[Stenting in obstructive pathology of pulmonary artery in patients with various forms of congenital heart failure].

A total of 124 stents were implanted to 91 patients with various forms of congenital heart failure for the resolution of obstruction of 111 segments in pulmonary arteries. All these patients were treated in A. N. Bakulev Research Centre of Cardiovascular Surgery in the period from 1994 to 2007. Analysis of observations in early and late postoperative periods indicates that the efficiency of stenting of obstructed pulmonary arteries was 96.4% and the restenosis rate in the follow-up period 3.9%. It is concluded that stenting of pulmonary arteries is an effective and safe method for the management of obstruction problems. In the majority of patients it allows to avoid surgical intervention on pulmonary arteries.

[One and a half ventricular correction in the surgical treatment of congenital heart failure].

Fifty four operations of one and a half ventricular correction were made for the treatment of congenital heart failure (CHF) in 1999-2006. Age of the patients varied from 1 yr 3 mo to 29 yr. Indications to the use of this method are discussed along with analysis of its role in the surgical treatment of CHF. Two-directional cavopulmonal anastomosis in certain complex forms of CHF reduced volume load on the right ventricle and thereby promoted success of its radical correction. One and a half ventricular correction involved the hypoplastic and functionally compromised right ventricle and pulmonary circulation and therefore created more favourable conditions for circulation.

[Attempt at allo-aortal conduits in the correction of congenital heart defects]. / Pervyi opyt ispol'zovaniia alloaortal'nykh konduitov pri korrektsii vrozhdennykh porokov serdtsa.

In the period September 1990 to April 1993, an allo-aortic conduit was used in 16 patients during reconstruction of the right ventricular outflow duct. The patients age ranged from 2 years 8 months to 14 years, their body weight was 11.8 to 26 kg. Seven patients were diagnosed as having pulmonary atresia with ventricular septal defect, 4 had Fallot's tetrad and 5 transposition of great vessels with pulmonary stenosis and ventricular septal defect. The allo-aortic conduit made by the procedure developed at the A. N. Bakulev Institute of Cardiovascular Surgery, Russian Academy of Medical Sciences, was used in all cases to reconstruct the right ventricular outflow duct. The allografts were sterilized in a solution containing culture medium RPMI-1640 and mixture of antibiotics. After sterilization, the prostheses were frozen in liquid nitrogen vapours and kept at -150 to -160 degrees C till their clinical application. In the immediate postoperative period, 2 patients died, which amounted to 13%. Two deaths were caused by excessive bleeding, but in one case the implanted conduit wall bled. The residual right ventricle-pulmonary artery gradient was no more than 23 +/- 17 mm Hg. A discharge echocardiographic examination of patients found no valvular dysfunction of the implanted conduits on days 12 to 26 days after surgery. The findings suggest that the allo-aortic conduits prepared at the A. N. Bakulev Institute of Cardiovascular Surgery, Russian Academy of Medical Sciences, can be regarded as the prostheses of choice in the surgery of congenital cardiac malformations.

[Experience with a prosthesis of the pulmonary artery trunk at the A.N. Bakulev Institute of Cardiovascular Surgery, Academy of Medical Sciences, USSR]. / Opyt protezirovaniia stvola legochnoi arterii v Institute serdechno-sosudistoi khirurgii im. A.N. Bakuleva AMN SSSR.

From April 1975 to March 1991 sixty-four operations were carried out on 61 patients with various congenital heart diseases attended by impaired anatomical connection between the right ventricle and the pulmonary arteries. The patients' ages ranged from 9 months to 28 years (8 years on average). The most frequent clinical diagnoses were total transposition of the great vessels with ventricular septal defect and stenosis of the pulmonary artery (26 cases), type I common arterial trunk (14), Fallot's tetralogy (11 cases). Origin of the aorta and pulmonary artery from the right ventricle with stenosis of the pulmonary artery was encountered in 5 cases, origin of the aorta and pulmonary artery from the left ventricle with stenosis of the pulmonary artery in 4, and type II atresia of the pulmonary artery in one case. Three patients were reoperated on (reimplantation of an artificial pulmonary trunk). Synthetic prostheses with a biological (xenoaortic) valve made at the Institute, Bjerk-Sheily (USA) and Tascon Medical Technology (USA) "conduits", and synthetic prostheses devoid of valves were used. A "fresh" aortic alloprosthesis was used in one case. A statistically significant tendency towards reduction of operative mortality has been recorded (the mortality rate for the last 5 years is 14%). The late-term postoperative results were studied in 30 patients in follow-up periods of 12 months to 14.5 years (5 years and 5 months on average). Analysis of the late-term results shows the method to be highly effective. Stenosis of the prosthesis is the most significant problem of the late-term period.

[Characteristics of the radical correction of Fallot's tetralogy in anomalous distribution of the coronary arteries]. / Osobennosti radikal'noi korrektsii tetrady Fallo pri anomaliiakh raspredeleniia koronarnykh arterii.

The variants of distribution of the coronary arteries were studied on 41 specimens of the heart with Fallot's tetralogy. The typical topography of the coronary arteries in this cardiac defect is characterized by counterclockwise rotation of the coronary sinuses, dominant system of the right coronary artery with a large infundibular branch, and right type of heart blood supply. There were 6 variants of anomalies of the coronary arteries. The most characteristic of Fallot's tetralogy were: a single coronary artery, origin of the large infundibular artery by an independent orifice, and anomalous origin of the anterior interventricular branch from the right coronary artery. The peculiarities of radical correction of the tetralogy in atypical distribution of the coronary arteries were discussed on the basis of analysis of 27 operations conducted with the use of non-traditional methods of correction.