["Guiding lights" for the diagnosis of chronic thromboembolic pulmonary hypertension in the flow of patients with pulmonary embolism].

On December 13, 2021, an expert council was held to determine the position of experts of different specialties regarding the reasons for the low level of diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) in real clinical practice in a pandemic of a new coronavirus infection and possible ways to improve detection in patients with pulmonary embolism (PE) ) in history. The reasons for the low level of diagnosis of CTEPH are the insufficient level of knowledge of specialists, especially primary care physicians; lack of clear regulatory documents and expert centers for the management of this category of patients. Primary diagnosis of CTEPH in a pandemic can be strengthened through the widespread use of telemedicine for consultations of primary care physicians with specialists from expert centers; to maximize the role of echocardiography and computed tomography (CT) as differential diagnostic tools for dyspnea, in particular in patients with COVID-19. To increase the detection rate of CTEPH, diagnostic vigilance is required in patients with risk factors and episodes of venous thromboembolism. To improve the screening of CTEPH, it is necessary to create an algorithm for monitoring patients who have had PE; provide educational activities, including through the media; create materials for patients with accessible information. The regulatory documents should designate the circle of responsible specialists who will be engaged in long-term monitoring of patients with PE. Educational programs are needed for primary care physicians, cardiologists, and other physicians who come into the field of view of patients with CTEPH; introduction of a program to create expert centers for monitoring and managing patients with the possibility of performing ventilation-perfusion lung scintigraphy, cardiopulmonary stress test, CT, right heart catheterization. It seems important to build cooperation with the Ministry of Health of Russia in order to create special protocols, procedures for managing patients with PE and CTEPH.

[Changes in pulmonary vessels in complicated congenital valvular defects with high pulmonary hypertension].

349 cases of morphological alteration of pulmonary vessels with complex inborn heart defects (major vessels transposition with intraventricular septum deficiency, Taussig-Bing anomaly, double vessels departure from the right ventricle, common arterial trunk, single heart ventricle) were studied by the time and growth speed of structural vascular changes of lung circulation in correspondence with classification of Heath-Edwards. It is established that formation of morphological changes of pulmonary vessels in those defects takes place during the first half of year of patient life. Most malignant vascular changes occur in common arterial trunck and transposition of major vessels with a defect of the interventricular septum. A isolated defect of interventricular septum, single ventricle, double departure of vessels from the right ventricle show a relatively favourable course of the disease.

[Correction of mitral valve insufficiency in the incomplete form of atrioventricular canal]. / Korrektsiia nedostatochnosti mitral'nogo klapana pri nepol'noi forme atrioventriculiarnogo kanala.

Correction of the incomplete atrioventricular canal is considered to be a routine operation leading to mortality no more than 5%. Significant insufficiency of the atrioventricular (AV) valve worsens prognosis and increases mortality up to 30%. From 1989 to 1999 the Research Center of Cardiovascular Surgery performed 151 operations for this defect in patients aged 3 months to 50 years, which showed general mortality rates of 8.6%. The latter were largely related to the baseline insufficiency of the left AV-ostium, to the patientsT age of patients and the year of an operation. A combination of reparative valvuloplasties permits one to restore obturative mitral function more completely and to improve the outcomes of defect correction. Significant insufficiency of the AV-valve (over ++) is a risk factor of its preservation after surgery and may lead to death. Consideration of adequate indications for primary valve prosthesis may substantially reduce mortality rates.

[Comparative assessment of hemodynamic parameters in ventricular septal defect, obtained by Doppler echocardiography and catheterization of cardiac cavities]. / Sravnitel'naia otsenka pokazatelei gemodinamiki pri DMZhP, poluchennykh s pomoshch'iu doppleroékhokardiografii i kateterizatsii polosteí serdtsa.

The study was undertaken to assess hemodynamic parameters by Doppler echocardiography in patients with ventricular septal defect (VSD) and pulmonary hypertension. Seventy-two patients aged 5 months to 9 years (mean 2.5 years) who had isolated VSD were examined. The authors conclude that it is possible and necessary to assess hemodynamics in the lesser circulation by using Doppler echocardiography. The method permits monitoring the time course of changes in the right heart, which makes it possible to follow the natural history of disease without applying invasive studies.

[Embryologic and pathogenetic aspects of the common atrioventricular canal development]. / Embriologicheskie i patogeneticheskie aspekty razvitiia obshchego atrioventrikuliarnogo kanala.

Atrioventricular canal (AVC) is an inherited defect the embryological basis of which is deficiency of the affluent part of the interventricular septum (IVS). Folds of the atrioventricular (AV) valves are formed from the myocardium and not from the endocardial thickening but much later than the IVS formation. Under the conditions of the affluent part of IVS the mode of connection of the anterior fold of the left AV valve creates the narrowing of the left ventricular effluent part. Endocardial thickenings play a role of a glue fixing corresponding structural components of AV valves and primary heart partitions. The degree of sticking together determines great variants of the defect anatomy. Important deficiency of the affluent part of IVS is possible this making the function difficult due to space change of the endocardial thickenings. The common valve ring with freely floating bridge-like folds is frequently revealed in such case. The notion "deficiency of the endocardial thickenings" has the only manifestation as an isolated splitting of the anterior fold of the mitral valve and exhibits main features of AVC.

[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.

[Initial experience in the correction of the tetralogy of Fallot in infants using an approach through the right atrium and the pulmonary artery]. / Pervyi opyt korrektsii tetrady Fallo u detei rannego vozrasta dostupom cherez pravoe predserdtsie i legochnuiu arteriiu.

Radical correction of Fallot's tetralogy by means of an approach through the right atrium and pulmonary artery without ventriculotomy (10 patients) or with minimal ventriculotomy (23 patients) was carried out in children whose ages ranged from 13 to 50 months and body weight from 7.9 to 15 kg. Lethality was 12%. The death of 3 patients was not connected with the peculiarities of the surgical tactics, the death of the fourth patient was due to insufficient experience in development of the surgical techniques of the first operations. The operative techniques applied are described in detail and the possibility of adequate correction of Fallot's tetralogy by it is proved principally. The late-term operative results are good in 10 patients. The first results of the suggested method of surgical correction of the anomaly are claimed by the authors to be promising, which allows them to continue its further elaboration.

[Pulmonary hypertension in surgery of ventricular septal defects]. / Legochnaia gipertenziia v khirurgii defekta mezhzheludochkovoi peregorodki.

The article discusses the appraisal of the degree of pulmonary hypertension and surgery of a ventricular septal defect with pulmonary hypertension in 108 patients whose ages ranged from 8 months to 31 years. The hemodynamic and morphological manifestations of pulmonary hypertension were found to increase with age. The hemodynamic manifestations of the anomaly may be similar in different types of changes of the vascular wall. A sharply hypertrophied middle muscular coat may be the cause of residual high pressure after closure of the defect, but with gradual reduction in contrast to the stable increase in sclerosis of the vascular lumen. This predetermines lung biopsy as an obligatory method for verifying the severity of pulmonary hypertension, which together with the hemodynamic data allows the indications for closure of the ventricular septal defect to be determined.

[Indications for open biopsy of the lung in patients with ventricular septal defects and high-degree pulmonary hypertension]. / Pokazaniia k otkrytoi biopsii legkogo u bol'nykh s defektom mezhzheludochkovoi peregorodki i vysokoi legochnoi gipertenziei.

Analysis of the values of hemodynamics and the results of open biopsy of the lung in 60 patients with ventricular septal defect and high-level pulmonary hypertension, as well as the results of surgical treatment of 30 of them showed the expediency of diagnostic open biopsy of the lung in patients of the IIIb hemodynamic group, except for patients whose hemodynamic values range as follows: the ratio of general pulmonary to general peripheral resistance in more than 0.7; the ratio of pulmonary to systemic circulation is less than 1.5; the arteriovenous shunt is less than 25%, and the mean pulmonary artery pressure is above 75 mm Hg, and these hemodynamic values correspond with the morphological changes characteristic of stage IV-V after Heat-Edwards.