[The Case of Successful Surgical Treatment of a Patient With Thoracic Endograft Infection in 5 Years After Thoracic Endovascular Aortic Repair].

We present here a case of successful staged treatment of a patient with para-aortic abscess that arose 5 years after thoracic endovascular aortic repair because of thoracic aortic aneurysm. After stabilization of the patient's condition by intensive antibiotic therapy we performed left-subclavian extra-thoracic debranching as the first stage of the surgical treatment. In 2 weeks via median sternotomy and on-pump we removed the infected endograft and performed extraanatomical ascending-to-descending aortic bypass with good postoperative result.

[Infectious complications after endoprosthetic repair of the thoracic aorta]. / Infektsionnye oslozhnenii pri éndoprotezirovanii grudnoi aorty.

Presented herein is a review of publications of foreign authors on the problem of infectious complications after endoprosthetic repair of the thoracic aorta. The problem discussed is of current importance, however in the Russian literature it is covered insufficiently. The article contains the data on frequency, terms and possible causes of the development of complications, also discussing the problems of diagnosis. The authors demonstrate extreme danger of infection of an aortic stent graft, difficulty of early diagnosis and mostly unsatisfactory therapeutic outcomes. Also noted are possible ways of prevention of complications and aimed at improving the results of this extremely severe patient cohort.

The Case of Successful Surgical Treatment of a Patient With Thoracic Endograft Infection in 5 Years After Thoracic Endovascular Aortic Repair.

We present here a case of successful staged treatment of a patient with para-aortic abscess that arose 5 years after thoracic endovascular aortic repair because of thoracic aortic aneurysm. After stabilization of the patient's condition by intensive antibiotic therapy we performed left-subclavian extra-thoracic debranching as the first stage of the surgical treatment. In 2 weeks via median sternotomy and on-pump we removed the infected endograft and performed extraanatomical ascending-to-descending aortic bypass with good postoperative result.

[Haemangioma of the left atrium]. / Gemangioma levogo predserdiia.

Presented herein is a clinical case report concerning successful surgical management of a rare variety of a primary tumour of the heart, i. e., a capillary haemangioma of the left atrium, simulating by the contours and localization a myxoma. The final diagnosis was verified only by histological examination. The authors describe difficulties of diagnosis of the disease involved, underlying the necessity of plastic correction for restoration of the normal anatomical configuration of the heart. This is followed by a review of the literature, reflecting a possible course of the disease, problems of diagnosis, and therapeutic policy.

[Caecal volvulus after heart surgery with artificial circulation].

Presented herein is a description of a rare complication, i.e. caecal volvulus, after heart surgery. This case report illustrates difficulty of diagnosis of abdominal organs complications after artificial circulation and necessity of active surgical policy.

[Liver resection in patient with hcc and right atrium thrombosis].

Presented herein is a case report concerning tumorous thrombosis of the inferior vena cava and right atrium, which is rather an uncommon but severe complication of primary hepatic cancer. The purpose of the article is to demonstrate successful surgical management of locally disseminated hepatic carcinoma complicated by tumorous thrombosis of the inferior vena cava and portal vein, as well as thrombosis of the right atrium. The patient was subjected to dextral hemihepatectomy with thrombectomy from the right portal vein, resection of the right cupola of the diaphragm, marginal resection of the lower lobe of the right lung, thrombectomy from the inferior vena cava and right atrium. The outcome of our case report, as well as literature data suggest that in case of resectability of hepatic tumour complicated by thrombosis of major vessels and even the heart, surgical intervention is justified if there is a possibility to completely remove thrombotic masses along with the primary tumour.

[Experience with osteosynthesis of the sternum after heart surgery in patients with limited physical abilities].

At the Department of Heart Surgery of the A. V. Vishnevsky Institute of Surgery in seven patients with limited physical abilities and having to ambulate on crutches for osteosynthesis of the sternum after cardiosurgical interventions we used Ti-Ni fixating cramps with self-regulating compression. This technique provided reliable fixation of the sternum even in the early postoperative period in patients with elevated loading on the shoulder gridle. On day 2-3 after the surgical intervention all patients began to observe the standard motor regimen, i.e., ambulation on crutches. The possibility of early activation in the initially severe cohort of patients with multifocal atherosclerosis and accompanying diseases was one of the factors of an uneventful course of the postoperative period and rapid rehabilitation. Neither sternal instability nor infectious complications during the in-hospital period were observed.

[Sternal osteosynthesis after cardiac surgery].

Sternal fixation with nickelide titanium staples with shape memory effect is considered to be a novel method of wound closure after cardiac operations. The study includes data of 140 patients and is devoted to the preliminary assessment of the use of the mentioned fixators with self-regulating compression. Osteosynthesis proved to be completely effective in 136 (97,1%) patients. The use of nitinol staples allows not only a secure sternal fixation with minimal risk of underlying structures' trauma, but decreases time of postoperative patients' rehabilitation after the major cardiac surgery.

[The role of multispiral computed tomographic coronarography].

The aim of the study was to assess the use of multispiral computed tomographic coronarography (MSCT-CG) in comparison with conventional coronary angiography. Overall 62 patients aged 45-72 years were examined, the MSCT-CG was conducted in 38 patients. The sensitivity of MSCT-CG was 92%, the specificity - 91,2%, in comparison with the CAG. The prognostic value of negative test was 95,7%, the prognostic value of positive test was 84%, overall accuracy was counted up to 91,5%. Though, the MSCT-CG showed certain overestimation in calculating the stenosis degree and, thus, false positive results, in cases with calcined atherosclerotic plaques. Main advantages of MSCT-CG were: non-invasiveness, possibility of vessel lumen, arterial wall and structure of the plaque assessment.

[Metabolic effects of mexidole during cardiosurgical operations using extracorporeal circulation].

The effect of mexidole on the levels of glutathione, the activity of its metabolic enzymes, glutathione reductase (GR) and glutathione peroxidase (GP), and antioxidative enzymes, superoxide dismutase (SOD) and catalase (CAT) in the red blood cells under hypothermic perfusion was studied. A total of 96 patients were examined. The study was performed before perfusion, at the cooling and warming stages, an hour after perfusion, and in the morning of a following day. Mexidole was administered to 26 patients in the evening, before surgery, and at the cooling and warming stages (Group 1). The agent was not given to 70 patients (Group 2). In Group 2, there was an association of the level of glutathione and the activity of the enzymes under study with temperature. There were the least changes observed at 30-34 and 26-29 degrees C and a substantial decrease (by more than 30%) at the cooling stage as compared with pre-perfusion values. In the mexidole group, the content of glutathione increased under all temperature conditions at the study stages (by 30 to 58%) and the activity of all the test enzymes: GR and GP up to 33%, SOD up to 20-60%, CAT by 20-30%. The elevated level of all the parameters was also preserved on the following postoperative day. It may be suggested that mexidole activates the biosynthesis of glutathione and antioxidative enzymes, thus enhancing the antioxidative defense of cell membranes.

Endovascular grafting of thoracic aortic pseudoaneurysm after operation for coarctation.

Presented herein is a case of successful repair of thoracic aortic aneurysm by endograft in a female patient 21 years after replacement of the descending aorta for coarctation. During scheduled examination the patient was found to have aneurysm of proximal anastomosis. Additional examination was followed by the stenting of the thoracic aorta using endograft manufactured by the "GORE" Company (USA). The immediate results were classified as good: aneurysm was not opacified, the patency of the vessels of the aortic arch was well preserved. According to the data of check examination carried out 5 months after operation, no graft dislocation was marked, aneurysm was not detectable. The given case demonstrates low-invasive endovascular intervention permitting the avoidance of complicated and traumatic open regrafting of the aorta and attainment of beneficial short- and long-term treatment results.

[Long-term outcomes of balloon angioplasty for aortic coarctation]. / Otdalennye rezul'taty ballonnoi angioplastiki koarktatsii aorty.

From 1994 to 2001 balloon angioplasty was fulfilled for 19 patients aged from 4 to 28 (mean 11.0+/-7.0) with discrete type aortic coarctation. Early outcomes were satisfactory in all cases. Catheterization showed 10 mm Hg decrease in systolic pressure gradient (SPG). Long-term results (from 6 months to 8 years, mean 3.0+/-2.5) were evaluated with transthoracic EchoCG, Doppler ultrasound, duplex scanning of iliofemoral segment and CT-angiography with 3D reconstruction. Surgical outcomes were considered good when SPG did not exceed 20 mm Hg for Doppler ultrasound and 25 mm Hg for Doppler EchoCG. In the study group there was statistically significant decrease in arterial pressure in right upper limb and SPG (measured with both Doppler EchoCG and Doppler ultrasonography) and rise of ankle-brachial index. Beneficial hemodynamic effect was detected in 15 from 19 patients (79%). Recoarctation has developed in 4 (21%) patients, in 1 (5.3%) case it was combined with true posttraumatic aortic aneurysm. Three patients underwent open surgical intervention with uneventful postoperative period. Aneurysmal dilatation of thoracic aorta has developed in 1 patient (5.3%), non-progressive intimal dissection - in another one (5.3%), 2 patients (10.5%) experienced ipsilateral 40-60% stenosis of right external iliac and femoral arteries. Thus good long-term outcomes of balloon angioplasty in patients with discrete type aortic coarctation were achieved in 79% cases. Patients after balloon angioplasty must be assessed regularly with non-invasive diagnostic methods such as Doppler ultrasonography, Doppler EchoCG, CT-angiography.

[Dislocation of the closing element of the disk mechanical graft at aortic valve replacement]. / Dislokatsiia zapiratel'nogo élementa diskovogo mekhanicheskogo proteza vo vremia protezirovaniia aortal'nogo klapana.

Presented herein is the first case of dislocation of the closing element of the artificial low-profile aortic valve to the abdominal aorta, which happened during replacement. Toward completion of extracorporeal circulation a 37-year-old man showed the signs of aortic insufficiency because of dislocation of the closing element. After resumption of extracorporeal circulation repeated replacement was accomplished. To detect the site of graft cusp embolism, transesophageal echocardiography and duplex scanning of the abdominal aorta were employed. On the 18th day following the first intervention the patient developed thromboembolism to the distal arterial bed. Emergency thrombectomy from the arteries of the right lower extremity was performed and a foreign body was removed from the abdominal aorta, using left-sided thoracophrenolumbotomy. The patient was discharged from the clinic in a satisfactory condition.

[Roentgeno-endovascular occlusion and surgical correction of patent ductus arteriosus]. / Rengenoéndovaskuliarnaia okkliuziia i khirurgichskoe lechenie otkrytogo arterial'nogo protoka (sravnitel'nye aspekty).

To establish the indications to classical surgical correction and roentgenoendovascular occlusion (REO) of patent ductus arteriosus (PDA) results of treatment of patients with PDA were compared. Immediate results of treatment of 209 patients with PDA were analyzed. 110 patients underwent classical surgical operations which were performed successfully in 109 (99%) patients. Complications in early postoperative period were the following: incomplete expanding of the left lung in 1 (0.9%) patient, reactive exudation into left pleural cavity--in 1 (0.9%), and chylothorax--in 1 (0.9%). REO of PDA was performed in 99 patients. Gianturco coils (COOK, Denmark) and Saveliev--Prokubovsky occluders were used. REO was successful in 93 (93.9%) patients. It failed in 6 (6%) cases including 3 cases with coils and 3--with Saveliev--Prokubovsky occluders. According to the results, PDA with diameter less than 4 mm in the narrowest part can be closed by REO with Gianturco coils. In PDA with diameter 4-10 mm Saveliev--Prokubovsky occluders are recommended. In case of PDA with diameter more than 10 mm, aortopulmonary defect or septic botallitis it is necessary to perform thoracotomy and surgical correction.

Recanalization and thrombectomy of internal anastomosis in a patient with tetralogy of Fallot using the AngioJet rheolytic catheter.

The modified Blalock-Taussig shunt is the palliative treatment of choice for tetralogy of Fallot. Shunt thrombosis is a potential complication, requiring high-risk reoperation. The use of percutaneous rheolytic devices for thrombus removal in such occluded shunts has not been previously reported. We describe a case in which use of a rheolytic catheter resulted in significant thrombus removal and rapid reversal of cyanosis and dyspnea in a 5-year-old patient. The patient remains free of symptoms at 30-day follow-up.

[Opportunity of operative traumatism decrease in patients with complicated tricuspid valve defect]. / Vozmozhnosti snizheniia travmatichnosti operatsii u bol'nykh s oslozhnennymi trekhklapannymi porokami serdtsa.

This study examined the results of surgical trivalve of 44 patients with trivalve heart defect. In all the patients the heart defect was combined with two and more complicating factors: advanced III-degree calcinosis of the valves, cardiomegaly, cardiac fibrillation, left atrium thrombosis, high pulmonary hypertension. In 20 patients the operative intervention on the heart was repeated. The analysis of the results allowed to recommend some surgical techniques which allowed to decrease surgical traumatism in patients with complicated trivalve heart defect. Low traumatism was possible because of incomplete removal of the calcium masses extending on the fibrotic ring and outside, use of two-row counter U-suture on linings for the prosthesis fixing, transdoubleatrial approach without isolation of the heart from the adhesions in dense pericardial obliteration, correction even insignificant trivalve heart defect or relative valve incompetence.