A New Look at Structural Changes in the Aortic Root in Aortic Valve Stenosis.

The aim of the study was to identify new anatomical landmarks of the aortic root and the relationship between the sizes of anatomical structures using the method of computed tomography angiography to improve models of heart valves and the methods for their selection in clinical practice. Materials and Methods: The dataset of computed tomography angiography prior to aortic valve replacement in 262 patients was analyzed. The mean age was 75.0±5.9 years. 99 (37.8±3.0%) men and 163 (62.2±3.0%) women took part in the study. The annulus fibrosus, sinotubular junction, and height of the sinuses of Valsalva were measured. Results: In the tricuspid aortic valve group (n=251), in more than 50% of the cases, the diameter of the annulus fibrosus ranged from 23 to 26 mm. No significant association between the diameter of the annulus fibrosus and patient height (r=0.35; p=0.01) or body surface area (r=0.25; p=0.01) and the height of the sinuses of Valsalva (r=0.34; p=0.01) were revealed. Based on the ratio of the height of the sinuses of Valsalva and the diameter of the annulus fibrosus, three variants of the structure of the aortic root were identified: type A - K>1.05; type B- 0.95≤K≤1.05; type C- K<0.95. Type C of the aortic root was found to predominate in most cases, namely, in 98.0±0.9% (n=246).In the bicuspid aortic valve group (n=11), 2 patients had a type A of the aortic root, 1 patient had a type B, and 8 patients had a type C. Conclusion: A classification of variants of the aortic root structure has been proposed, which will be useful not only for practitioners when choosing a treatment method, but also for researchers to understand the structural characteristics of the aortic root in patients with its pathology.

[Hybrid procedures for aortic arch disease]. / Obzor gibridnykh vmeshatel'stv pri zabolevaniiakh dugi aorty.

Different surgical approaches for aortic arch disease were reviewed in the article. We have also compared various vascular prostheses for aortic replacement.

[Effect of polyethylene terephthalate (Dacron®) on functional potential of human bone-marrow/progenitor stem cells]. / Vliianie poliétilentereftalata (Dakron®) na funktsional'nyi potentsial kostnomozgovykh stvolovykh/progenitornykh kletok cheloveka.

Vascular grafts made of polytetrafluoroethylene and polyethylene terephthalate have widely been used in cardiovascular surgery. The causes of delayed colonization of such grafts by endotheliocytes and mesenchymal stem cells have not been adequately investigated. The authors examined the effect of polyethylene terephthalate on the functional activity of human bone marrow mesenchymal stem cells and endothelial progenitor cells in vitro. Proliferation (MTT assay, real-time cellular impedance), migration (Boyden chamber, real-time cellular impedance), and nitric oxide production (spectrophotometciacally) by progenitor endothelial cells and mesenchymal stem cells were assessed with and without the presence of polyethylene terephthalate. The functional activity of the cells was shown to depend on the presence of polyethylene terephthalate in a well with cells. Thus, polyethylene terephthalate turned out to exhibit a toxic effect on progenitor endothelial and mesenchymal stem cells. Treatment of grafts with gelatine or fibronectin improved colonization of grafts with cells.

[The Problem of Adherence to Therapy in Cardiology].

This review article presents results of studies on adherence to drug therapy of patients after discharge from hospital. It contains analysis of the reasons for poor adherence, assessment of the impact of quality of adherence on the immediate and long-term results of surgical and medical treatment, structured methods of improvement of adherence to therapy; as well as economic aspects of the problem.

[Radiofrequency Pulmonary Artery Ablation for Treatment of Residual Pulmonary Hypertension After Pulmonary Endarterectomy].

OBJECTIVE: to assess the safety and efficiency of radiofrequency pulmonary artery ablation for treatment of residual pulmonary hypertension after pulmonary endarterectomy. MATERIAL AND METHODS: Radiofrequency pulmonary artery denervation (PADN) was performed in 16 patients (10 men, mean age 39 years [26; 51]). Indication for PADN was mean pulmonary artery pressure (PAP) >25 mm Hg with absence of proximal pulmonary artery lesion according to computer tomography. PADN procedure was performed with nonfluoroscopic 3D navigation system. RESULTS: After PADN mean PAP decreased from 37.3 mm Hg [29; 38] to 24.6 mm Hg [17; 30] (p=0.01); pulmonary vascular resistance decreased from 672 dyn·s·c -5 [387; 566] to 386 dyn·s·c -5 [155; 449] (р=0.02); cardiac output increased from 3.4 l / min [3.2; 3.4] to 3.5 l / min [3.2; 4.0] (p=0.4); 6­minute walk test distance increased from 427 meters [352; 510] to 447 meters [370; 525] (p=0.16), respectively. CONCLUSION: Initial results allow to assume that radiofrequency pulmonary artery denervation combined with optimal medical therapy may take its rightful place in the treatment of this category of patients.

Radiofrequency Pulmonary Artery Ablation for Treatment of Residual Pulmonary Hypertension After Pulmonary Endarterectomy.

OBJECTIVE: to assess the safety and efficiency of radiofrequency pulmonary artery ablation for treatment of residual pulmonary hypertension after pulmonary endarterectomy. MATERIAL AND METHODS: Radiofrequency pulmonary artery denervation (PADN) was performed in 16 patients (10 men, mean age 39 years [26; 51]). Indication for PADN was mean pulmonary artery pressure (PAP) >25 mm Hg with absence of proximal pulmonary artery lesion according to computer tomography. PADN procedure was performed with nonfluoroscopic 3D navigation system. RESULTS: After PADN mean PAP decreased from 37.3 mm Hg [29; 38] to 24.6 mm Hg [17; 30] (p=0.01); pulmonary vascular resistance decreased from 672 dyn∙s∙c-5 [387; 566] to 386 dyn∙s∙c-5 [155; 449] (р=0.02); cardiac output increased from 3.4 l/min [3.2; 3.4] to 3.5 l/ min [3.2; 4.0] (p=0.4); 6-minute walk test distance increased from 427 meters [352; 510] to 447 meters [370; 525] (p=0.16), respectively. CONCLUSION: Initial results allow to assume that radiofrequency pulmonary artery denervation combined with optimal medical therapy may take its rightful place in the treatment of this category of patients.

[5-year surgical results in patients with chronic postembolic pulmonary hypertension]. / Pyatiletnie rezul'taty khirurgicheskogo lecheniya patsientov s khronicheskoi postembolicheskoi legochnoi gipertenziei.

AIM: To evaluate 5-year results of surgical treatment of patients with chronic postembolic pulmonary hypertension. MATERIAL AND METHODS: 170 patients with chronic postembolic pulmonary hypertension underwent pulmonary thrombendarterectomy. Mean age was 48±21.5 years. The operation was carried out using standard technique with hypothermia and circulatory arrest. We have analyzed clinical and functional status of 47 patients (23 males) prior to surgery and in long-term postoperative period (5-6 years). Distance of 6-minute walk test, mean pulmonary artery pressure and vascular resistance according to right heart catheterization, RV ejection fraction and volumes according to echocardiography, pulmonary artery diameter according to CT-angiography were analyzed. RESULTS: In remote postoperative period average distance of 6-minute walk test was increased by 2.8 times compared with initial values. Right heart catheterization revealed reduction of the average pulmonary pressure from 54.04±23.35 to 25.16±15.41 mmHg and vascular resistance from 539.66±120.59 dyn·sec·cm-5 to 101.39±89.20 dyn·sec·cm-5. Echocardiography showed increase of RV EF from 36±2.3 to 51.8±4.1% and decrease of RV end-diastolic volume from 109.4±39.2 to 39.1±6.8 ml. According CT-angiography there was decrease of pulmonary trunk diameter from 35.10±5.25 to 30.30±8.65 mm. CONCLUSION: Our 5-year data show that pulmonary thrombendarterectomy has high long-term effectiveness in patients with proximal form of chronic postembolic pulmonary hypertension.

[Surgical treatment of a patient with coronary artery disease combined with stenosis of the left subclavian artery].

Presented in the article is a clinical case report regarding successfully used hybrid technology in combined lesions of the coronary arteries and the first segment of the left subclavian artery. The patient was subjected to simultaneous hybrid operation, i. e., transaortic angioplasty with stenting of the left subclavian artery by means of the Assurant stent accompanied by coronary artery bypass grafting. The early postoperative period turned out uneventful. The patient was discharged with no complications and in a satisfactory condition. At the 12-month follow-up visit, the patient presented no complaints, felling satisfactory as he stated, and there was no evidence of restenosis as revealed by the findings of ultrasonographic examination. This clinical case report demonstrates that in this type of combined lesion the use of hybrid technologies makes it possible to obtain a favourable surgical outcome both in the immediate and remote postoperative periods.

[Efficiency of Operation Trombendarterektomy From Pulmonary Artery Branches Depending on the Degree of Pulmonary Hypertension and Duration of Disease].

AIM: to assess effect of thromboendarterectomy from pulmonary artery branches on clinical functional state of patients with chronic thromboembolic pulmonary hypertension (CTEPH) in dependence on degree of pulmonary hypertension and disease duration. MATERIAL: Patients (n=152) were divided into 3 groups: (1) with systolic pulmonary artery pressure (SPAP) less or equal 50 mm Hg (n=20), (2) with SPAP>50- less or equal 80mm Hg (n=46), (3) with SPAP >80mm Hg (n=86). METHODS: Examination included registration of dynamics of general clinical state and character of complaints, six-minute walk test, transthoracic echocardiography with measurement of SPAP and right ventricular ejection fraction, pulmonary perfusion scintigraphy with calculation of index of perfusion deficit. RESULTS AND CONCLUSION: Pulmonary thromboendarterectomy from pulmonary artery branches was associated with stable improvement of clinical functional state of patients with CTEPH and regression of symptoms irrespective of preoperative level of pulmonary hypertension.

[Five-year results of surgical management of patients with chronic post-embolic pulmonary hypertension].

Over the period from 2004 to 2013, a total of 146 patients presenting with chronic post-embolic pulmonary hypertension (CPEPH) underwent the operation of pulmonary thromboendarterectomy (TEE) at the Centre for Surgery of the Aorta, Coronary and Peripheral Arteries. The operation was carried out according to the conventional technique with the use of hypothermia and circulatory arrest. The dynamics of the clinical and functional state was assessed by analysing the following parameters: 6-minute walk test, mean pulmonary artery pressure, and resistance of lesser circulation vessels (according to the data of catheterization of the right parts of the heart), as well as the diameter of the pulmonary artery trunk (by data of MSCT angiography of the pulmonary artery). The distance of the 6-minute walk was indicative of the corresponding functional class of chronic heart failure according to the NYHA classification. The obtained results showed that pulmonary TEE eliminates the main cause of pulmonary hypertension - thrombotic obstruction of pulmonary arteries, thus leading to normalization of the lesser circulation, a decrease in the load on the right ventricle and, consequently, to considerable improvement of the functional state of patients. Performing the operation of TEE from PA branches leads to improved clinical and functional condition of patients with CPEPH both at the hospital stage and further in the remote period after surgery, which is confirmed by a more than 2.5-fold increase of the 6-minute walk distance and a decrease of CHF functional class (by NYHA). A decrease of vascular resistance of the lesser circulation from 539.66±120.59 din×s×cm(-5) before surgery to 101.39±89.20 din×s×cm(-5) in the remote period is indicative of remodelling of the right ventricle and distal arterioles of the lesser circulation. A decrease of the PA trunk diameter from 35.10±5.25 mm before the operation to 30.30±8.65 mm in the remote period is suggestive of structural rearrangement of the pulmonary arterial bed with a tendency towards normalization and of efficacy of surgical treatment performed.

[EFFICACY OF DIFFERENT FORMS OF LOCAL HEMOSTATIC MATERIALS BASED ON OXIDIZE CELLULOSE IN THE EXPERIMENT].

The bleeding of intraoperative period is one of the actual problem in surgery. There aren't any universal hemostatic means in spite of large variety of modern hemostatic methods. An experimental research studied the results of hemostatic activity of different forms of materials on the basis of oxidize cellulose (a gauze, a powder) as compared with their foreign analog (a hemostatic gauze "SurgiceI"). Median of hemostasis time consisted of (120 ± 59.9) and (73 ± 46.8) s, in case of application of gauze and powder preparations, respectively. The rate of group using the hemostatic gauze "Surgicel" was (142 ± 77.4) s. The authors made a conclusion on the basis of given research, that the hemostatic material based on oxidize cellulose (the powder form) showed a more expressed hemostatic activity and reliably twice reduced the time of hemostasis as compared with their analog forms of gauze (p < 0.05).