[The Distinguish Method of Severe Aortic Stenosis Treatment Geriatric High Mortality Risk Patients].

Aim To improve quality of treatment for senile patients with pronounced aortic stenosis (AS).Material and methods Aortic valve stenosis (AS) is the most common valve pathology in cardiosurgical patients. Surgical correction of aortic valve (AV) stenosis accounts for 10 to 22 % of open-heart operations. 125 patients with pronounced AS were treated in the N. N. Burdenko Main Military Clinical Hospital between 2010 and 2017. This study was based on the implementation of new, minimally invasive methods in our clinic in 2013: balloon aortic valvuloplasty (BAVP) of the aortic valve and transcatheter aortic valve prosthesis (TCAVP).Results In the group of patients receiving the drug therapy alone, the in-hospital mortality was 2 %. At the time of maximum follow-up duration (3 years), the survival rate was 50.5 %. In the group of patients who underwent the AV replacement with extracorporeal circulation, the 3 year postoperative mortality was 16.6 %. There was no 3 year mortality in the group of patients who underwent TCAVP. The short-term beneficial effect of BAVP was confirmed.Conclusion An algorithm was developed for medical care of patients older than 75 with pronounced AS; the place of BAVP in the step-by-step management of these patients was determined. Using the developed approach in the management of these patients provided a 32 % (p<0.05) increase in the number of cases of radical surgical care.

Pulmonary Vein Isolation for Treatment of Paroxysmal Atrial Fibrillation on Patient with Situs Inversus Totalis.

A 56-year-old male with paroxysmal atrial fibrillation refractory to class IC and class III antiarrhythmic drugs was admitted to our hospital for radiofrequency catheter ablation of atrial fibrillation. During preoperative examination situs inversus totalis was revealed. Pulmonary vein (PV) isolation was successfully performed with atrial fibrillation termination and elimination of all PV potentials. The procedure was performed without any complications. Our report shows that PV isolation for treatment of drug-refractory atrial fibrillation can be safely performed in patients with dextrocardia and situs inversus totalis.

[Secondary intrathoracic reconstruction after prosthetic repair of the brachiocephalic trunk for traumatic aneurysm of the right subclavian artery].

The article deals with a case report of successful secondary surgical treatment of a patient who endured prosthetic repair of the brachiocephalic trunk for a traumatic false aneurysm of the right subclavian artery complicated by thrombosis of the reconstruction zone. Long-term conservative treatment resulted in progression of cerebrovascular insufficiency, invalidization, increasing ischaemia of the right upper limb, which required performing secondary intrathoracic reconstruction with prosthetic repair of the common carotid artery, vertebral artery and axillary artery on the right. Presented herein are the results of check up contrast-enhanced and CT-angiography performed at 10 months after the operation.

[Intraoperative assessment of blood flow along coronary and internal thoracic arteries before and after myocardial revascularization].

The article deals with intraoperative assessment of the blood flow in the coronary arteries and internal thoracic artery before and after myocardial revascularization. This is accompanied and followed by ultrasonographic characteristics of the coronary blood flow before and after surgical intervention, as well as competence of anastomoses and functional state of revascularization depending on the degree of the atherosclerotic lesion and the diameter of coronary arteries. The average linear and volumetric velocities of the blood flow in the coronary arteries were found to depend upon the degree of the lesion of coronary arteries, the diameter and capacity of the coronary bed. The work was based on studying a total of forty-eight patients presenting with coronary artery disease and subjected to myocardial revascularization using the internal thoracic artery (ITA). Also determined was efficacy of myocardial revascularization in different diameters of the coronary arteries and parameters of the ITA blood flow.

[Outcomes of surgical management of elderly and aged patients with complicated forms of coronary artery disease].

The article is dedicated to comparative analysis of surgical management of elderly and aged patients presenting with complicated forms of coronary artery disease (CAD). Suggested herein is an algorithm of concerning the choice of methods aimed at surgical correction of postinfarction aneurysms of the right ventricle of the heart and postinfarction ruptures of the interventricular septum in these patients, depending on the morphological structure of the right-ventricular postinfarction aneurysms and postinfarction ruptures of the interventricular septum, followed by determining the incidence rate of using "complete" and "incomplete" myocardial revascularization in elderly and aged patients with complicated forms of CAD depending on peculiarities of the coronary blood flow. Also considered herein is efficacy of preventing rethrombosis following correction of right-ventricular postinfarction aneurysms and thrombectomy. The article is based on studying a total of forty-two 60-to-78-year-old patients with CAD. The measures taken made it possible to decrease postoperative lethality and postoperative complications rate in the patients concerned.

[Surgical treatment of acquired defects and ruptures of interventricular septum]. / Khirurgicheskoe lechenie priobretennykh defektov i razryvov mezhzheludochkovoi peregorodki serdtsa.

Surgical repair of posttraumatic ventricular septal defects, aortic-right ventricular fistulas and postinfarction ruptures of interventricular septum was carried out in 15 patients aged 18-75 years. Methods of radical correction included suturing, plastic repair with synthetic and autopericardial patches, and amputation of cardiac apex. Procedures were performed 14 days - 12 months after myocardial infarction and 1-12 months after penetrating knife wounds of the chest and the heart. Duration of follow-up was from 1 month to 9.5 years. There were no cases of defect recanalization and deaths.

[The surgical results in postinfarct aneurysms of the left ventricule and in coronary artery lesions]. / Rezul'taty khirurgicheskogo lecheniia postinfarktnykh anevrizm levogo zheludochka serdtsa i porazhenii koronarnykh arterii.

In 1992-1997 66 patients with ischemic heart disease and postmyocardial infarction aneurysms in the left ventricle in association with 1 to 6 coronary arteries' lesion underwent surgical intervention when aneurysm elimination operations were accompanied by shunting of 1 to 6 arteries, which resulted in a better contractile ability of the ventricle and load tolerance. As compared with the reference literature data the lethality rate reduced by 2.4 times.