[Immediate and Long-term Results of the First in Russia of IntrocoronaryMetal Stent in the Coronary Artery].

The authors present immediate and long term results of the first in Russia implantation in coronary artery of Palmaz-Shatz metal stent. Indications for stenting were urgent after complicated dissection as a result of balloon dilation of discrete bifurcational stenosis of anterior interventricular artery (IVA). Immediate angiographic and clinical result was good. At control angiography after 13 years their was no restenosis in stented IVA. However novel narrowing was found in left main coronary artery (LMCA) in which drug eluting stent was implanted. Coronary angiography carried out after 7.5 years after stenting of LMCA and in 20 years after stent implantation in IVA revealed good patency of both stented segments without signs of restenosis. This case report demonstrates possibility of long term preservation of angiographic and clinical effect of staged endovascular treatment of coronary atherosclerosis.

[The donor's heart 22 years after the orthotopic transplantation].

The orthotopic heart transplantation is an acknowledge method for the treatment of cardiomyopathies of various etiology. Specific vasculopathy of the transplanted heart is considered to be a significant problem of the long-term postoperative period and serves the reason of low 10-years survival rates (not more then 50%). The issue unites the experience of follow-up and intravital electronic microscopy of transplantated heart's biopsies from 20 patients. Previously unknown data can help the clarification of posttransplantational cardiomyopathy.

[Prevalence and influence of risk factors on coronary shunting operations in patients with aterosclerosis of abdominal aorta and peripheral vessels].

Retrospective study analysis concerning the prevalence of risk factors for unfavorable outcomes after coronary operations in patients with peripheral arterial atherosclerosis is presented. Meta-analysis of individual risk factors was carried out. Frequency of complications after coronary shunting in patients with various concomitant diseases is evaluated. The multifactorial relative risk affecting hospital lethality is defined. The study includes 131 patients with generalized atherosclerosis, which have underwent myocardial revascularization at the first stage (the main group) and at the second stage have been operated on abdominal aorta and peripheral arteries. 1128 patients without peripheral arterial atherosclerosis have made the control group. They underwent only coronary shunting. All patients were treated from December of 1994 till June of 2006. Relying on the results of the study cumulative relative risk for unfavorable outcomes after revascularization is 1.8 times higher in patients from the main group than in patients from the control group, and the risk for primary complications is 2.03 times higher. Concomitant atherosclerotic arterial involvement among cardiosurgical patients is associated with high risk for stroke in postoperative period. In case of chronic renal failure risk factors are cumulated. In the main group lethality made 5% , which was higher as compared with the control group. Correlation of such risk factors as heart failure and renal failure (creatinine level more than 1.8 mg/dl) with lethality has been revealed among patients from the main group. Lethality risk raises in 5.30 times in the presence of heart failure in medical history, and raises in 13.15 times in case of initially elevated creatinine level. Age of patient didn't have any influence on lethality in early postoperative period.

[Algorithm of cardiac risk assessment before vascular surgery].

THE OBJECT: to detect the informative value of algorithm of cardiac risk assessment recommended by American Heart Association compared with original standard enlarged protocol. Overall 456 patients underwent vascular operations. First group consisted of 198 patients who were examined according original enlarged protocol; other 258 patients (2nd group) were examined with AHA protocol. At 1st group 41% patients didn't need myocardial revascularization (according coronarography results), preventive coronary bypass surgery was performed at 32% patients. At 2nd group coronarography was performed at 133 (51%) patients according risk factors stratification and stress-examination results. Preventive coronary bypass surgery was performed at 97 patients; 27 patients refused this recommendation. Enlarged protocol increases in 2.6 times the odds of unnecessary invasive procedure. It is concluded that AHA algorithm permits to reduce in 2 times and more the number of invasive diagnostic procedures compared with standard enlarged protocol; AHA algorithm increases the clinical and economic effectiveness.

[Combination of reconstructive vascular operations with gene-engineering technologies of angiogenesis stimulation: a present-day policy aimed at improving the remote results of treating patients with lower limb chronic ischaemia].

The authors have studied therapeutic outcomes in a total of 38 patients diagnosed with occlusions of the femoropopliteal segment. In the Study Group patients (n = 19), the operation of femoropopliteal bypass grafting was supplemented by using gene stimulators of angiogenesis (gene constructions with the genes of vascular endothelial growth factor, and angiogenin). The Control Group patients (n = 19) were subjected to a reconstructive vascular operation alone. The remote results were followed up from six to twenty-six months, having shown reliably better therapeutic outcomes obtained in the Study Group patients, as judged by the distance of pain-free walking, the time of restoration of the baseline parameters of blood flow during the treadmill test, muscular perfusion, and the quality of life indices. A conclusion was made that the use ofangiogenesis-stimulating methods combined with reconstructive vascular operations improves the long-term outcomes in patients presenting with lower limb chronic ischaemia.

[Preservation of subvalvular mechanism at mitral valve replacement].

According to literature data there is no common approach to method of mitral valve replacement with preservation of subvalvular structures. Results of 175 operations of mitral valve replacement are analyzed. The preservation of fibrous-papillary contact must not be regarded as the goal itself, but it must improve the clinical effect of operation. Further study of left ventricle remodeling at mitral valve disease and repair of physiological function after surgery permits to predict and improve the functional results in early and long-term postoperative period.

[Clinical, diagnostic and surgical aspects of heart space-occupying lesions at children and youths].

Clinical, diagnostic and surgical aspects of primary heart tumors, pseudotumor and morphologically unidentified heart space-occupying lesions were analyzed at 52 childhood and adolescence patients. Difficulty of early diagnosis, more aggressive clinical course in majority cases, and individual approach to the choice of surgical approach has been demonstrated. Principle of oncological determinant has been ensured the success in surgical treatment of patients with non-malignant intracavitary and intramuscular neoplasms, and also with pseudotumor space-occupying lesions. Postoperative lethality was low (2.2%), and there were no true recurrences of disease in long-term period after surgery.

[Functional and anatomic classification in the surgery of combined thoracoabdominal aorta aneurysms].

The functional and anatomic classification of occlusive lesions of arterial system is proposed. This classification permits to evaluate the sate of arterial bed, the bulk and priority of affected arteries revascularization at patients with thoracoabdominal aorta aneurysms, to choice optimal treatment tactics, and to carry out the dynamic evaluation before and after surgery.

[The technologies of genetic engineering in treatment of chronic lower limb ischemia].

The article contains experimental data on angiogenesis stimulated by plasmid containing the angiogenin gene. After the introduction of the gene construction, the number of capillars in the chorion-allantois membrane increases 2 to 3 times; in an ischemized limb of a rat it increases by 20 to 30%. Intramuscular administration of genetic engineering construction to patients with chronic lower limb ischemia improved the patients' condition, consisting in an increase in painless walking distance and ankle-brachial index, as well as in trophic defect healing and the betterment of muscular perfusion. Positive effects were noted after 2 to 4 weeks of treatment and remained during 6 to 24 months. There were no side-effects, except low grade fever during 1 to 2 days.

[Surgical treatment of dilated cardiomyopathy].

The efficacy and safety of different variants of left ventricular geometrical reconstruction (LVGR) in patients with dilated cardiomyopathy (DKMP) were studied in 2-stage clinical trial during 4 years. Results of left ventricle plication, "Myosplint" surgery and implantation of extracardial net framework (ECNF) complemented with mitral insufficiency correction (in case of need) have been evaluated on the first stage of the study. Based on this study, the implantation of ECNF and correction of mitral insufficiency are recognized as the most effective and safe method of DKMP surgical treatment. Short- and long-term results of these surgical procedures have been studied on the second stage of the study. Overall 30 surgeries of LVGR have been performed (18 on stage 1 and 12 on stage 2 of the study). Hospital lethality on stage 1 was 27%, 4-year actuarial survival rate (taking into account hospital lethality)--54+/-12%. Original protocols of surgical, anesthetic and intensive care management led to decrease of hospital lethality to 8% and an increase of 2-year actuarial survival rate to 91.6+/-7.9% (that significantly higher than in the control group treated with therapeutic methods only).

[Preventive intraaortic balloon counterpulsation during surgical myocardial revascularization].

Fifty patients with low myocardial functional reserves (left ventricular ejection fraction less than 40%, disseminated cardiosclerosis, multiple affection of coronary arteries, NYHA class III-IV) after coronary artery bypass surgery (CABS) were examined. All the patients were divided into 2 groups. Preventive intraaortic balloon counterpulsation (IABC) was used in 24 patients (group 1). Group 2 consisted of 26 patients with similar physical state where IABC has not been used. It was revealed that preventive IABC leads to stabilization of the left ventricle function and cardiac output, a decrease in the doses and period of catecholamines administration. The rate of cardiac rhythm disorders in group 1 was 7 times, myocardial infarction -- 2.5 times, respiratory failure -- 5 times, stay at the intensive care unit -- 2 times less compared with those of group 2. Lethality was 12.5% in group 1 and 26.9% in group 2.

Surgical management of patients with ascending aortic aneurysms.

Between 1988 and 2002, 104 patients with ascending aortic aneurysms were operated on. The patients were distributed into 2 groups: the first group presented with aortic incompetence (n=66) and the second one had no aortic incompetence (n=38). In the first group, 8 patients received valvesparing operations, 58 (88%) patients underwent replacement of the aortic valve and ascending aortic segment according to different techniques. In the second group, 20 (53%) patients underwent graded aneurysmal resection and intimasparing exoreplacement by synthetic grafts and 18 (47%) were provided supravalvular replacement of the ascending aorta. In the shortterm postoperative period, the lethality in the first group accounted for 3% (6 patients), in the second group, it was equal to 2.6% (1 patient): of note, in the group provided aortoplasty, the lethality was 0%. In ascending aortic aneurysm associated with aortic incompetence, the Bentall DeBono operation is the method of choice of surgical treatment. Valvesparing operations are to be performed according to strict indications (in the absence of anuloaortic ectasia and microscopic lesions of aortic valve cusps). The graded resection of aneurysm with intimasparing exoreplacement may be an alternative to linear replacement of the ascending aorta in ascending aortic aneurysm without aortic incompetence and in the absence of aortic wall dissection.

[The CELO-ANG recombinant avian adenovirus with human angiogenine gene inducing neovascularization in the anterior tibial muscle of rat]. / Recombinantnyi adenovirus ptits CELO-ANG, nesushchii gen angiogenina cheloveka, indutsiruet neovaskuliarizatsiiu v perednei bol'shebertsovoi myshtse krysy.

The CELO recombinant avian adenovirus carrying the gene coding the human angiogenine (ANG) synthesis was obtained. Expression of the angiogenine gene was shown in the LMH cell culture after infection with the CELO-ANG virus. The ability of CELO recombinant adenoviruses to carry out the delivery and expression of alien genes in muscle cells was demonstrated in experiments with laboratory animals (Wistar line rats). The induced neovascularization in rat muscles after the animals were administered the CELO-ANG viruses was shown.

[Transplantation of the liver right lobe from a related donor]. / Transplantatsiia pravoi doli pecheni ot rodstvennogo donora.

From 1997 to 2003 transplantation of liver's right lobe from alive related donor was performed in 64 patients (28 men, 36 women) aged from 6 to 61 years (mean age was 22.6 +/- 3.2 years). Body weight of recipients ranged from 18 to 92 Kg (52.7 +/- 2.8 Kg on average). Indications for surgery were following: cirrhosis of liver due to Wilson's disease (34), primary sclerotic cholangitis (6), viral cirrhosis of liver (6), primary biliary cirrhosis (4), Bayler's disease (3), Caroly's disease (3), Budd-Chiary syndrome (3), secondary biliary cirrhosis (2), cirrhosis of liver due to deficient of alpha(1)-antitrypsin (1), hepatocellular carcinoma (1), total nodular transformation of liver (1). Intensive care before transplantation was needed for 68.75% potential recipients. Donors of liver's right lobe were relatives of patients similar to blood group. Age of donors ranged from 18 to 49 years, mean age was 37.9 +/- 1.4 years. Donors underwent right-sided hemihepatectomy, there were no complications. Lethal outcome in recipients was seen in 2 (3.1%) cases and was not associated with function of transplant. Lethal outcome in long-term period after transplantation was seen in 4 (6.5%) cases. All the others patients survived and followed from 1 to 73 months (23.8 +/- 2.4 months on average). Quality of life was good. Transplantation of liver's right lobe from related donor is the independent line in orthotopic transplantation of liver and ensure reliable results.

[Genetic engineering potential and perspectives in the management of critical ischemia]. / Vozmozhnosti i perspektivy lecheniia kriticheskoi ishemii s ispol'zovaniem genno-inzhenernykh tekhnologii.

The paper presents a new approach to management of lower limb critical ischemia which implements recent advances in molecular biology and genetic engineering technologies. A new original compound incorporating angiogenin gene was developed to activate neoangiogenesis processes after injection into living tissues. Experimental data evidence a potential efficacy of new method for complex management of critical ischemia.

[Electrical stimulation of the spinal cord in cardiovascular disease]. / Elektricheskaia stimuliatsiia spinnogo mozga pri serdechno-sosudistoi patologii.

The early and late outcomes of electrical stimulation of the spinal cord are analyzed in chronic critical ischemia of the lower extremities and coronary heart disease with peripheral involvement of coronary arteries. The clinical capacities of this treatment that has enjoyed little use in our country due to its high cost showed atraumaticity of electrical stimulation of the spinal cord; a few cases of complications and no hospital mortality; a rapid positive clinical effect after the initiation of electric neurostimulation, and better life quality in patients in the postoperative periods.

[Transplantation of the right hepatic lobe from an alive relative donor]. / Transplantatsiia pravoi doli pecheni ot zhivogo rodstvennogo donora.

The use of relative donors in the transplantation of the liver has shown a good performance as an alternative line in its orthotopical grafting. Shortage of donor organs actively stimulates the development of relative transplantation. The main problem of relative hepatic transplantation is the limited capacity of obtaining a required mass of a hepatic graft for obese recipients. To settle this problem, the Russian Surgery Research Center, Russian Academy of Medical Sciences, has developed an original safe procedure for obtaining the right lobe of the liver from an alive relative donor and for implanting it in a recipient. In November 1997 to October 2001, transplantation of the right hepatic lobe from an alive relative donor was made in 23 recipients (10 males and 13 females aged 9 to 55 (mean 22.3 +/- 3.1) years. Their body weight was 24 to 80 (mean 51.4 +/- 3.0) kg. Indications for surgery were as follows: hepatic cirrhosis (HC) at the end stage of the Wilson-Konovalov disease (n = 10), primary sclerotic cholangitis (n = 4), HC of viral etiology (n = 3), Bailer's disease (n = 2), primary biliary HC (n = 2), HC in the presence of alpha 1-antitrypsin deficiency (n = 1), and secondary biliary HC (n = 1). The donors of the right lobe of the liver were recipients' mothers in 9 cases, their fathers in 6 cases, sisters in 2 cases, sons in 1 cases, their daughter, brother, aunt, cousin in 1 case each. The donors' age ranged from 19 to 49 (mean 37.9 +/- 1.4) years. The donors underwent right hemihepatectomy, complications were absent in them. There were early mortality among the recipients. Two patients died in the late postoperative period. The remaining 21 recipients were survivors and followed up for 1 to 48 (mean 14.9 +/- 2.9) months. Their life quality was good. The use of the right lobe of the liver from an alive relative donor is the optimum alternative to transplantation of the cadaverous liver and partially compensates the shortage of donor organs for children, adolescents, and adults.