[Surgical correction of double aortic arch in infants]. / Khirurgicheskaia korrektsiia dvoinoi dugi aorty u grudnykh detei.

The article generalizes the experience in the surgical correction of a rare anomaly of the aortic arch--a vascular ring in the form of a double arch of the aorta in 2 babies. In a 9-month-old baby with Fallot's tetralogy the double aortic arch was found during an operation. The child died after the operation (division of the left arch of the aorta distal to the left subclavian artery in a left descending aorta and formation of a subclavian-pulmonary anastomosis). In the other 3-month-old patient with a marked picture of tracheo-esophageal compression tracheobronchoscopy and esophagography showed a double aortic arch with predominance of the right arch, right descending aorta, and a wide patent ductus arteriosus. The operation involved division of the ductus arteriosus and the hypoplastic left aortic arch between the left common carotid and left subclavian arteries. A prolonged period of regression of the symptomatology of tracheoesophageal compression was noted in the postoperative period. Early recognition of this anomaly of the aortic arch and active surgical tactics facilitate improvement of the results.

[Postponed closure of the sternum after operations on the heart with extracorporeal circulation]. / Otstrochennoe zakrytie grudiny pri operatsiiakh na serdtse s iskusstvennym krovoobrashcheniem.

Data on postponed closure of the sternum in 3 patients who were operated on with extracorporeal circulation are discussed. Various clinical and technical aspects of the applied method are considered. On the basis of their personal experience and the literature data, the authors discuss the causes of the development of acute heart dilatation in operations with extracorporeal circulation and, with due regard for this, substantiate the indications for the use of the method. Postponed closure of the sternum is a promising method of treatment of critical hemodynamic disorders which occur at the stage of closure of the sternotomy and are characterized by the picture of cardiac tamponade.

[Late cardiac tamponade in heart surgery practice]. / Pozdniaia tamponada serdtsa v kardiokhirurgicheskoi praktike.

Late cardiac tamponade (LCT) is a poorly studied life threatening complication after operation on the heart. Two cases of LCT developing 18 and 47 days after an operation are described. With consideration for the literature, the authors discuss the causes of LCT, the peculiarities of its clinical course, the diagnosis and treatment. A poor prognosis in LCT is an indication for early active surgical tactics. Puncture of the pericardium with its drainage, as well as pericardiotomy performed through an epigastric approach or by thoracotomy or by means of median sternotomy are effective methods for the management of this menacing complication.

[Adequate venous autoplasty in severe superior vena cava syndrome]. / Adekvatnaia autovenoznaia plastika pri tiazhelom sindrome verkhnei poloi veny.

Eleven patients underwent plastic operations on the superior vena cava (SVC) in its severe occlusion. The SVC syndrome was caused by malignant tumors of the right lung and mediastinum in 9 patients, lymphogranulomatosis in one patient, and by chronic fibrous mediastinitis in another patient. The SVC and its main branches were replaced by a multisegmental graft (lineal or bifurcation) of autogenous vein formed by parallel stitching together of 3-5 longitudinally cut segments of the vena saphena magna. Venous drainage was adequate and the graft remained unobstructed for a long time due to the anatomical conformity of the graft to the SVC and the equal diameters of the joined vessels. The immediate and late-term (3 to 26 months) results of plastics with a multisegmental graft or autogenous vein were good.