[Perspective Directions in Management of Severe Group Two Pulmonary Hypertension].

PURPOSE: To compare immediate results of mitral valve surgery in patients with severe pulmonary hypertension with versus without concomitant pulmonary artery denervation. MATERIALS AND METHODS: From January to December 2015 30 patients were randomly assigned into two groups. Patients of one group underwent mitral valve surgery (comparison group), in the other group mitral valve surgery was accompanied by pulmonary artery ablation (ablation group). Both groups had comparable anthropometric, echocardiographic, and hemodynamics characteristics. RESULTS: There were no hospital mortality and specific ablation-related complications. Left ventricular remodeling and decrease of pulmonary artery pressure were observed in both groups at discharge. On the third day after surgery systolic and mean pulmonary artery pressure assessed by right heart catheterization were 48 and 22 versus 59 and 39 mm Hg in ablation and comparison group, respectively (p.

[Effectiveness of Extended Myectomy in Patients With Hypertrophic Cardiomyopathy With Midventricular Obstruction].

PURPOSE: to assess effectiveness and safety of extended myectomy performed in patients with hypertrophic obstructive cardiomyopathy (HOCM) with midventricular obstruction. MATERIAL AND METHODS: Between 2010 and 2013 185 HOCM patients were operated for left ventricular outflow tract (LVOT) obstruction. Among these patients 32 had midventricular obstruction. Their age was 22-74 (mean 51.9+/-14.2) years. Mean peak gradient across LVOT was 89.1+/-20.4 mm Hg, thickness of interventricular septum was 26.9+/-4.3 mm. Operations were guided by intraoperative transesophageal echocardiography (TEE). RESULTS: There were no early deaths. Gradient at LVOT according to TEE decreased to 15.4+/-5.7 mm Hg. There were no complications specific for extended myectomy (such as ventricular septal defect, left ventricular wall rupture, or aortic regurgitation). In 2 (6.9%) patients permanent pacemaker was implanted because of complete atrio-ventricular block. Mean follow-up was 18.7 (95% confidence interval [CI] 17.2 to 20.3) months. Kaplan-Meier estimate of survival was 100% at 12 and 94.2% (95% CI 65.8-99.1%) at 22 months. CONCLUSION: Extended myectomy can be safely and effectively performed in HOCM patients with midventricular obstruction and should be considered individually in each patient.

Outcomes of the Ross procedure in patients with an accompanying ascending aortic aneurysm.

Analysed in the article are the results of the Ross procedure in patients presenting with dilatation of the ascending portion of the aorta. A combination of aortic valve defects with dilatation of the ascending aorta of more than 45 mm supposes simultaneous prosthetic repair of the aortic valve and ascending aorta. The most common surgical procedure remains the Bentall-DeBono operation whose main disadvantage is associated with implantation of a mechanical prosthesis and the necessity of lifelong anticoagulant therapy. An alternative method is the Ross procedure demonstrating low risk of thromboembolic complications and freedom from anticoagulant therapy. Over the period from 2002 to April 2015, specialists of the Novosibirsk Scientific Research Institute of Circulatory Pathology named after Academician E.N. Meshalkin carried out a total of 162 Ross procedures in patients presenting with accompanying dilatation of the ascending aorta (more than 45 mm). The mean diameter of the aorta at the level of Valsalva sinuses amounted to 45.6±8.6 mm, with that of the ascending aortic portion equalling 53.4±7.8 mm. The technique of total replacement of the aortic root was used in all cases. When the aneurysm extended to distal portions of the ascending aorta, additionally performed were the following procedures: in 24 patients--reduction aortoplasty, in 6 patients--replacement of the resected aorta with an insert from xenopericardium, and in 2 patients with a vascular graft. The average duration of follow up amounted to 40.1±21.6 months. Ten patients were subjected to repeat operations for autograft dysfunction. There were no reoperations on the ascending portion of the aorta. The regression analysis revealed that predictors of the development of autograft dysfunction were the baseline dilatation of the fibrous ring (FR) of the aortic valve of more than 27 mm (p=0.04) and uncorrected arterial hypertension in the postoperative period (p=0.03). In the group of patients with the FR less than 27 mm there were no cases of allograft dysfunction. The results of the study suggest that the Ross procedure is a safe and effective method in patients with accompanying dilatation of the ascending aorta. Risk factors for autograft dysfunction are dilatation of the FR of the aortic valve exceeding 27 mm and arterial hypertension in the postoperative period.

[Immediate Results of Mitral Valve Surgery in Asymptomatic Patients With Severe Mitral Regurgitation Due to Degenerative Mitral VaIve Disease].

Degenerative mitral valve disease nowadays is the most common cause of mitral insufficiency in developed countries and is associated with high morbidity and mortality. In the last decades repairing the mitral valve has become the operation of choice for treatment of the mitral valve prolapse, enabling to improve the geometry and function of the left ventricle and long-term survival. Nevertheless, the problem of choice of method of management of severe mitral regurgitation in asymptomatic patients with degenerative mitral valve disease remains unsolved. In this article we present immediate results of a prospective comparative study of mitral valve surgery in asymptomatic and symptomatic patients in dependence on NYHA class of heart failure.

[Immediate Results of Mitral Valve Surgery in Asymptomatic Patients With Severe Mitral Regurgitation Due to Degenerative Mitral Valve Disease].

Degenerative mitral valve disease nowadays is the most common cause of mitral insufficiency in developed countries and is associated with high morbidity and mortality. In the last decades repairing the mitral valve has become the operation of choice for treatment of the mitral valve prolapse, enabling to improve the geometry and function of the left ventricle and long-term survival. Nevertheless, the problem of choice of method of management of severe mitral regurgitation in asymptomatic patients with degenerative mitral valve disease remains unsolved. In this article we present immediate results of a prospective comparative study of mitral valve surgery in asymptomatic and symptomatic patients in dependence on NYHA class of heart failure.

[A case of severe intravascular hemolysis after double mechanical heart valve implantation].

A case report of a patient with a triple cardiac valve replacement complicated by severe postoperative intravascular hemolysis is presented. The patient had neither prosthetic valvular dysfunction nor paravalvular leak and had an excellent hemodynamic response to the operation. Replacement of the aortic and mitral prostheses with stented porcine prosthesis alleviated the problem.

[The study of microcirculation in walls of chambers of the heart in patients with aortic stenosis in dependence on heart failure stage].

We studied microcirculatory blood flow (MBF) by laser Doppler flowmetry (LDF) in 52 patients with stage III-IV aortic stenosis (AS) and class II-IV chronic heart failure (CHF). MBF was assessed in walls of right and left cardiac chambers before and after correction of the defect. Aim of this study was to assess functional state of MBF in walls of different chambers of the heart before and after defect correction in patients with AS at various stages of CHF. We distinguished 2 groups of patients: group 1 with class II CHF, group 2 with class III-IV CHF. In group 2 compared with group 1 before and after AS correction of AS we found the lowest level of MBF in walls of left cardiac chambers and right atrium and highest parameters of the left ventricular and atrial function according to echocardiography data. Progression of anatomic-functional changes of left ventricle at the background of AS and development of CHF is characterized by lowering of MBF volume velocity in walls of left cardiac chambers.

[The possibility to predict results of aortic valve prosthetics from initial anatomic and functional properties].

The study included 394 patients selected for aortic valve prosthetics. Group 1 comprised patients with prevailing aortic stenosis (n = 165 or 41.9%), group 2 patients with prevailing aortic insufficiency (n = 229 or 58.1%). Their preoperative characteristics were arbitrary categorized as follows: circulatory disturbances (F1), anthropometric parameters (F2), central hemodynamic parameters (F3), anatomofuntional parameters (F4), left ventricular myocardium parameters (F5), valvular morphology (F6), valvular parameters (F7). Correlation analysis was used to predict surgery outcome. Excel 2000-based software was created to assess the probability of favourable outcome.

[Surgical correction of aortic valve disease with various types of prostheses].

Aortic valve replacement was carried out 394 patients. Among them 311 patients were men, 83 - women. Age of the patients varied from 10 to 78 years; mean age amounted 36.9+/-1.3 years. The patients were divided into 2 groups. 165 (41.9%) patients with aortic stenosis and combined aortic valve disease with predominance of stenosis formed the 1st group. 229 (58.1%) patients with aortic insufficiency and combined aortic valve disease with predominance of insufficiency formed the 2nd group. Mechanical valve prosthesis was applied in 224 patients, biological valve prosthesis - in 47 patients. Functional changes in left ventricular dynamics were evaluated in terms from 7 to 15 days after the operation. Received data show that implantation of mechanical valve prosthesis provides for optimal changes of left ventricular, myocardial mass and leads to functional recovery of mitral valve and left atrium. Significant increase of left ventricle ejection fraction was not observed after the implantation of biological valve prostheses; on the contrary ascending aorta size increases in early postoperative period.