[The use of polytetrafluoroethylene vascular prostheses (Gore-Tex) for subclavian-pulmonary anastomosis in children with tetralogy of Fallot]. / Primenenie sosudistykh protezov iz politetrafliuoroétilena (Gore-Tex) dlia podkliuchichno-legochnogo anastomoza u detei s tetradoi Fallo.

The paper provides the results of a modified subclavian pulmonary anastomosis by employing Gore-Tex vascular prostheses in 91 babies with Fallot's tetrad whose age was 10 days to 32 months and weight was 3.6 to 15 kg. In 89 patients, the operation was performed by using a prosthesis, 4-6 mm in diameter, without crossing the subclavian artery, whereas in 2 patients, this was done by lengthening the crossed short subclavian artery. In the early postoperative period, 2 (2.2%) patients died, anastomosis thrombosis requiring a reoperation, occurred in 3 (3.3%) patients; other non-fatal complications were observed in 8 (8.8%) patients. A clear-cut effect of the operation was seen in all patients. SaO2 rose from 54 +/- 18 to 80.0 +/- 8%. In the long-term (6-60 months) postoperative periods, a total of 77 patients were examined: anastomosis function proved to be impaired in 4 (5.2%), all the vascular prostheses, 6 mm in diameter, were patent up to 60 months of surgery. The thrombosis probability for anastomosis, 5 mm in diameter, was 5% during 12 months of operation and 16% during 24-60 months. Three patients needed therapeutical management of heart failure. Other serious complications, including deformity of the pulmonary artery or upper extremity, were not found in the examinees. In the palliative treatment of Fallot's tetrad, subclavian pulmonary anastomosis via the Gore-Tex vascular prosthesis can be the method of choice in the first-year-old infants and has some substantial advantages over the classical Blelock-Taussig anastomosis.

[Total anomalous drainage of pulmonary veins into the coronary sinus (clinical aspects, diagnosis and surgical treatment)]. / Total'nyi anomal'nyi drenazh legochnykh ven v koronarnyi sinus (klinika, diagnostika i khirurgicheskoe lechenie).

Total anomalous drainage of the pulmonary veins into the coronary sinus is a complicated congenital heart disease which takes a particularly severe course at early age. Its diagnosis is based on the discovery of overfilling of pulmonary circulation on radiography in a cyanotic patient, atrial septal defect and distended coronary sinus on echocardiography, and, in some cases, anomalous drainage of the pulmonary veins into the coronary sinus. The final diagnosis may be established during selective pulmonary arteriography. Operations were performed on 12 patients with this pathological condition under extracorporeal circulation and hypothermia with good results. In patients over one year of age the operation consisted in widening the atrial septal defect with resection of the part of the interatrial septum between the defect and the superior border of the coronary sinus and closure of the newly formed defect with a graft and transposition of the coronary sinus and the abnormally draining pulmonary veins into the left atrium. In patients under one year of age the interatrial septum was not resected.

[Comparative evaluation of the results of surgery in closing ventricular septal defects using transventricular and transatrial approaches in young children]. / Sravnitel'naia otsenka rezul'tatov operatsii zakrytiia defektov mezhzheludochkovoi peregorodki chrezzheludochkovym i chrespredserdnym dostupami u detei rannego vozrasta.

The results of operations for correction of ventricular septal defects (VSD) in 97 young children (from 12 to 48 months of age) were evaluated. In 57 children the operation was conducted through a transventricular (group 1) and in 40--through a transatrial approach (group 2). The results of the operations in the two groups did not differ in essence. Essential differences were revealed in the cardiac index (CI) value and the requirements in cardiotonics: the CI was much lower and the doses of adrenalin higher in group 1 than in group 2. A more pronounced stability of hemodynamics on the first postoperative day and lesser possibility of the development of acute cardiac failure are important advantages of the transatrial approach and allow the authors to recommend it as the method of choice in closure of perimembranous VSD, particularly if they are complicated by high pulmonary hypertension.

[Results of performing a Blalock-Taussig anastomosis on young infants with tetralogy of Fallot]. / Rezul'taty vypolneniia anastomoza Bleloka-Taussig u detei rannego vozrasta s tetradoi Fallo.

The authors performed 61 operations for the creation of Blalock - Taussig's subclavian-pulmonary anastomosis in young children with tetralogy of Fallot. The risk of the operation is high in the group of patients with concomitant anomalies, and the only condition for improving the results in these patients is preoperative establishment of the exact anatomical diagnosis and individual determination of indications for one or another operation. In the group of patients with isolated tetralogy of Fallot (54 patients), the results of the operations were good, the lethality rate was 1.8%, which is evidence in favour of this type of anastomosis in children of the first months of years of life.

[Aortic coarctation associated with endocardial fibroelastosis in infants (clinical aspects, diagnosis and surgical treatment)]. / Koarktatsiia aorty v sochetanii s fibroelastozom endokarda u detei rannego vozrasta (klinika, diagnostika, khirurgicheskoe lechenie).

Among 111 infants with coarctation of the aorta, fibroelastosis of the left ventricular endocardium was found in 14 cases comprising 12.6%. Such a combination usually caused an extremely poor state of the patients and served as an indication for surgery. A resection of the coarctation of the aorta in cases of fibroelastosis provides for a significant reduction of the workload on the left ventricular myocardium, for an improvement of the patient's state permitting to survive the critical first three years of life. The problems of intravital diagnosis of fibroelastosis in patients with coarctation of the aorta are presented, the importance of chronic ischaemia of the left ventricle in the development of fibroelastosis is emphasized. The details of surgical tactics and postoperative care of such patients are discussed.