[Successful correction of congenital heart defects: multiple defects and atrial septal aneurysm].

A case of congenital cardiac disorder with multiple defects in the secondary interventricular septum and atrial septum aneurysm in a young serviceman is reported. Plastic surgery of the atrial septum with a good clinical outcome included closure of the defect with a flap harvested from the autopericardium under conditions of artificial blood circulation and warm blood cardioplegia.

[Successful correction of arterial fistula between coronary arteries and pulmonary trunk].

A case of congenital heart disease (fistula between left coronary artery and right pulmonary artery, right coronary artery and pulmonary trunk) diagnosed accidentally during planned medical examination is reported. Corrective surgery included disconnection of left coronary and right pulmonay arteries, right coronary artery and pulmonary trunk under artificial circulation and warm blood cardioplegia.

[Surgical treatment of coronary heart disease in elderly patients].

Current approaches to the provision of effective medical aid to elderly patients with cardiovascular diseases are discussed. Clinical characteristics of such patients, concomitant pathologies, the strategy and extent of cardiosurgical treatment and postoperative therapy are described The original observations are compared with literature data concerning the immediate postoperative outcomes, clinical features, and peculiarities ofsurgical intervention in the patients of this age group.

[Plastic surgery of the mitral valve in patients with coronary heart disease].

Modern approaches to cardiosurgical plastic intervention on the mitral valve in case of its ischemic insufficiency are discussed. Etiology of this condition, indications for surgery, and the history of such operations are described. It is concluded that plastic surgery of the mitral valve is the method of choice for the treatment of patients with coronary heart disease.

[The use of biological cardiac valve prostheses in modern cardiosurgery].

The present review is devoted to the problem of bioprosthetics of cardiac valves with special reference to its methodological and technological aspects including peculiarities of the most extensively used varieties of biological prostheses, current tends in the choice of indications for their application in the treatment of various congenital valvular diseases and for their implantation to the specific groups of patients. The main causes and mechanisms underlying structural degradation of bioprostheses depending on the technological processes of their manufacture and the patterns of calcium salt accumulation in the fixed tissues are considered Physiological consequences and delayed results of bioprosthetics are discussed.

[Coronary artery bypass grafting in the elderly patients: anesthesia and postoperative period].

The objective of the present work was to clarify whether the advanced age of the patients with chronic coronary heart disease may be a precipitating factor with respect to anesthesia and aortocoronary/mammarocoronary bypass grafting surgery. The study group was comprised of 34 patients at the age from 66 to 75 years. The control group consisted of 38 patients aged between 60 and 65 years. The two groups were matched for a variety of characteristics. The overall intrahospital lethality rate was estimated at 1.39% (including one patient from the control group). The patients of the study group were characterized by higher functional classes of angina and cardiac failure in conjunction with lower myocardial contractile reserve. The duration of aortic compression, artificial blood circulation, inotropic support, and artificial lung ventilation was greater in the study group than in the control one even though the total duration of the hospital stay was similar. It is concluded that the surgical treatment of elderly patients presenting with chronic coronary heart disease has beneficial outcome in the early postoperative period; for this reason, the advanced age is not a contraindication for the surgical intervention on such patients.

[Atrial fibrillation after coronary artery bypass grafting].

The review is focused on atrial fibrillation soon after coronary artery bypass grafting. The most popular algorithms for the prevention and management of this condition are discussed including the protocol accepted in the Cardiosurgical Centre of P. V. Martynov 2nd Central Military Hospital. Modern concepts of pharmacotherapy of atrial fibrillation, restoration, and maintenance of sinus rhythm are considered.

[Correction of mitral regurgitation in conditions of surgical treatment of coronary heart disease].

It was the purpose of this search to announce that elaborating an optimal tactics for patients with coronary heart disease (CHD), complicated with ischemic mitral regurgitation (IMR). There were operated 85 patients with CHD and IMR in the course of 2006-2008. Previously all patients were separated on 3 groups in dependence of severity of IMR, character of damage of coronary race and changing of left ventricle. In the first and the second groups was realized an aorta-coronary shunting with annuloplasty. In the third group was realized an isolated shunting. Mortality in hospital was zero percents. A rudimentary regurgitation was noted by 10% of patients of the 1st group. The maximum period of monitoring was 24 months. Freedom from mitral regurgitation for the 1st and 2nd group was 95%, for the 3rd--93%. So, adequate and mutual estimation of flap-connected factors as well as condition of coronary race by the patients with IMR reduces the risk of by-pass mitral regurgitation and shows good short-term and long-term results.

[Stenosis of the trunk of left coronary artery: state-of-the-art].

Coronary artery bypass grafting (CABG) is traditionally considered to be the "golden standards" of treatment for patients with the affected trunk of left coronary artery (LCA) due to its good early and late outcome, low mortality rate and frequency of repeat surgery. This fact is well documented as reflected in relevant guidelines of European and American scientific societies. However, the recent years have witnessed markedly extended application of drug-coated stents despite the fact that immediate and delayed results of such treatment need more comprehensive verification. This review is focused on the evaluation of advisability of using drug-coated stents to manage lesioned LCA based on the results of randomized studies in comparison with CABG and percutaneous transluminal coronary angioplasty. An optimal method for the treatment of the affected LCA trunk is proposed based on the available data. It is concluded that CABG remains the method of choice for the treatment of this pathology (in the absence of contraindications) ensuring good early and late outcome, low mortality rate and necessity of repeat surgery.

[Surgical treatment of post-infarction left ventricular aneurysm complicated by thromboendocarditis].

This paper reports the result of surgical treatment of a patient with hemodynamically significant post-infarction left ventricular aneurysm spreading over the apex, anterolateral wall of the left ventricle, and a major part of interventricular septum complicated by thromboendocarditis.

[Nutritional status of old patients on programmed hemodialysis].

AIM: To study nutritional status of old patients on programmed hemodialysis. MATERIAL AND METHODS: A total of 82 patients aged 60-88 years were divided into two groups by age: group 1 (n = 41) consisted of 60-75 year-olds, group 2 (n = 41) included 76-year-olds and older. The nutritional status (NS) was assessed by anthropometric and laboratory data, a prognostic hypotrophy index. RESULTS: In group 1 NS was normal in 65.9% patients while in group 2--only in 29.2%. Older patients had obesity in 21.9% cases. CONCLUSION: It is shown that two thirds of presenile and senile patients have abnormal nutritional status. Taking into consideration the fact that protein-energy insufficiency is an unfavourable factor affecting the patients'survival, old patients need a special control of nutritional status and its early correction.

[Revascularization of myocardium: coronary artery bypass grafting or stenting?].

The aim of the study was comparative analysis of long-term results (5 years) after coronary angioplasty and stenting (CAS) and coronary artery bypass grafting (CABG). The results of the treatment of 1100 patients with coronary heart disease, operated since 1999 to 2006 year, were analyzed. 720 (65.5%) patients had undergone CABG (group 1), 226 (20.5%) had had an implantation of stents with pharmaceutical coverage (group 2) 154 (14%) had been implanted with stents without pharmaceutical coverage (group 3). Clinical examination as a rule had occurred before operation, 29-30 days after operation and in every 12 months after discharge from the hospital. Five years survival rate in group of CABG patients was 85.9% and in groups of CAS patients it was 84.1% and 70.8% respectively. Restenosis occurred more frequently in CAS patients: in group 2 in 18.1% patients, in group 3--in 70.1% In group of CABG patients acute myocardial infarction occurred in 11.9% cases to the end of 5th year, in groups 2 and 3 this index was 10.9% and 18.3% respectively. Angina pectoris was absent in 1 year in CABG patients (62%) than in CAS patients (46.7% and 24.3% in groups 2 and 3 respectively; p < 0.05). Comparing results of CAS with use of stents with and without pharmaceutical coverage, the best clinical result was in the group with implanted stents of new generation. Relatively better clinical effect during 5 years occurred in CABG patients.

[Postinfarction remodeling and left ventricular aneurysm].

The degree of cardiac insufficiency, which to a large extent is determined by changes in the volume and geometric characteristics of the left ventricle (LV), is an important prognostic factor of survival of patients after myocardial infarction. The term "postinfarction LV remodeling" was introduced to describe processes that lead to its dysfunction. This process becomes most important when postinfarction LV aneurysm (LVA) is formed. Recent research into the role of LV structure and mechanics show the hemodynamic significance of postinfarction LVA, especially in cases of its substantial expansion onto the interventricular septum (IVS). That is why a clear concept of the hemodynamic significance of postinfarction LVA and the extent of IVS involvement in a case with a prominent disorder of stereometric characteristics is a key factor for both choice of the optimal tactics and prediction of the end result of treatment of this threatening complication of coronary heart disease.

[Echinococcosis of the heart].

Basic clinical and special methods of diagnosis of cardiac echinococcosis are described. Among 12 patients with cardiac echinococcosis 5 patients have been operated and 7 patients have been not. Five of seven non-operated patients died during 1 year due to disruption of the cysts. All 5 operated patients survived. It is demonstrated that surgical treatment should be performed with artificial extracorporeal circulation, and postoperative anti-recurrent anti-helminth therapy is mandatory. Medication before surgical procedures is contraindicated because it leads to cysts disruption with high risk of lethal outcome.

[Single-photon emission computed tomography in diagnosis of left ventricular post-infarction aneurysm]. / Odnofotonnaia émissionnaia tomografiia miokarda v diagnostike postinfarktnoi anevrizmy levogo zheludochka.

AIM: To assess value of single-photon emission computed tomography with (99m)Tc-sestamibi ((99m)Tc MIBI SPECT) for detection of post-infarction left ventricular aneurysm in patients with coronary artery disease. MATERIAL: Fifty nine patients were operated upon because of coronary heart disease. In 27 patients with post-infarction left ventricular aneurysm modified Dor operation (aneurysmectomy with endoventricular circular patch plasty reconstruction) was performed. In 24 patients with extended cardiosclerosis direct myocardial revascularization was conducted. RESULTS AND CONCLUSION: Comparison of (99m)Tc MIBI SPECT data obtained at rest and during dobutamine stress test revealed some diagnostic features characteristic of patients with left ventricular post-infarction aneurysm. Quantitative and qualitative assessment of viability of myocardium in basal and "borderline" zones influenced not only the volume of revascularization, it was important for preliminary determination of post-infarction left ventricular aneurysm resection level, selection of type of plasty, prognostication of complications in immediate and remote postoperative periods.

[Prognosis of outcome of radical surgery in patients with lung cancer associated with severe complications and concurrent diseases]. / Prognozirovanie iskhodov radikal'nykh operatsii u bol'nykh rakom lëgkogo s tiazhëlymi sochetannymi i konkuriruiushchimi zabolevaniiami.

From 1981 to 2001 (20 years) 1307 patients with lung cancer underwent surgery. Postoperative lethality was 1.7% (after 635 pneumonectomies it was 2.4%, after 672 lob- and bilobectomies--1.2%). Medical histories of 171 operated patients with severe concomitant diseases was studied to analyze surgical outcomes depending on such important factors as age, concomitant diseases, surgical trauma. It is demonstrated that age of patients is not a factor of postoperative prognosis, but concomitant diseases and surgical trauma (i.e. pneumonectomy) are important factors of it. Results of surgery in the group of patients with four and more concomitant diseases after pneumonectomy were most unfavorable (lethality was 22.9%). In less severe surgical trauma (lobectomy) results of surgery were more favorable. It is concluded that surgery in patients with a lot of concomitant diseases must be less radical to obtain lower lethality. Radicality of treatment in these patients is ensured due to complex chemo- and radiation therapy after surgery.