[Geometric and morphological features of the aortic root in norm and aortic regurgitation]. / Geometricheskie i morfologicheskie kharakteristiki kornia aorty v norme i pri nedostatochnosti aortal'nogo klapana.

AIM: To assess linear and geometric parameters of the aortic valve and to determine the changes which are associated with impaired leaflets coaptation and aortic root enlargement. MATERIAL AND METHODS: Surgical anatomy of the aortic root and its spatial relationships with surrounding heart structures were studied with plastination by using of combined silicon technologies. 123 specimens of the aortic root with preserved original geometry were created with silicone plastination technique and perfusion embalming. Analysis included 15 heart specimens with the signs of aortic root dilatation and 108 specimens without evidence of dilatation. Multiple logistic regression was used for statistical analysis. RESULTS: Anatomical and clinical analysis showed that deviation angle of the intercusp triangle is the factor contributing impaired aortic root geometry and aortic regurgitation (OR 1.3, 95% CI 1.114-1.350, p<0.0001). CONCLUSION: 1) Increased deviation angle of intercusp triangles is associated with impaired coaptation of aortic valve leaflets. 2) Restoration of intercusp triangle deviation angle within 1.7±1.2° degrees is geometrically necessary to achieve normal function of the aortic valve.

[Aortic stenosis of alkaptonuric genesis].

Main approaches to intravital diagnosis of alcaptonuria are described. Attention is focused on damages determining invalidisation of patients. A clinical case is presented which demonstrates success of surgical treatment of aortic stenosis of alkaptonuric genesis.

[The first experience with using xenografts in treatment of aortic valve disease].

A comparative analysis of biomechanics of implanted xenografts has shown that the functioning of the newly formed aorta root might be dependent on constructive features of the bioprosthesis, choice of the optimal type size and on the implantation technique. The best hemodynamic and biomechanical characteristics were obtained when using the technique of a complete prosthesis of the aorta root with the Medtronic Freestyle xenograft and subcoronary implantation of bioprosthesis AB-Mono- and AB-Composit-Kemerovo.

[Infectious endocarditis as a surgical problem in Russia]. / Infektsionnyi éndokardit kak khirurgicheskaia problema v Rossii.

Infectious endocarditis (IE) is mainly a surgical problem and requires an integration of efforts of specialists of different fields for its treatment. Successful treatment of this severe disease is to be based on the early diagnosis and early operation. So IE should be estimated as a surgical pathology and this nosological form must be included in all manuals on general surgery and studying infectious endocarditis must be included in the programs of training doctors at surgical series of lectures. Such interpretation of this question will change doctors' mentality and will lead to the earliest admission of the patient with this pathology to specialized cardiosurgical hospital and will allow to avoid severe disabling complications of IE, to increase the number of valve-saving operations and to improve prognosis in the treatment of this disease.

[Non-standard situations in surgical treatment of infectious endocarditis]. / Nestandartnye situatsii v khirurgicheskom lechenii infektsionnogo éndokardita.

The authors have analyzed 139 patients with specific features of the clinical course of infectious pathology, massive and unusual destruction of the intracardiac structures, non-standard kinds of valvuloplasty. They required individualized strategy of diagnosing and operative treatment.

[Use of neural networks for prognosis of outcomes of operations for ischemic heart disease]. / Ispol'zovanie neironnykh setei dlia prognozirovaniia iskhodov operativnykh vmeshatel'stv po povodu ishemicheskoi bolezni serdtsa.

Using a mathematical model of artificial neuronal network the authors have determined the main significant factors for prognosis of the development of acute myocardial insufficiency during aorto-coronary shunting.

[Ganglion block in cardiopulmonary bypass surgery]. / Ganglionarnaia blokada pri operatsiiakh na serdtse s iskusstvennym krovoobrashcheniem.

Ganglion blockers increase the antinociceptive defense in anesthesiological support of cardiopulmonary bypass operations for mitral and aortic valve failure. Benzohexonium decreased total peripheral vascular resistance, increased cardiac and stroke indexes, and increased systolic potency of the heart. Ganglionar blocking was associated with an increase of systemic oxygen transport, arrhythmias developed rarely, blood concentrations of epinephrine, norepinephrine, ACTH, vasopressin, and leukinferon were lower.

[Brain protection in open heart surgery in patients with infective endocarditis]. / Zashchita golovnogo mozga pri operatsiiakh na otkrytom serdtse u bol'nykh infektsionnym éndokarditom.

Effect of nimotope on cerebral metabolism and incidence of mental disorders in patients operated on under forced ventilation of the lungs (FVL) was studied in 32 patients subjected to replacement of mitral and aortic valves for infective endocarditis. Nimotope was used for preventing hypoxic disorders of the CNS. The drug was injected starting from the stage of operation before FVL. Cerebral hypoxia was diagnosed using lactate-oxygen index (LOI) and other cerebral metabolic coefficients. LOI increased in all patients immediately after FVL, being much higher in the patients without cerebral protection. Moreover, numerous neurotic and mental disorders were observed in this group of patients during the early postoperative period. By contrast, no mental disorders, disorders of memory or attention were detected in the patients treated with nimotope. These data indicate that nimotope decreases the unfavorable effect of FVL on the CNS function in patients with infective endocarditis. The difference of lactate content in arterial blood and in the internal jugular vein bulb and LOI can be used for the diagnosis of brain ischemia in heart surgery with FVL.

[The Epstein-Barr virus in patients with infectious endocarditis]. / Virus Epshteina--Barr u bol'nykh infektsionnym éndokarditom.

Serological markers of Epstein-Barr virus (EBV) infection has been investigated in 28 patients with infectious endocarditis. In 75% of patients IgM antibodies to "early" antigen of the virus which are the marker of active viral infection occurred vs 6.2% among healthy blood donors. Specific for infectious endocarditis reaction profile (anti-EBV combination in one person) indicates reactivation of latent viral infection. The conclusion is made on the necessity of further investigation of both the role of EBV in pathogenesis of pyoseptic diseases and immunologic mechanisms for reactivation of latent viral infections.

[The activation mechanisms in cytomegalovirus infection]. / O mekhanizmakh aktivatsii tsitomegalovirusnoi infektsii.

Antibodies to cytomegalovirus class IgG and IgM and level of tumor necrosis factor (TNF) in the serum were measured in 81 patients with severe surgical infections. In patients with acute lung abscess TNF level was twice higher and activation of cytomegalovirus infection (specific IgM) was three times more frequent than in patients with infectious endocarditis. The conclusion is made that severe surgical infections inducing progressive immunodeficiency create conditions for activation of latent viral infections, cytomegalovirus, in particular). Recommendations on prevention of hemotransmissible cytomegalovirus infection are presented.

[Calcinosis and its meaning in heart surgery]. / Kal'tsinoz i ego znachenie v kardiokhirurgii.

The paper presents the analysis of calcinosis frequency and expressivity of calcinosis revealed during surgical treatment of 598 patients with acquired heart defect. In operative interventions under EKG conditions calcinosis was observed in 25% cases, and in performance of closed mitral commissurotomy in 36.7%. Retrospective analysis of special features of the illness course in 346 patients with rheumatic mitral defect accompanied by predominant stenosis in dependence on presence and degree of stenosis expessivity. The role of calcinous conglomerates as chronic intracardiac infection reservoirs is noted.

[Closed mitral commissurotomy in the surgical treatment of complicated mitral stenosis]. / Zakrytaia mitral'naia komissurotomiia v khirurgicheskom lechenii oslozhnennogo mitral'nogo stenoza.

Under analysis was an experience with closed mitral commissurotomies (CMCT) in 865 patients. Among them 285 patients had mitral stenosis complicated by calcinosis, thrombosis of the left auricle, mitral insufficiency of the I-II degree or by a previously done commissurotomy. CMCT was shown to be possible and sometimes even necessary in spite of the presence of aggravating factors.

[Cardiac abscesses]. / Abstsessy serdtsa.

The paper analyzes the experience in treating 75 patients with cardiac abscesses of various sites. Abscesses complicated the natural history of infectious endocarditis in all patients. The clinical features of cardiac abscesses are shown to be related to the stage of the destructive process. Echocardiography, follow-up analysis of ECH, PhCG and overall clinical data are demonstrated to play a role in their diagnosis. The paper discusses the specific features of surgical intervention into the heart if abscesses are present. Out of 75 patients who have been operated on for abscessing infectious endocarditis, 53 have had an operation and survived.