[The use of biological cardiac valve prostheses in modern cardiosurgery].

The present review is devoted to the problem of bioprosthetics of cardiac valves with special reference to its methodological and technological aspects including peculiarities of the most extensively used varieties of biological prostheses, current tends in the choice of indications for their application in the treatment of various congenital valvular diseases and for their implantation to the specific groups of patients. The main causes and mechanisms underlying structural degradation of bioprostheses depending on the technological processes of their manufacture and the patterns of calcium salt accumulation in the fixed tissues are considered Physiological consequences and delayed results of bioprosthetics are discussed.

[Common sense in operative treatment of thoracoabdominal aortic aneurysms].

Treatment approaches of patients with thoracoabdominal aneurysms and aortic dissections type B should be individual. Risk ratio of surgery itself and progression of non-operated disease, such as aneurysm rupture, is the determining factor in defining pro et contra surgical treatment.

[Use of artificial circulation during prosthetic repair of the abdominal aorta in single-step operations (a meta-analysis)].

To assess the risk of complications during the use of extracorporeal circulation at the stage of prosthetic reconstruction of the abdominal aorta in single-step interventions we carried out a systemic analysis of 20 publications mentioning the use of artificial circulation during aortic reconstruction, as well as analysed the works wherein aortic prosthetic repair was performed after artificial circulation was discontinued. The postoperative mortality rate in single-step interventions with the use of artificial circulation at the stage of aortic prosthetic reconstructions ranges from 0 to 25%, and that without artificial circulation varies from 0- 6.7%. A meta-analysis of the publications showed that the cumulative relative risk for development of complications is 3.14 times greater in those patients who at the stage of aortic reconstruction continued receiving artificial circulation. The use of artificial circulation does not decrease the incidence rate of myocardial infarction neither does it influence the rate of development of haemorrhage or purulent complications. However, the use of artificial circulation at the stage of prosthetic reconstruction of the abdominal aorta considerably increases the incidence rate of respiratory, renal and neurological complications. Hence, the advantages of using artificial circulation are levelled by high incidence of complications, while the opinion that the use of artificial circulation at the stage of prosthetic repair of the abdominal aorta decreases the incidence of myocardial infarction was not confirmed in our systemic review, therefore the use of extracorporeal circulation in single-step operations should be well-grounded.

[Atrial fibrillation after coronary artery bypass grafting].

The review is focused on atrial fibrillation soon after coronary artery bypass grafting. The most popular algorithms for the prevention and management of this condition are discussed including the protocol accepted in the Cardiosurgical Centre of P. V. Martynov 2nd Central Military Hospital. Modern concepts of pharmacotherapy of atrial fibrillation, restoration, and maintenance of sinus rhythm are considered.

[Early postoperative complications of surgical treatment of thoracoabdominal aortic aneurisms and dissections].

Early postoperative complications and lethality after 166 operations on the thoracoabdominal aneurisms were analyzed. Overall frequency of the early complications was 31,9+/-3,6%, though some complications could cause the lethality of 88,9+/-10,5%. Thorough evaluation of pre- and intraoperative risk factors and individual patient-defined surgical tactics should lead to the decrease of early complications frequency.

[Surgical treatment of post-infarction left ventricular aneurysm complicated by thromboendocarditis].

This paper reports the result of surgical treatment of a patient with hemodynamically significant post-infarction left ventricular aneurysm spreading over the apex, anterolateral wall of the left ventricle, and a major part of interventricular septum complicated by thromboendocarditis.

[Staging treatment of aorta aneurysm disease].

Overall 13 patients with aorta aneurysm disease underwent staging operations with 2 weeks - 12 years interval. Surgical treatment of aneurismal lesion of the whole of aorta is very difficult due to severity of the disease and non-typical surgical technique, and characterized by high complications rate and lethality. Individual approach to each patients and staging surgery permitted to achieve the positive results of surgical treatment with 10% lethality.

Primary aortoesophageal fistula: a rare variant of a ruptured chronic posttraumatic dissecting aneurysm of the descending thoracic aorta.

Presented herein is own experience in successful management of a female patient diagnosed with a primary aortoesophageal fistula secondary to a rupture of a chronic posttraumatic dissecting aneurysm of the descending thoracic aorta into the oesophagus. The contained herein review of the literature deals with the problems concerning surgical policy of and indications for different variants of reconstructive operations on the aorta and oesophagus.

[Surgical treatment of the patients with posttraumatic aneurysms of subclavian arteries].

Posttraumatic aneurysm of clavicular artery is the rare pathology (less 1% of all peripheral aneurysms). Experience of surgical treatment of 5 patients with this disease is analyzed. All the patients underwent different surgical procedures depending on aneurysm size and localization. There were no lethal outcomes. Preoperative diagnostic methods, surgical techniques and postoperative complications are described. Review of literature is also available.

[Simultaneous interventions on the ascending portion, arch of the aorta and cardiac valves in patients with Marfan's syndrome].

Simultaneous surgical interventions on the aorta and valvular system of the heart were performed in four patients presenting with aortic dissections and aneurysms conditioned by Marfan's syndrome. The following reconstructive operations were carried out: 1) prosthetic repair of the aortic valve and the ascending portion of the aorta by means of a valve-containing conduit with replantation of the openings of the coronary arteries into the side of the prosthesis according to the Benthall - De Bono technique, annuloplasty of the tricuspid valve according to the De Vega technique, valvuloplasty of the mitral valve by the Alferi technique; 2) grafting of the aortic valve and the ascending portion of the aorta by means of a valve-containing conduit with replantation of the openings of the coronary arteries according to the Kabrol's technique, plasty of the tricuspid valve by the De Vega technique; 3) prosthetic repair of the aortic arch with distal wedge-like excision of the membrane of the dissection and directing the blood flow along the both channels, plasty of the mitral valve, plasty of the aortic valve and the ascending portion of the aorta with a valve-containing conduit, accompanied by replantation of the openings of the coronary arteries into the side of the graft according to the Benthall - De Bono technique; (4) plasty of the mitral valve with a disk graft through the fibrous ring of the aortic valve, prosthetic repair of the aortic valve and the ascending portion of the aorta with a valve-containing conduit, accompanied by replantation of the openings of the coronary arteries into the side according to the Benthall-De Bono technique.

[Surgical treatment of false post-traumatic aneurysm of the aortic arch with arteriovenous anastomosis].

Traumatic injuries to the thoracic aorta consequent on closed chest traumas present an extremely severe and unfavourable condition as regards natural history. One of the specific disease variants lies in the formation of false post-traumatic aortic aneurysm with an arteriovenous fistula. In the presence of post-traumatic aneurysm of the thoracic aorta with an arteriovenous fistula, the disease course may be complicated by the phenomena of circulatory decompensation. Taking into account certain features of the morphology and pathogenesis of the given disease, surgical interventions require strict adherence to a number of the rules which make it possible to avoid intraoperative aneurysmal rupture. The present paper describes a case of successful surgical treatment of acute false post-traumatic aneurysm of the aortic arch with an arteriovenous fistula under profound hypothermia and circulatory arrest. Presented herein is also a review of the literature concerned with the topic.

[Grafting of carotid arteries].

Over 5-years, 167 reconstructive surgeries for stenosis of internal carotid arteries (ICA) were performed in 124 patients. Mean age of the patients was 63.5 years. One hundred and twenty-nine carotid endarterectomies (CEAE) in 86 patients and 38 reconstructive operations of ICA in 38 patients were performed. There were no lethal outcomes in short- and long-term postoperative period. In short-term period after prosthesis of ICA restenosis was revealed in 3% patients, after eversion CEAE in 3% patients the embolism was seen, after standard CEAE restenosis were diagnosed in 8% patients and thrombosis -- in 3%. In long-term period after grafting of ICA the strokes were seen in 3%, stenosis -- in 6% patients, after eversion endarterectomy -- in 0 and 3% patients, and after standard CEAE -- in 3 and 24% patients, respectively. It is concluded that grafting of ICA is adequate surgical method of reconstruction and stroke prevention in specific variants of carotid atherosclerosis.

Intraoperative ruptures of thoracic aortic aneurysms.

Intraoperative rupture of thoracic aortic aneurysm is a severe complication which may have an adverse effect on the outcome of operation. Among all intraoperative aneurysmal ruptures the most difficult and uncontrolled are ruptures of aortic aneurysms in the presence of dissection and of false aortic aneurysm during repeat interventions in this area. At intraoperative aortic rupture the priority task of the surgical team consists in urgent attainment of maximal temporary hemostasis and an adequate replenishment of blood loss. Presented herein are two most demonstrative clinical cases of intraoperative aortic ruptures: of the ascending aorta during cannulation of the right atrium and of false aneurysm of the aortic isthmus, which developed after aortic isthmoplasty by dacron patch for coarctation where the posterolateral wall of aneurysm was visceral pleura of the left lung. The authors provide a detailed description of the treatment policy for the given condition. Review the reported data pertaining to the problem under consideration.