Immediate results of the 'Bioglis' valve use in the surgical treatment of Ebstein's anomaly.

BACKGROUND AND AIM OF THE STUDY: The optimum material for heart valves bioprostheses remains in dispute. We have created a biological valve made from hepatic Glisson's capsule and named 'Bioglis'. Experimental studies have shown the major characteristics of the 'Bioglis' valve to be equivalent to, and in some cases superior to, those of traditional valves made from xenopericardial tissue. We present the first experience of the 'Bioglis' valve use in surgical treatment of Ebstein's anomaly. METHODS: Twelve consecutive patients (age range: 7-48 years) with Ebstein's anomaly who underwent surgery between 1997 and 1999 were reviewed. A 'Bioglis' valve was implanted in all cases; two patients underwent repeat surgery because of incompetence of a previously implanted xenopericardial valve. The 'Bioglis' valve was formed, using a flexible frame, from the hepatic Glisson's capsule of bull calves. Short-term results at between two and 10 weeks after surgery were analyzed. Valvular function of the implanted 'Bioglis' valve was monitored by echocardiography. RESULTS: The implanted 'Bioglis' valve diameter ranged from 31 to 33 mm. There were no in-hospital deaths or complications. Echocardiography showed good function of the bioprostheses. Consequent peak and mean pressure gradients across the biological valve ranged from 3 to 7 mmHg and from 1.2 to 2.3 mmHg, respectively. Valve insufficiency occurred in one patient, but was minimal. CONCLUSION: Preliminary results with the 'Bioglis' support our recommendation of this new biological valve for clinical use.

[Catheter therapy of congenital cardiovascular defects]. / Kateternaia terapiia vrozhdennykh porokov serdtsa i sosudov.

The authors analyze the experience gained in catheter operations performed at their Department over the recent 28 years. A total of 500 balloon (Rashkind) and 35 knife (Park) atrioseptostomies were performed in critical patients with different "blue" congenital diseases over this period. An immediate hemodynamic effect at the operation table was attained in 95% of patients. Transluminal balloon valvuloplasty (TLBVP) was performed in 372 patients with valvular stenosis of the pulmonary artery. The results of this operation depend on the patient's age, anatomy of the defect, and correct choice of the diameter of balloon catheter. This intervention is particularly effective in patients aged under 1. In patients with combined valvular and infundibular stenosis the results of TLBVP depend on the severity of stenosis and age of patient. An attempt at TLBVP of congenital aortal stenosis was undertaken in 67 patients. Valvuloplasty was carried out in 57 patients. The operation was effective in 13 (62%) out of 21 patients aged under 1. The mortality in this group was 5.5%. Balloon valvuloplasty of the pulmonary artery was carried out in 71 patients with cyanotic congenital heart diseases. The intervention helped eliminate the critical state, rise the systolic pressure in the pulmonary artery, improve blood saturation with oxygen, and evade the operation for creation of a systemic-pulmonary anastomosis. Isolated and postoperative stenoses of pulmonary arteries were removed in 65 patients. Six Johnson and Johnson stents were effectively implanted to 3 patients with rigid postoperative stenoses; in 32 patients transluminal balloon angioplasty (TLBAP) for coarctation and recoarctation of the aorta brought about a satisfactory immediate hemodynamic effect. TLBAP of Blalock-Taussig's stenosed anastomosis were performed in 60 patients with various cyanotic congenital heart diseases. Its results were good in 39 (65%) patients, satisfactory in 19 (31.7%), and unsatisfactory in only 2 (3%) cases. Of the novel endocardial interventions, dilatation of the conduit following Rastrelli's operation, creation of a defect of the atrial septum after Fontain's operation, and embolization of the coronary-cardiac fistulas and of patent ductus arteriosus were carried out. This review demonstrates wide use of endocardial surgery methods in the treatment of some congenital heart diseases; in many cases such treatment may be an alternative to surgical interventions.

[Pulmonary sling in a patient with anomalous intrathoracic heart displacement (diagnosis and surgical treatment)]. / Lëgochnaia petlia u bolnogo s anomaliei vnutrigrudnogo raspolozheniia serdtsa (diagnostika i khirurgicheskoe lechenie).

The pulmonary sling is the origin of the left pulmonary artery from the right one, this is a rare abnormality giving a marked clinical picture. The paper presents a case of solely rare combination of the pulmonary of the pulmonary sling with abnormal cardiac placement--dextroversion. A three-year-old child underwent explorative thoracotomy for erroneously diagnosed mediastinal cyst. The thoracotomy revealed a suspected pulmonary sling. To make an accurate diagnosis, a comprehensive study (chest X-ray with esophageal contrasting, tracheobronchography, echocardiography, digital subtraction angiography) was performed. Echocardiography clearly showed the absence of bifurcation of the pulmonary trunk and the origin of the left pulmonary artery from the right one proved to be most informative, as evidenced by colour Doppler mapping. The paper deals with the specific features of surgical treatment of this pathology (the patient was successfully operated on through lateral sternotomy by using extracorporeal circulation). The good functional result of the operation was confirmed by echocardiography and angiography.

[Experience with the use of standardized inference in Doppler echocardiographic study]. / Opyt primeneniia standartizirovannogo zakliucheniia ékhodopplerkardiograficheskogo issledovaniia.

The authors propose a scheme for the inference on the results of ultrasonic cardiovascular investigation in cardiological patients. The scheme for putting into the computer has been developed in the A. N. Bakulev Institute for Cardiovascular Surgery. Its introduction improved the diagnosis, allowed monitoring of the follow-up examinations with comparison of the results in different patients as well as statistical processing of the findings and making diverse calculations. The programs designed imply the work of an operator whom should be a specially trained physician in the department of ultrasonic diagnosis.

[Origin of the aorta and pulmonary artery from the right ventricle: anatomic and echocardiographic comparisons]. / Otkhozhdenie aorty i legochnoi arterii ot pravogo zheludochka (anatomo-ékhokardiograficheskie sopostavleniia).

The origin of the aorta and pulmonary artery from the right ventricle is a complicated and little studied congenital cardiac malformation. The A. N. Bakulev Institute of Cardiovascular Surgery, USSR Academy of Medical Sciences, have developed anatomic and morphological criteria for the malformation. With the criteria, echocardiograms from 64 patients were retrospectively analysed and their anatomic and echocardiographic comparisons were made. The findings revealed the echocardiographic measures of the aorta and pulmonary artery from the right ventricle and determines the optimal echocardiographic projections for their estimate.

[Echocardiographic diagnosis of the origin of the aorta and pulmonary artery from the right heart ventricle]. / Ekhokardiograficheskaia diagnostika otkhozhdeniia aorty i legochnoi arterii ot pravogo zheludochka serdtsa.

The origin of the aorta and pulmonary artery from the right ventricle is a congenital heart disease whose anatomical and echocardiographic criteria are the object of wide current discussion. The classification of the disease has been developed at the Bakulev Institute of Cardiovascular Surgery, USSR AMS. It is based on identification of the anatomical differences in the types of origin of the aorta and pulmonary artery from the right ventricle (RV OAPA). The present research was devoted to the study of the possibilities of echocardiography in the differential diagnosis of the types of the anomaly in the RV OAPA complex and the possibilities of noninvasive differential diagnosis of RV OAPA and adjacent anomalies of the conotruncus. The results of the study allow the conclusion that location of intracardiac structures with purposeful use of ultrasonic projections provides the possibility of making the differential diagnosis of the types of the anomaly in the RV OAPA complex and that the obtained echocardiographic criteria may serve for establishing the differential diagnosis of RV OAPA and other congenital anomalies of the conotruncus.

[Surgical treatment of congenital mitral valve insufficiency]. / Khirurgicheskoe lechenie vrozhdennoi nedostatochnosti mitral'nogo klapana.

The experience of surgical treatment of 55 congenital mitral incompetence patients aged 3 to 34 years is analysed. Patients with the anomalies of the conotruncus, mitral stenosis, and open atrioventricular conduit were not included into the analysis. The preoperative clinical status of all the patients was evaluated as functional class III-IV. Twenty-one patients had attendant septal defects. Lung hypertension of group II was seen in 14 patients and of hemodynamic group IIIA in five patients. Pronounced disorders of intracardiac hemodynamics and circulatory impairments were indications to an operation. Failure of the mitral valve to close was secondary to several developmental defects. Deformities of the septa and of the chordal and papillary apparatus varied greatly. The mitral incompetence degree was aggravated in most patients by dilatation of the fibrous ring. The diversity of the morphological causes underlying mitral incompetence dictated a strictly individualized approach to the choice of the type and volume of a surgical intervention. Ten of the 55 patients underwent mitral valve replacement; various types of valvuloplasty were done to 45 patients. General hospital mortality rate was 10 percent; good and satisfactory outcomes were seen after reconstructive operations. Analysis of the outcomes of surgery for congenital mitral incompetence has shown that reconstructive operations on the valve are effective enough and may be recommended as a method of choice. Annuloplasty is required in most reconstructive procedures; in young children preference should be given to suture annuloplasty.

[Clinico-morphological comparison in children with infectious endocarditis]. / Kliniko-morfologicheskie sopostavlenii pri infektsionnom éndokardite u detei.

As many as 21 children suffering from infectious endocarditis (IE) were examined for the clinical and morphological picture of the disease. The patients' age ranged from 2 to 15 years. In 15 children, IE developed in association with different congenital diseases; in one patient, in the presence of rheumatic heart disease, and in 5 patients, in unaffected heart valves. The sectional material was examined in 19 cases whereas the operational material in 2 cases. Analysis of the data obtained has shown that early diagnosis of IE (primary and secondary) may not infrequently be fairly difficult, which is likely to result in the late administration of antibacterial therapy. In addition to the involvement of the valvular apparatus of the heart, the majority of the patients demonstrated the signs of focal myocarditis and postmyocarditic cardiosclerosis, which is one of the causes of the development of refractory heart insufficiency. IE children mostly die from heart insufficiency and thromboembolism.

[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.

[Diagnosis of hypoplasia of the heart ventricles: role of morphometry and morphology in its assessment]. / Diagnostika gipoplazii zheludochkov serdtsa: rol' morfometrii i morfologii v ee otsenke.

The article deals with the results of the study of the quantitative anatomy and morphology of hypoplastic ventricles. The object of study were 28 specimens of the heart: 15 with hypoplasia of the left ventricle and 13 with hypoplasia of the right ventricle. The control group was composed of 10 specimens of normal hearts. Morphometry was conducted in all of the 28 specimens. At the same time angiocardiometry and calculations of the volume characteristics of the ventricles were undertaken in the diagnosis of hypoplasia of the right ventricle. The morphometric criteria of hypoplasia of the heart ventricles and their morphological variants were determined as a result. It was found that the lineal characteristics of the heart yielded sufficient information both for the diagnosis of hypoplasia and for determining its degree. Morphometry showed that constant ratios exist between the diameters of the atrioventricular valves and the lineal sizes of the ventricles in normal and pathological hearts. Knowledge of the aforesaid is of much practical importance because having determined the sizes of the atrioventricular valves during echocardiography one may calculate all linear characteristics of the heart and evaluate the sizes of the ventricles by means of the quantitative criteria. The article gives the method of such calculation, while its results are evidence of the high precision of the suggested constants.

[Study of hemodynamics after creation of a new experimental outflow tract for the left heart ventricle]. / Izuchenie gemodinamiki posle sozdaniia v éksperimente novogo vyvodnogo trakta iz levogo zheludochka serdtsa.

Experimental analysis was made of hemodynamic changes occurring in the left heart and systemic circulation after making an aorto-left-ventricular shunt while simulating the complete obstruction of an outflow segment in the left ventricle. The hemodynamics of the left cardiac cavities in a "new operation" was studied. Analysis of the recording of pressure curves in the aorta, large arteries, and left ventricle, of electromagnetic flowmetric, echo-, and Doppler cardiographic findings suggested good results of the operations in the periods up to 12 months. The proposed model of an experimentally induced artificial aorto-left-ventricular shunt with conduit allows one to test and study the functional state of various types of prosthetic valves (biological and artificial) in long periods after surgery.

[Possibilities of echo- and Doppler echocardiography in the diagnosis of congenital coronary fistulas]. / Vozmozhnosti ékho- i doppler-kardiografii v diagnostike vrozhdennykh fistul koronarnykh arterii.

A complex ultrasound examination makes it possible to tentatively differentiate a coronary fistula and recommend to perform coronary angiography. The tentative diagnosis of coronary fistula can be made on the basis of a set of the following sings: location of aneurysmally enlarged ostium and proximal segment of a coronary artery along with an intact contralateral one; recording of abnormal turbulent systolic and diastolic blood flow in the aneurysmally enlarged coronary artery. The location of coronary distal segments and the site of the coronaryfistular shunt are a complicated problem that awaits further exploration.

[Quantitative evaluation of hypoplasia of the heart ventricles and its significance for heart surgery]. / Kolichestvennaia otsenka gipoplazii zheludochkov serdtsa i ee znachenie dlia kardiokhirurgii.

The quantitative anatomy and morphology of hypoplastic ventricles were studied in 28 afflicted hearts (15 with left ventricular hypoplasia, 13 with right ventricular hypoplasia). The control comprised 10 normal heart specimens. All the 38 specimens were studied morphometrically; this was complemented with angiocardiometry and ventricular volume estimations in diagnosing right ventricular hypoplasia. Based on the study results, the morphometric criteria of ventricular hypoplasias and their variant forms were established. The linear characteristics were found to be informative enough both in hypoplasia diagnosis and in its degree assessment. To choose a therapeutic method, two degrees of right ventricular hypoplasia were distinguished. Radical correction aimed at eliminating concomitant conditions was found to be feasible and performed in 27 patients with moderate right ventricular hypoplasia.

[Ultrasonic methods of diagnosing infectious endocarditis in children]. / U'ltrazvukovye metody issledovaniia v diagnostike infektsionnogo éndokardita u detei.

Ultrasound research methods were applied in 32 children with the clinical signs of infectious endocarditis (IE). The patients' age varied from 3 to 16 years. In 5 patients, IE turned out primary in the intact valves whereas in 27 patients, it superadded on different congenital heart disease. In 10 patients, IE had developed before surgical correction of the diseases and in 17, within different times after operation. The direct and indirect echo-signs of IE were delineated. The direct echo-signs included vegetations which were discovered in 22 out of the 32 patients. The indirect echo-signs included the signs of regurgitation in the externally unchanged or minimally changed cusps of the valves and blood drop at the level of the ventricles in connection with the defect reshunting in the interventricular septum. The data obtained are in good agreement with the clinical picture, surgical and morbid anatomy data.