[Oxygen metabolism with low hematocrit levels in the course of guided hemodilution procedure in cardiosurgical patients]. / Obmen kisloroda v usloviiakh nizkogo gematokrita pri provedenii upravliaemoi gemodiliutsii u bol'nykh kardiokhirurgicheskogo profilia.

Influence of hemodilution on the oxygen metabolism in patients, operated, using the artificial blood circulation apparatus, was studied up. Factors, determining the oxygen delivery to tissues, was estimated, correlational links between the blood rheological properties and its oxygen--transporting function were established. Experience of application of apparatus Aeprex, promoting the oxygen delivery to tissue improvement and the need in donor's blood lowering, performing operations, using the artificial blood circulation apparatus.

[Double and single ventricular correction of dual deviation of main vessels from the right ventricle of transposition type]. / Dvukh i odnozheludochkovaia korrektsiia dvoinogo otkhozhdeniia magistral'nykh sosudov ot pravogo zheludochka transpozitsionnogo tipa.

The experience of surgical treatment of double deviation of main vessels from right ventricle of transpositional type for the 1996-2001 period. Double ventricular correction was done in 22 (73.3%), singleventricular one--in 8 (26.7%) patients. Total hospital mortality was 18.1%. Tactics of surgical treatment of the failure, depending on anatomical peculiarities and the presence of concomitant failures, was determined. In the late follow-up period 22 (84.6%) patients, of that survived, were examined. The patients were followed up from 6 to 48 months, (24.4 +/- 12.3) months at average. The condition of patients was good. The meticulous estimation of the anatomy peculiarities before the operation permits to apply optimal surgical intervention and to improve result of correction.

[The evaluation of application efficacy of cardioplegic solution with perftoran in addition to surgical correction of congenital heart defects]. / Otsenka éffektivnosti primeneniia kardioplegicheskogo rastvora s dobavleniem perftorana pri khirurgicheskoi korrektsii porokov serdtsa.

Experience of the myocardium defense for correction of the heart failures in conditions of artificial blood circulation was analyzed in 55 patients. Antegrade pharmacool crystalloid cardioplegia, based on the potassium chloride solution was applied in 32 patients. In 23 patients perftoran was added to cardioplegic solution. Investigations of systemic hemodynamics in early postperfusion period data of electrocardiography and of the biopsies histological investigation as well confirm the efficacy of cardioplegic action of crystalloid cardioplegic solution raising while its oxygenation, after adding perftoran in its contents.

Pseudoaneurysm of subclavian artery 21-years after staged repair of tetralogy of Fallot.

Three cases of pseudoaneurysm of subclavian artery in long-term follow-up after staged repair of tetralogy of Fallot are described. The angiographical study revealed that aneurysms were located in the systemic end area of previously ligated modified Blalock-Taussing shunt. Aneurysmectomy with resection of a shunt and segment of subclavian artery was performed. We believe division of a prosthetic shunt should be routinely performed during complete repair of tetralogy to prevent morbidity in the long-term follow-up period.

[Methods of myocardium defense in radical correction of Ebstein anomaly]. / Metody zashchity miokarda pri radikal'noi korrektsii anomalii Ebshteina.

Experience of myocardium defence while correcting Ebstein anomaly in 75 patients was analyzed. In 25 patients antegrade pharmacorefrigerating crystalloid cardioplegia based on potassium chloride was applied, in 10--method of Kirsch using miganesiun-aspartate-procaine solution. In 40 patients antegrade pumping of normothermic potassium chloride solution with subsequent antegrade infusion of cooled magnesium-aspartate-procaine solution applied for primary heart arrest. Application of combined defence of myocardium using normothermal crystalloid cardioplegia and refrigerating, of antegrade infusion of magnesium-asparate-procaine cardioplegic solution has advantages in comparison with another methods of myocardium defence, reduces the threat of an acute cardiac insufficiency occurrence in early postoperative period.

Surgical treatment of Wolf-Parkinson-White syndrome during plastic operations in patients with Ebstein's anomaly.

OBJECTIVE: Ebstein's anomaly is the most common pathology associated with the accessory conduction pathways. METHODS: From January 1990 to August 1999 48 patients underwent surgical repair of Ebstein's anomaly by various plastic techniques. The pathways were identified and characterized at preoperative electrophysiologic mapping in 17 (34.5%) patients. There were seven males and ten females. The patients age ranged 6-35 years (mean 12.7+/-2.1 years). Five patients were in NYHA class II and were in 12 in NYHA class III. The cardiothoracic ratio ranged from 0.59 to 0.69 (mean 0.65+/-0.08). Tachycardia was present in 15 patients with Wolf-Parkinson-White (WPW) syndrome. Atrial septal defect was present in 12 patients (70. 6%). Accessory conduction pathways were in the right posterior septal area in seven patients, in right posterior septal area and free wall in seven patients and in right free wall in three. The pathways were successfully ablated in all patients during cardiopulmonary bypass. RESULTS: There were no deaths, no relapses. Follow-up ranged from 4 months to 7 years (mean 4.7+/-1.1 years). There were no late deaths, but one patient required successful tricuspid valve replacement because of severe tricuspid insufficiency. At follow-up 57.8% of patients were in NYHA class I. CONCLUSIONS: Preoperative electrophysiologic study allows to identify the accessory conduction pathways in patients with Ebstein's anomaly. The combined approach of tricuspid valve repair and surgical ablation of accessory atrioventricular connections has been proved safe and effective. This operative procedure allows to improve functional results in patients with Ebstein's malformation and concomitant accessory conduction pathways.

Double patch closure of ventricular septal defect with increased pulmonary vascular resistance.

BACKGROUND: Closure of a large ventricular septal defect (VSD) in children with elevated pulmonary vascular resistance is associated with significant morbidity and mortality. Pulmonary hypertensive episodes continue to be a major cause of postoperative morbidity and mortality. We designed a fenestrated flap valve double VSD patch in an effort to decrease the morbidity and mortality associated with the closure of a large VSD with elevated pulmonary vascular resistance. METHODS: Eighteen children (mean age, 5.7 years) with a large VSD and elevated pulmonary vascular resistance (mean, 11.4 Wood units) underwent double patch VSD closure using moderately hypothermic cardiopulmonary bypass and cardioplegic arrest. The routine VSD patch was fenestrated (4 to 6 mm) and on the left ventricular side of the patch, a second, smaller patch was attached to the fenestration along its superior margin before closure of the VSD. RESULTS: All children survived operation and were weaned from inotropic and ventilator support within 48 hours postoperatively. Postoperative pulmonary artery pressures were significantly lower than preoperative values. One child died 9 months postoperatively. CONCLUSIONS: Closure of a large VSD in children with elevated pulmonary vascular resistance can be performed with low morbidity and mortality when a flap valve double VSD patch is used.

[The use of bi-directional cava-pulmonary anastomosis in the treatment of severe congenital heart defects]. / Primenenie dvukhnapravlennogo kava-pul'monal'nogo anastomoza v lechenii slozhnykh vrozhdennykh porokov serdtsa.

Two-directional cava-pulmonary anastomosis was done in 35 patients with a inborn heart failure, ageing from 10 months to 11 years. In 29 patients the significant improvement of their state was noted. The level of arterial blood saturation with an oxygen have rised up to (90.1 +/- 2)% at average. Of 7 patients with the syndrome of right ventriculus hypoplasia one have died, of 27 patients with the single venticular heart-3.

[The factors influencing the incidence of heart rhythm disorders after the radical correction of the tetralogy of Fallot]. / Faktory, vliiaiushchie na chastotu narushenii ritma serdtsa posle radikal'noi korrektsii tetrady Fallo.

The frequency and factors favouring the development of cardiac rhythm disorders were studied in 306 patients operated on radically for Fallot's tetralogy (follow-up: 6 months--29 years). This complication was found in 99 patients (32.3%). Most patients showed ventricular arrhythmia--62 (62.6%). Paroxysmal tachycardia was noted in 11 patients, atrio-ventricular block in 15 patients, combination of different arrhythmias in 11 patients. Risk factors were: inadequate correction of the malformation, age over 15 at the time of operation, approach through the right ventricle with plastic repair of the drainage tract, five years after surgery.