation of the conduit following Rastrelli's operation, creation of a defect of the atrial septum after Fontain's operation, and embolization of the coronary-cardiac fistulas and of patent ductus arteriosus were carried out. This review demonstrates wide use of endocardial surgery methods in the treatment of some congenital heart diseases; in many cases such treatment may be an alternative to surgical interventions.

[The percutaneous transluminal balloon valvuloplasty of valvular stenosis of the pulmonary artery in treating tetralogy of Fallot as an alternative to the surgery of applying a systemic-pulmonary anastomosis]. / Chreskozhnaia transliuminal'naia ballonnaia val'vuloplastika klapannogo stenoza legochnoi arterii pri lechenii tetrady Fallo kak al'ternativa operatsii nalozheniia sistemno-legochnogo anastomoza.

From January 1991 to May 1992 transluminal balloon valvuloplasty [correction of vulvoplasty] of severe valvular stenosis of the pulmonary artery was performed in 14 patients with Fallot's tetrad at the Institute of Cardiovascular Surgery named after A. N. Bakulev. Five of them had pulmonary artery hypoplasia, 2 had stenosis and hypofunction of the systemic-pulmonary anastomosis applied by the Blalock-Taussig, which made them perform balloon angioplasty of the narrowed distal portion of the anastomosis. The patients' age ranged from 11 months to 14 years (mean age 6.8 +/- 1.1 years). Arterial blood oxygen saturation varied from 51 to 72% (mean 69.2 +/- 2.4%). The diameter of a valvular ring was 8-13 mm. The diameter of a balloon catheter exceeded that of the valvular ring by 20-25%. After dilation, arterial blood oxygen saturation increased from 69.86 +/- 2.5 to 85.1 +/- 1.2%. The angiometry performed after pulmonary artery valvuloplasty in patients with pulmonary hypoplasia showed an increase in sizes of all pulmonary arterial segments on an average by 22.5 +/- 4.1%. Later on 5 patients were radically operated on. Thus, with the ultimate goal of preparation of patients with severe Fallot's tetrad for radical surgery, transluminal balloon valvuloplasty in some patients with severe valvular stenosis of the pulmonary artery may be alternative to a systemic-pulmonary anastomosing operation.

[The treatment of critical valvular stenosis of the pulmonary artery by the balloon valvuloplasty method in patients in the first 3 years of life]. / Lechenie kriticheskogo klapannogo stenoza legochnoi arterii metodom ballonnoi val'vuloplastiki u bol'nykh pervykh 3 let zhizni.

The work generalizes the experience of the Bakulev Institute of Cardiovascular Surgery in balloon valvuloplasty of valvular pulmonary stenosis in 58 children of the first 3 years of life: 8 were 1 to 6 months of age, 10 were 7 to 12 months of age, 18 were 13 to 24 months old, and 22 were 25 to 36 months old. Cyanosis was found in 27 of them. As the result of balloon valvuloplasty, the systolic pressure gradient between the right ventricle and the pulmonary artery reduced from 114.7 +/- 12.6 to 31.4 +/- 7.2 mm Hg in children under 1 year of age, from 143 +/- 12.6 to 40.1 +/- 8.3 mm Hg in children aged from 1 to 3 years. In patients with cyanosis, saturation of arterial blood with oxygen increased to 92%. The late-term results were studied in follow-up periods of 6 to 36 months in 35 patients, by means of catheterization and angiocardiography in 15 of them. Analysis showed balloon valvuloplasty to be effective. Balloon valvuloplasty was repeated in 5 patients with critical stenosis because a hemodynamic effect was not achieved by the first dilatation.

[Transluminal balloon valvuloplasty in the treatment of congenital critical aortic valve stenosis in infants in the 1st year of life]. / Transliuminal'naia ballonnaia val'vuloplastika v lechenii vrozhdennogo kriticheskogo klapannogo stenoza aorty u detei 1-go goda zhizni.

Balloon valvuloplasty was performed in 14 patients with congenital valvular aortic stenosis. Their age was 28 days to 12 months. All the patients had severe heart failure. Balloon valvuloplasty was successfully conducted in 8 patients. The systolic pressure gradient between the aorta and the left ventricle decreased, on the average, from 81.2 +/- 21.4 to 31.3 +/- 8.2 mm Hg, i.e. by 61.5%. Only 2 patients developed moderate aortic insufficiency after balloon valvuloplasty. The left ventricle could not be catheterised in 6 infants: in 4 patients due to critical valvular stenosis, in 2 due to a. lusoria. One of them died when the guide was attempted to be introduced through the narrowed aortic valve, which resulted in aortic sinus perforation. Long-term results were studied in 4 patients 3 to 24 months after surgery. Their clinical condition improved. The systolic pressure gradient between the left ventricle and the aorta was in agreement with the values obtained just after transluminal balloon valvuloplasty. Transluminal balloon valvuloplasty can be successfully performed in 1-year-old infants with congenital critical aortic valvular stenosis and yields good immediate results. A further accumulation of clinical findings, development of procedures for transluminal balloon valvuloplasty and study of long-term results will allow indications for this tool to be worked out in this group of patients.

[Complications of catheter-balloon valvuloplasty (analysis of their causes and the methods of prevention and treatment]. / Oslozhneniia kateternoi ballonnoi val'vuloplastiki (analiz prichin, sposoby profilaktiki i lecheniia).

The authors analyse the results of 1,404 operations of catheter-balloon valvuloplasty in stenoses of the pulmonary, aortic, and mitral valves. The experience was accumulated by the leading heart surgeons of the country from 1984 to 1990. The total number of complications was 77 (5.4%), 23 (1.6%) of them were fetal. The least number of complications (1.88%) occurred in catheter-balloon valvuloplasty in pulmonary stenosis, 1% were fetal. Complications in aortic stenosis were encountered in 11.3% of cases, 4.8% were fatal. The greatest number of complications (44) were recorded in mitral stenosis with a relatively low mortality (2.7%). The authors distinguish unspecific complications connected with the use of standard diagnostic catheters and instruments, and specific complications linked with the use of balloon catheters or caused by the course of the disease, and the character of the valve affection. As the result of analysis of the causes of complications, the authors suggest a system for preparation of patients for operation and the principles of its safe accomplishment and describe the order of the acts undertaken by the surgeon for the management of complications. Analysis of complications of catheter-balloon valvuloplasty demonstrates the efficacy and mild injurious character of this method, which makes it possible to rank it among the generally accepted cardiosurgical methods for the correction of heart valvular stenoses.

[The transluminal balloon angioplasty of a stenosed Blalock-Taussig systemic-pulmonary anastomosis in congenital heart defects of the blue type]. / Transliuminal'naia ballonnaia angioplastika stenozirovannogo sistemno-legochnogo anastomoza po Bleloku--Taussig pri vrozhdennykh porokakh serdtsa sinego tipa.

Dilatation of a stenosed Blalock-Taussig anastomosis was performed in 15 patients with blue-type congenital heart diseases at the Bakulev Institute of Cardiovascular Surgery, AMS USSR, from March, 1989 to May, 1991. Seven of these patients had a severe form of Fallot's tetralogy, 4--double origin of the great vessels from the right ventricle with stenosis of the pulmonary artery, 2--atresia of the right atrioventricular orifice with stenosis of the pulmonary artery, 1--atresia of the right atrioventricular orifice with atresia of the pulmonary artery, and 1 patient had corrected transposition of the great vessels with stenosis of the pulmonary artery. The patients' ages ranged from 4 to 13 years (9.45 +/- 8.1 years on the average). Saturation of arterial blood with oxygen varied from 38 to 77% (64.2 +/- 2.9% on the average). A low-amplitude to-and-fro sound of the anastomosis was either recorded or absent on the phonocardiogram. The diameter of the balloons used ranged from 4 to 13 mm. Inflation of the balloon lasted from 5 to 60 sec. Dilatation was conducted 3 to 9 times. After dilatation saturation of arterial blood with oxygen increased to 81 +/- 2.7% on the average. A clearly defined to-and-fro murmur of the anastomosis was recorded on the phonocardiogram. Angiometry of the anastomosis performed before and after dilatation showed it to be widened considerably from 3.5 +/- 0.2 mm to 5.7 +/- 0.4 mm on the average. One patient underwent a radical operation 8 months after balloon dilatation.

[Angiocardiographic diagnosis of atresia of the right atrioventricular orifice and associated congenital heart defects]. / Angiokardiograficheskaia diagnostika atrezii pravogo atrioventrikuliarnogo otverstiia i soputstvuiushchikh vrozhdennykh porokov serdtsa.

Ninety patients with atresia of the right atrioventricular orifice were examined. Their ages ranged from 3.5 to 24 years (9.9 +/- 0.5 years on the average). Stenosis of the pulmonary artery was found in 86 patients and was absent in 4 patients. Various intraarterial anastomoses had been established previously in 46 patients with stenosis of the pulmonary artery. All the patients were subjected to angiocardiographic examination including angiocardiography from the right and left parts of the heart and from the great vessels. Several anatomical variants of atresia of the right atrioventricular orifice and concomitant anomalies were studied. The following program of roentgeno-surgical examination in this complex congenital heart disease was elaborated. 1. Catheterization of the right and left parts of the heart and the great vessels. 2. Angiocardiography: right atriography; left ventriculography in anteroposterior, lateral, and, if indicated, axial views; aortography; pulmonary arteriography and, when indicated, right ventriculography.