[Two-directional cavopulmonal anastomosis in the surgical treatment of congenital heart failure].

World-wide experience with the use of two-directional cavopulmonal anastomosis (TDCPA) for the surgical treatment of congenital heart failure (CHF) is summarized together with the results of analysis of immediate and late outcomes of this operation. It is concluded that TDCPA in certain complex forms of CHF and in patients at risk of poor outcome of Fontan surgery may be used as the final stage of hemodynamic correction.

[Fontan right heart bypass as a corrective procedure for congenital heart disease with single-ventricle hemodynamics].

Treatment of patients with complex cyanotic congenital heart disease is one of the most difficult problems in heart surgery. In a number of cases, when normal introcardiac hemodynamics is impossible to reestablish, the operation of choice consists in hemodynamic correction, which implies excluding the right heart from pulmonary circulation by rerouting venous blood directly to the lungs. The analysis of the outcomes of the operation, performed in various modification, shows that the most optimal method to date is extracardial bypass of the right heart with a valveless tubular prosthesis. This method is associated with a relatively rare early and long-term complications. Improvement of outcomes can be achieved mainly via dividing the correction procedure into stages, including bidirectional cavapulmanal anastomosis, and via thorough selection and preoperative preparation of patients.

[Bidirectional cava-pulmonary anastomosis in complex congenital heart defects]. / Dvunapravlennyi kavapul'monal'nyi anastomoz pri slozhnykh vrozhdennykh porokakh serdtsa.

An operation for bidirectional cava-pulmonary anastomosis was performed in 11 patients. Anatomical correction could not be made due to the multiple pattern and complexity of the malformation. None of them was, however, an ideal candidate for hemodynamic correction either. The authors took into account not only anatomical and hemodynamic contraindications for Fontana's operation, but the latter was not performed when the patient's status was grave (severe hypoxemia). The operation was made under extracorporeal circulation and hypothermia. In addition to bidirectional cava-pulmonary anastomosis, dilation of the intraatrial junction, pulmonary artery plasty, etc. were conducted in some cases. Bilateral bidirectional cava-pulmonary anastomosis was performed when an accessory vena cava superior was present. Nine patients benefited from the operation. There was a significant health improvement and a substantial increase in arterial blood oxygen saturation. Four patients underwent a repeated examination one year after surgery. The anastomosis was found to function well.

[Results of the use of a graft with a monocusp in radical correction of Fallot's tetrad]. / Rezul'taty primeneniia zaplaty s monostvorkoi pri radikal'noi korrektsii tetrady Fallo.

The article deals with the results of complex study of the effect of pulmonary insufficiency on intracardiac hemodynamics and function of the heart in the immediate and late-term periods after radical correction of Fallot's tetralogy. Answers are also given to questions concerning the expediency of the use and functional adequacy of a xeno-pericardial monocusp in the closure mechanism of the pulmonary artery valve. The study showed that massive pulmonary regurgitation has a negative effect on the functional condition of the right ventricle in late-term postoperative periods. Convincing data were obtained which allow a graft with a monocusp of a bull's pericardium to be recommended for further clinical use to prevent insufficiency of the pulmonary artery valve after radical correction of Fallot's tetralogy.

[Total cavo-pulmonary anastomosis in the surgery of complicated congenital heart defects]. / Polnyi kavopul'monal'nyi anastomoz v khirurgii slozhnykh vrozhdennykh porokov serdtsa.

The authors discuss experience in 8 operations for total cavo-pulmonary anastomoses in patients with various complicated congenital heart anomalies in which radical or anatomical correction could not be undertaken. The operation for total cavo-pulmonary anastomosis is an alternative of Fonten's method since many authors claim that the last-named has some shortcomings. Total cavo-pulmonary anastomosis was established in 4 stages under conditions of extracorporeal circulation. End to side cavo-pulmonary anastomosis was formed in the first stage; the proximal end of the divided superior vena cava was joined to the pulmonary artery in the second stage; the communication between the heart and pulmonary artery was closed in the third stage, and, finally, a tunnel was formed between the inferior and superior venae cavae by means of a xenopericardial flap in the fourth stage. Six patients tolerated the operation successfully. The immediate postoperative period was more favourable than after Fonten's operation. However, to come to a deeper general conclusion and compare the two methods clinical material must be accumulated and the long-term results of the operations studied.