[Outcomes of reoperations in dysfunction of mechanical prostheses in relation to the clinical course]. / Iskhody povtornykh operatsii, sviazannykh s disfunktsiei mekhanicheskikh protezov, v zavisimosti ot klinicheskogo techeniia.

Operations were conducted for the second time on 87 patients (98 operations). Reoperations were performed on 75 (76.5%) and closure of the fistula in 23 (23.5%) patients. The outcome of the operation was appraised according to the clinical course: without sepsis and with prosthetic septic endocarditis, respectively, in 57 (65.5%) and 30 (34.5%) cases. It was found that survival was lower among patients with prosthetic septic endocarditis than among those without sepsis, 37.9% and 53%, respectively. The position of the prosthesis determined the time of the development of the complication, both in fistulas and in thromboses. Disturbances in the function of the prosthesis occur mainly in the first postoperative months in patients without sepsis and in the first months and the late-term periods after surgery in patients with prosthetic septic endocarditis.

[Long-term results of mitral valve prosthetics depending on the prosthesis model (ball, disk)]. / Otdalennye rezul'taty protezirovaniia mitral'nogo klapana v zavisimosti ot modeli proteza (sharovoi, diskovyi).

The authors conducted a comparative analysis of patients of 2 groups--with a MK4 model ball prosthesis and an folding disc prosthesis. It was found that the number of late-term (repeated) thromboembolic complications was significantly less in patients with a disc prosthesis (3.95 cases per 100 patient-years) and 4.28 cases among patients with a ball prostheses. No fatal outcomes associated with thromboembolism occurred among patients with a disc prosthesis, the lethality among those with a ball prosthesis was 27.5%. The advantages of a disc prosthesis in indices of physical activity and increased survival were also established.

[Analysis of results of surgical treatment of patients with infectious endocarditis]. / Analiz rezul'tatov khirurgicheskogo lechenia bol'nykh s infectsionnym éndokarditom.

The results of surgical treatment of 180 patients were studied according to the character of infectious endocarditis (primary--PIE and secondary--SIE), the functional class (FC) in the preoperative period, and the patients' immune status. The survival of patients with PIE (with hospital mortality taken into account) was somewhat higher than that of patients with SIE. Survival in the late-term periods was significantly higher in patients with PIE. There were no fatal outcomes among patients with PIE of FC III, mortality among patients with SIE was 7.7%; mortality in FC IV was, respectively, 10 and 21.6%; the mortality rate among patients with PIE and SIE of FC V was 43.5 and 57.5%, respectively. The late-term results were good in 85.5 and satisfactory in 14.5% of patients. Twenty-one (16%) patients died. Cardiac failure and recurrent sepsis were the main causes of fatal outcomes. The preoperative immunological parameters (the concentration of ceruloplasmin, blood serum IgG and IgM, the activity of lymphocyte mitochondrial enzymes and the neutrophil test) reflect the activity of infectious endocarditis and have an effect on the development of postoperative complications and on the mortality.

[Causes of decreased stability of good survival results and the incidence of complications in patients with multiple heart valve prostheses]. / Prichiny snizheniia stabil'nosti khoroshikh rezul'tatov vyzhivaemosti i chastota oslozhnenii u bol'nykh s mnogoklapannym protezirovaniem serdtsa.

The results of six-year follow-up of 368 patients after multiple prosthetic valve implantation (mitral and aortic prostheses in 173, mitral and tricuspid prostheses in 129, three prostheses in 36, mitral and aortic prostheses with tricuspid annuloplasty in 30) are reviewed. The mean functional class was 4.05 prior to the operation, and eventually declined to 2.1, being indicative of increased physical activity of the patients. Good results were stabilized in 61% of cases. Major causes of insufficient stability of good results were specific complications and progressive attendant heart diseases. There were no specific complications in 51% of the patients. The survival rate was 39.2%, including the intraoperative mortality rate. Long-term survival rate was 59.3%. Myocardial insufficiency, mostly occurring in patients with aortic prostheses and preoperative functional class 4 or 5, was one of the leading causes of reduced long-term survival. Therefore, patients should undergo surgery when in functional class 3, and those with aortic defects, while they are in functional class 2.

[Diagnosis and outcome of dysfunction of mechanical prostheses of the heart valves (analysis of 143 cases)]. / Diagnostika i iskhody narushenii funktsii mekhanicheskikh protezov klapanov serdtsa (analiz 143 nabliudenii).

Diagnosis of dysfunction of heart valve prostheses has been reviewed in 143 patients over 17 years of follow-up. Sixty-eight paravalvular fistulas, 69 thromboses and 6 prosthetic ball or disk changes have been detected. Sepsis was the cause of prosthetic dysfunction in 61 (42.7%) patients. Diagnosis was difficult to make in cases of thrombosis in the area of the ventricular ring of the mitral prosthesis, thrombosis of the aortic prosthesis and ball changes. Because of similar phonocardiographic features, thrombosis of the obturative part of mitral prosthesis should be differentiated from thrombosis of the atrial part of the prosthesis and paravalvular fistula. The absence of diastolic murmur and prevailing symptoms of right ventricular insufficiency are distinctive features of obturator thrombosis rather than atrial thrombosis of the prosthesis. Thrombosis of the aortic prosthesis or a ball change should be suspected, if the ratio of the opening to closing tone amplitude drops below 0.5 and intermittent protodiastolic murmur emerges. Clinical phonocardiographic studies are capable of detecting prosthetic dysfunction in most cases.