[Anatomic orthotopic heart transplantation: the surgical characteristics and the advantages of the method]. / Anatomicheskaia ortotopicheskaia transplantatsiia serdtsa: khirurgicheskie osobennosti i dostoinstva metodiki.

Standard technique of establishment of interatrial anastomoses allows to carry out orthotopic transplantation of the heart quickly and reliably. However the accumulation of collective experience evidences about a number of unavoidable shortcomings of such operation: rhythm disturbances, worsening of hemodynamics in discordant atrial contractions of recipient and donor, atrio-ventricular valve insufficiency, thromboembolism, coronary fistulas. Since 1990 in RRCS 25 operations were carried out with the use of standard technique and we also met with the risk of developing the above complications. In experiment on 30 mongrel dogs the technique of anatomical, truly orthotopic transplantation of the heart with six anastomoses was developed: left pulmonary veins with a common cuff, separate anastomoses of the superior and inferior caval veins, anastomoses of aorta and pulmonary artery. Particular attention was paid to developing of original surgical modes for prophylaxis of stenoses in the area of anastomoses of pulmonary and caval veins. In 1997 the anatomical technique of heart transplantation was successfully introduced by us into clinical practice. Clinical electrophysiological, echocardiographic and functional examinations have confirmed the results of the experiments and have evidenced for substantial advantages of the anatomical technique of orthotopic transplantation of the heart. By reliability the new operation is not inferior to standard method of N. Shumway.

[Comparison of transesophageal and transthoracic echocardiography in cardiac surgical care]. / Sravnitel'naia kharakteristika transtorakal'noi i transézofageal'noiékhokardiografii v kardiokhirurgicheskoi praktike.

This paper analyzes the results of 1093 transesophageal (TEE) and transthoracic echocardiographic (TTE) studies made in patients with various cardiovascular diseases in December 1989 to November 1996. The investigation was undertaken to define indications for TEE. Undoubtedly, TEE has some advantages over TTE in diagnosing abnormalities of the descending aorta, thromboses of the left atrium, small vegetations of cardiac valves, insignificant atrial septal defects and in evaluating excursions and systolic thickening of middle and basal segments of the left ventricular anterior wall. However, detection of thrombosis of the left ventricular apex remains to be priority in TTE. TEE was found to supplement TTE and considerably improves the diagnostic quality in cardiovascular diseases.

"Temporary prosthesis" of the fibrotic ring for relative insufficiency of the tricuspid valve.

BACKGROUND: De Vega type suturing dosage plasty is the intervention most widely used for relative insufficiency of the tricuspid valve (TV). In fact, this operation may be considered as an equivalent of prosthetic reconstruction of the fibrotic ring, shaping a fixed orifice for passage. Intrapulmonary pressure normalized as early as during the first months after surgery in patients with the mitral-tricuspid cardiac valvular disease. Under such conditions a rigid suture (prosthesis of the anulus) at the interface of the right atrium and ventricle is not physiological. METHODS: We used Maxon CV 2-0 (D+G) suture absorbable for 6 months. Xenopericardial pads were fixed at the edge of the suture. The pads were prepared by enzymatic and chemical processing. RESULTS: Operations were performed in 7 patients, the results were followed for up to 28 months. The size of the TV fibrotic ring was measured by transesophageal ultrasonography (Hewlett-Packard SONOS 1500; OMNIPLANE) on the operating table and for 2 years postoperation. No signs af tricuspid insufficiency were detected.

[Intraoperative transesophageal echocardiography in diagnosing left atrial thrombosis in patients with mitral valve disease]. / Intraoperatsionnaia chrespishchevodnaia ékhokardiografiia v diagnostike tromboza levogo predserdiia u bol'nykh mitral'nymi porokami serdtsa.

Intraoperative transesophageal echocardiography was conducted in 63 patients with various cardiosurgical pathology (mitral stenosis--43, combined mitral valvular disease--3, mitral incompetence--10, combined mitral-aortal valvular disease--8). Thrombosis of the left atrium was diagnosed in 13 patients. Transesophageal echocardiography in 38 patients revealed spontaneous echo-contrasting of blood currents in the cavity of the left atrium. Statistical analysis showed this sign to be characteristic of mitral stenosis complicated by thrombosis of the left atrium (p < 0.001). Transesophageal echocardiography allows visualization of thrombi of small diameter (1.0-1.5 cm). Specificity of the method is 100%, sensitivity 87%.