[Pulmonary sling in a patient with anomalous intrathoracic heart displacement (diagnosis and surgical treatment)]. / Lëgochnaia petlia u bolnogo s anomaliei vnutrigrudnogo raspolozheniia serdtsa (diagnostika i khirurgicheskoe lechenie).

The pulmonary sling is the origin of the left pulmonary artery from the right one, this is a rare abnormality giving a marked clinical picture. The paper presents a case of solely rare combination of the pulmonary of the pulmonary sling with abnormal cardiac placement--dextroversion. A three-year-old child underwent explorative thoracotomy for erroneously diagnosed mediastinal cyst. The thoracotomy revealed a suspected pulmonary sling. To make an accurate diagnosis, a comprehensive study (chest X-ray with esophageal contrasting, tracheobronchography, echocardiography, digital subtraction angiography) was performed. Echocardiography clearly showed the absence of bifurcation of the pulmonary trunk and the origin of the left pulmonary artery from the right one proved to be most informative, as evidenced by colour Doppler mapping. The paper deals with the specific features of surgical treatment of this pathology (the patient was successfully operated on through lateral sternotomy by using extracorporeal circulation). The good functional result of the operation was confirmed by echocardiography and angiography.

[Surgical treatment of congenital mitral valve insufficiency]. / Khirurgicheskoe lechenie vrozhdennoi nedostatochnosti mitral'nogo klapana.

The experience of surgical treatment of 55 congenital mitral incompetence patients aged 3 to 34 years is analysed. Patients with the anomalies of the conotruncus, mitral stenosis, and open atrioventricular conduit were not included into the analysis. The preoperative clinical status of all the patients was evaluated as functional class III-IV. Twenty-one patients had attendant septal defects. Lung hypertension of group II was seen in 14 patients and of hemodynamic group IIIA in five patients. Pronounced disorders of intracardiac hemodynamics and circulatory impairments were indications to an operation. Failure of the mitral valve to close was secondary to several developmental defects. Deformities of the septa and of the chordal and papillary apparatus varied greatly. The mitral incompetence degree was aggravated in most patients by dilatation of the fibrous ring. The diversity of the morphological causes underlying mitral incompetence dictated a strictly individualized approach to the choice of the type and volume of a surgical intervention. Ten of the 55 patients underwent mitral valve replacement; various types of valvuloplasty were done to 45 patients. General hospital mortality rate was 10 percent; good and satisfactory outcomes were seen after reconstructive operations. Analysis of the outcomes of surgery for congenital mitral incompetence has shown that reconstructive operations on the valve are effective enough and may be recommended as a method of choice. Annuloplasty is required in most reconstructive procedures; in young children preference should be given to suture annuloplasty.

[Surgical treatment of patients with tetralogy of Fallot in combination with a double aortic arch]. / Khirurgicheskoe lechenie bol'nykh s tetradoi Fallo, sochetaiushcheisia s dvoinoi dugoi aorty.

A late congenital anomaly--double arch of the aorta (DAA)--was combined with Fallot's tetrad (FT) in 4 patients whose ages ranged from 21 months to 11 years. The diagnosis of DAA and FT was established before the operation in 3 patients, in one patient DAA was discovered during the operation. In three children DAA was manifested clinically by dysphagia and stridor. A palliative operation (FT) was carried out through a left posterolateral approach along the third intercostal space. One-stage separation of the vascular ring by cutting the smaller left arch of the aorta at its junction with the descending aorta and formation of anastomosis between this arch and the left pulmonary artery by the end to side method were conducted. In deficient length of the cut arch of the aorta the left subclavian artery was divided; in equal diameter of both arches the lumen of the arch was reduced to 0.5 cm with stitches before formation of the anastomosis so as to prevent hyperfunction of the shunt. In the case in which DAA was not recognized before the operation, an attempt to dilate the hypoplastic segment of the left arch led to rupture of the thinned wall and the patient died from hemorrhage. The advantages of one- and two-stage radical correction of both developmental anomalies (DAA and FT) are still debatable.

[Diagnosis of hypoplasia of the heart ventricles: role of morphometry and morphology in its assessment]. / Diagnostika gipoplazii zheludochkov serdtsa: rol' morfometrii i morfologii v ee otsenke.

The article deals with the results of the study of the quantitative anatomy and morphology of hypoplastic ventricles. The object of study were 28 specimens of the heart: 15 with hypoplasia of the left ventricle and 13 with hypoplasia of the right ventricle. The control group was composed of 10 specimens of normal hearts. Morphometry was conducted in all of the 28 specimens. At the same time angiocardiometry and calculations of the volume characteristics of the ventricles were undertaken in the diagnosis of hypoplasia of the right ventricle. The morphometric criteria of hypoplasia of the heart ventricles and their morphological variants were determined as a result. It was found that the lineal characteristics of the heart yielded sufficient information both for the diagnosis of hypoplasia and for determining its degree. Morphometry showed that constant ratios exist between the diameters of the atrioventricular valves and the lineal sizes of the ventricles in normal and pathological hearts. Knowledge of the aforesaid is of much practical importance because having determined the sizes of the atrioventricular valves during echocardiography one may calculate all linear characteristics of the heart and evaluate the sizes of the ventricles by means of the quantitative criteria. The article gives the method of such calculation, while its results are evidence of the high precision of the suggested constants.

[Quantitative evaluation of hypoplasia of the heart ventricles and its significance for heart surgery]. / Kolichestvennaia otsenka gipoplazii zheludochkov serdtsa i ee znachenie dlia kardiokhirurgii.

The quantitative anatomy and morphology of hypoplastic ventricles were studied in 28 afflicted hearts (15 with left ventricular hypoplasia, 13 with right ventricular hypoplasia). The control comprised 10 normal heart specimens. All the 38 specimens were studied morphometrically; this was complemented with angiocardiometry and ventricular volume estimations in diagnosing right ventricular hypoplasia. Based on the study results, the morphometric criteria of ventricular hypoplasias and their variant forms were established. The linear characteristics were found to be informative enough both in hypoplasia diagnosis and in its degree assessment. To choose a therapeutic method, two degrees of right ventricular hypoplasia were distinguished. Radical correction aimed at eliminating concomitant conditions was found to be feasible and performed in 27 patients with moderate right ventricular hypoplasia.

[Echocardiographic diagnosis of Valsalva's sinus aneurysm]. / Ekhokardiograficheskaia diagnostika anevrizmy sinusa Val'sal'vy.

Valsalva's sinus aneurysm is a congenital heart disease that may occur both as isolated abnormality or combined with other ailments. The present paper summarizes the results of the use in 20 patients of non-invasive research methods, namely ultrasound cardiography and Doppler's cardiography, in the diagnosis of Valsalva's sinus aneurysms and concomitant heart diseases. Analysis of the findings has shown that the use of ultrasound cardiography in conjunction with pulse Doppler's cardiography permits demonstration with a high accuracy of the direct signs of Valsalva's sinus aneurysm without use of invasive methods, identification of the rupture of its wall and the pathological diastolic blood flow to the cavity corresponding to the rupture. In addition, the application of the above techniques makes it possible to diagnose with a high degree of significance the concomitant abnormalities such as the defects of the interventricular and interatrial septa, aortal valve failure and, in some cases, the signs of concomitant bacterial endocarditis.