[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.

ACETAMINOPHEN ADMINISTERING IN ORDER TO OBLITERATE HEMODYNAMICALLY SIGNIFICANT PATENT DUCTUS ARTERIOSUS IN NEONATES WITH EXTREMELY LOW BIRTH WEIGHT.

BACKGROUND: Patent ductus arteriosus (PDA) is one of the most common pathological conditions within the neonatal period Functioning of hemodynamically significant patent ductus arteriosus can cause a development ofvarious complications. This is why the earliest possible drug therapy or surgery is required in order to eliminate this fetal communication. THE AIM: to study the efficacy and safety of acetaminophen administering to infants with low birth weight for medical obliteration of hemodynamically significant ductus arteriosus. MATERIALS AND METHODS: The study included 16 infants with gestational age up to 29 weeks and birth weight less than 1200 g, the average birth weight was 980±230 g and gestation was 26,4±1,4 weeks. The average age of the observable patients at the moment of the beginning of the acetaminophen therapy was 56±6 h. Ductus arteriosus diameter was 3,75±1,25 mm. All the children underwent drug obliteration of the PDA through the intravenous acetaminophen administering. 15 mg / kg of the drug was given every 6 hours for three days. The full treatment course included 12 injections. RESULTS: The expected effect (closing of the ductus arteriosus) was achieved in 14 (87.5%) children undergoing the drug therapy. Two children with the birth weight of 1000 g and 1200 g remained with the ductus arteriosus open, but the signs of the left heart volume overload decreased significantly. To achieve a clinical benefit, it took 11 injections of the drug, on average. The children with the ongoing therapy were receiving enteral nutrition with the standard dosages corresponding to their age. No complications of the urinary tract, gastrointestinal tract or haemostatic system were registered. CONCLUSION: Using acetaminophenfor medical obliteration of the ductus arteriosus is a highly effective and safe method of treatment that has to be used in routine clinical practice. Dosing of the drug is easy to control and change, hence it is possible to cancel the drug administering as soon as the required result is achieved so as to minimize any complications.

[ASSESSMENT OF EFFICACY OF TEMPORARY EPICARDIAL BIVENTRICULAR RESYNCHRONIZATION PACING AFTER CARDIAC SURGERY].

The temporary pacing is provided as a key principle of maintenance and correction of hemodynamics after weaning the patient from cardiopulmonary bypass. There are conventional algorithms of temporary pacing, but the substantiation of electrode fixation areas is variable. The authors experimentally investigated the efficacy of temporary epicardial pacing in DDD and DDDBV using 18 laboratory animals after cardiac surgery with application of cardiopulmonary bypass. The hemodynamic parameters were compared in given groups. It was noted that in case of temporary epicardial pacing in DDDBV conditions was the best hemodynamic effect. The authors recommended more optimal areas for electrode fixation in temporary pacing: bachmans bunble (closest to the artrial septum), proximal part of the crista terminalis for the right atrium electrodes; the front-side free wall of the right ventricle at the distance of 3-4 cm from the apex of the heart, diaphragmatic surface of the right ventricle proximal to artioventricular groove for the right ventricle electrodes; obtuse margin (side wall of the left ventricle), diaphragmatic surface of the left ventricle proximal to artioventricular groove for the left ventricle electrodes.

[RESULTS OF APPLICATION OF THE METHOD OF STERNAL INFECTION ELIMINATION IN CARDIOSURGICAL PATIENTS].

A retrospective analysis of cases of sternal infection development was made in 388 cardiovascular patients from 2006 to 2012. The standard preventive measures of wound infection development were applied in the first period from 2006 to 2009. The method of "elimination of sternal infection" was used in the second period from 2009 to 2012. The application of the method of "elimination of sternal infection" allowed reducing the rate of sternal infection from 7.7 to 0.5% (odds ratio 0.099, 95% CI: 0.013-0.747; p = 0.025). According to results of statistical analysis the most significant factors were: body mass index (p = 0.002), resternotomy in early postoperative period (p < 0.001), risk according EuroSCORE Logistics (p < 0.001) and usage of the method of "elimination of sternal infection" (p = 0.006). The prevention of postoperative infectious complications shorthens the terms of hospital stay no less than 3 weeks, improves the quality of life for the patients and decreases treatment costs on 2.5 times.

[Prognosis of probability of the development of atrial fibrillation after successful surgical correction of mitral valvular disease].

The estimation of frequency of occurence of atrial fibrillation in patients with mitral valvular diseases was made before operation and at the early postoperative period. A logistic regressive analysis has shown that the appearance of atrial fibrillation in long-term periods is influenced by 4 independent preoperative factors: preoperative atrial fibrillation, age, anterior-posterior size of the left atrium, diagnosis of rheumatism. The dependence of the appearance of atrial fibrillation on the preoperative status of the patient was detected. A statistical model having the prognostic value 89.6% has been constructed. The model is good in use, reliable and can be effectively used in everyday clinical practice in order to determine the probability of the appearance of atrial fibrillation at the postoperative period of the concrete patient and decision on necessity of surgical ablation.

[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.