[The endovascular approach to the open arterial duct surgery].

There are different ways of the open arterial duct treatment, based on its anatomical form. Endovascular occlusion is considered to be the safest. The morphometric protocol was developed for the adequate choice of the occluder. The first-stand results of the endovascular occlusion of the open arterial duct with the use of two types of guided occluders (Flipper and Amplatzer ductus occluder) are presented in the article.

[Use of Amplatzer septal occluder system for atrial septal defect closure].

Short-term results of minimally invasive transcatheter closure of atrial septal defect using Amplatzer septal occluder system (AGA Medical Corporation, USA) at 72 patients are analyzed. Technique of surgical procedure is described in detail. Morphometric protocol used for determination of indications and contraindication for endoscopic closure is also described. The causes of impossibility of endovascular procedures are established. The rate of transoccluder blood bypasses in postoperative period is demonstrated.

[Endovascular balloon valvuloplasty of pulmonary artery valvular stenosis].

Summarized experience of balloon valvuloplasty in isolated stenosis of pulmonary artery valve is analyzed. This procedure was performed in Russian Research Center of Surgery in 53 patients from 1980 to 2006. The technique of balloon valvuloplasty is described; short- and long-term results are analyzed. Complications and unsatisfactory results of this surgery are outlined.

[Valve-preserving reconstructive surgical procedures on pulmonary artery root in Fallot's tetralogy].

Original surgical method of dilated valvuloplasty is described. In moderate isolated hypoplasia of the fibrous ring of the pulmonary artery this method permits one to perform organ-preserving reconstruction of this zone without transannular plastic operation. Schemes of the surgery, experimental data and clinical experience based on surgical treatment of 31 patients with Fallot's tetrad in combination with hypoplasia of the fibrous ring of the pulmonary artery are presented. Short- and long-term results of the defect correction are reported.

[Double disposition of the major vessels from the right ventricle of the Fallot tetralogy type]. / Dvoinoe otkhozhdenie magistral'nykh sosudov ot pravogo zheludochka po tipu tetrady Fallot.

Forty-six patients with double disposition of the major vessels from the right ventricle in combination with stenosis of the pulmonary artery, in sub-aortal and bi-committed defects of the interventricular septum have undergone biventricular intraventricular correction. The most specific and accurate anatomic characteristics were: 1) position of the major vessels (particularly side-to-side); 2) location of two and a part of the third aortal sinuses above the right ventricle; 3) bilateral cone; 4) absence of aorto-mitral contact; 5) location of valves of aorta and pulmonary artery on the same level. One (2,2%) patient died during surgery due to progressed cardiac insufficiency. One (2,5%) patient died 2 years after radical correction of the defect due to progressive dysfunction of the right ventricle.

[Short and long-term results of surgical correction of the aortal valve dysplasia]. / Blizhaishie i otdalennye rezul'taty khirurgicheskoi korrektsii displazii aortal'nogo klapana.

Nearest and long-term results of surgical treatment of 108 patients with dysplasia of aortal valve were analyzed. Necessity of individual approach to choice of method of surgical correction (prosthesis or valvuloplasty of aortal valve) depending on degree of dysplasia and/or secondary valvular pathology, it anatomic variants, presence of concomitant infectious endocarditis and age of patients is noted. This permitted to reduce hospital lethality from 8.8 to 3.9%. Survival in 1, 5 and 10 years after prosthesis and valvuloplasty of aortal valve was 92.3 +/- 3.3, 86.8 +/- 4.8 and 85.7 +/- 5.7% versus 100, 94.1 +/- 4.1, 94.1 +/- 4.1% respectively. Quality life in remote period was evaluated as good in 80.3% operated patients, as satisfactory--in 11.1% and unsatisfactory--in 8.6%.

[Surgical correction of incomplete form of open atrioventricular canal in adults]. / Khirurgicheskaia korrektsiia nepolnoi formy otkrytogo atrioventrikuliarnogo kanala u vzroslykh.

Clinical and anatomo-hemodynamic features of adult patients with incomplete form of the open atrioventricular canal are presented, policy of surgical treatment and optimal degree of surgical intervention on mitral valve are determined. The study of variant anatomy of the defect, revealed two variants of left atrioventricular valve formation (with "functional" and with "anatomical" septal commissure). In the first anatomic variant the mitral insufficiency was hemodynamically important and required surgical correction. In the second variant, the mitral valve had good closure function, that permitted to avoid the routine suturing of anterior velum's splitting.

[Program of examination for patients with isolated mitral valve defects to evaluate the degree of pulmonary hypertension]. / Programma obsledovaniia bol'nykh s izolirovannymi mitral'nymi porokami serdtsa dlia otsenki stepeni legochnoi gipertenzii.

98 patients with isolated rheumatic mitral valve defects of the heart entered the study. Their central hemodynamics was studied intraoperatively before surgical correction of the defect. The results were compared to those provided by conventional noninvasive methods: chest x-ray, ECG, echo-CG, external respiration function test. Correlation analysis using computer intellect PolyAnalyst v.1.01R helped to design a program and practical nomogram which can quantitatively determine the degree of pulmonary hypertension on the basis of digital values of Rv1 wave amplitude (ECG) and right ventricular cavity size (echoCG).

[Enalapril treatment of residual pulmonary hypertension in patients operated rheumatic mitral valve defects]. / Lechenie rezidual'noi legochnoi gipertenzii énalaprilom u bol'nykh, operirovannykh po povodu revmaticheskikh mitral'nykh porokov serdtsa.

A pilot trial of efficiency of enalapril maleate in the treatment of residual pulmonary hypertension was made in 22 patients operated for rheumatic mitral valve defects. Degree I, II and III of pulmonary hypertension was registered in 5, 13 and 4 patients, respectively. Thus, the patients had NYHA functional classes III and IV (22.7 and 77.3%, respectively. Enalapril given for 6 months in a mean daily dose 12.3 +/- 1.57 mg/m2 (5-30 mg a day) normalized pressure in the pulmonary artery in 18.2% of patients. 50% of patients showed hypertension degree I, only one female retained hypertension degree III. To the end of the treatment the functional classes were the following: II--in 68.2%, III--in 27.3% and IV--in 4.5%.

[Ultrasonic diagnosis of congenital membraneous subvalvular aortic stenosis]. / Ul'trazvukovaia diagnostika vrozhdennogo membranoznogo podklapannogo stenoza ust'ia aorty.

The paper reviews a 10-year experience with complex ultrasonic diagnosis of membraneous subvalvular aortic stenosis, a rare congenital defect. Fifteen subjects operated on for this abnormality were examined. Profound systolic closure of the aortic cusps, concentrated left ventricular myocardial hypertrophy, linear-shaped echo signals generated by the membrane in the subaortic area, turbulent systolic blood flow in the ascending aorta are the most significant signs for the diagnosis of the membraneous subvalvular aortic stenosis.

[Ultrasonic diagnosis of aneurysmal rupture of the sinus of Valsalva]. / Ul'trazvukovaia diagnostika razryva anevrizmy sinusa Val'salvy.

Echocardiographic findings in 8 patients operated on for Valsalva's sinus aneurysm rupture are summed up: aneurysm and the site of its rupture shown on two-dimensional echocardiogram, abnormal diastolic blood flow through the aneurysm, evidenced by Doppler cardiography, and dilatation of cardiac chambers, dependent on the direction of blood discharge through the aorto-cardiac fistula.

[Echocardiography in the diagnosis of paravalvular fistulae in mitral prosthesis]. / Ekhokardiografiia v diagnostike paraval'vuliarnykh fistul pri mitral'nom protezirovanii.

Echocardiographic findings were analysed in 25 patients after surgical application of biological mitral valve prosthesis BAKS-M and 10 patients with paravalvular fistulas developing after similar operations employing different types of prosthesis. A tendency to increased postoperative size of the heart, left-atrial systolic turbulent flow, normalized ventricular septal movement and high-frequency oscillations of the aortic valve cusps are characteristic echocardiographic signs of paravalvular fistula.

[Status of the contractile function of the myocardium in patients with a mild form of infectious-allergic myocarditis]. / Sostoianie sokratitel'noi funktsii miokarda u bol'nykh s netiazheloi formoi infektsionno-allergicheskogo miokardita.

The authors analysed the results of echocardiography of patients with a mild ("ambulatory") form of infectious allergic myocarditis (the 1st group). Enhanced myocardial contractility was revealed in the 1st group as compared to the group of healthy persons (controls), decreased left ventricular contractility was noted in patients of the 2nd group (with dilated cardiomyopathy). A conclusion was made that a mild form of infectious allergic myocarditis was characterized by enhanced left ventricular contractility as a sign of its compensatory hyperfunction in response to myocardial damage.

[Echocardiographic determination of the degree of valvular regurgitation in isolated acquired heart defects]. / Ekhokardiograficheskoe opredelenie ob'ema klapannoi regurgitatsii pri izolirovannykh priobretennykh porokakh serdtsa.

A simple echocardiographic method for the assessment of the valve regurgitation volume in patients with isolated acquired heart diseases is described. It can be widely used in the routine clinical practice due to its relative simplicity.

[Diagnosis of subvalvular adhesions in mitral stenosis by 2--dimensional echocardiography]. / O diagnostike podklapannykh srashchenii pri mitral'nom stenoze metodom dvukhmernoi ékhokardiografii.

Echocardiographic signs of subvalvular fusions are discussed, as they frequently complicate the course of mitral stenosis. The diagnostic value of two-dimensional echo-cardiography is established for this abnormality. Subvalvular fusions of the chordal apparatus are shown to be associated with certain signs on the two-dimensional echocardiogram, such as additional echoes under mitral valve cusps in short-axis heart section (sensitivity 67.2%, specificity 90.7%), and mitral orifice drawn towards the interventricular septum (sensitivity 35.7%, specificity 93.5%), thickened subvalvular structures in the long-axis section of the heart's left compartments (sensitivity 40.7%, specificity 82.9%), and fissural or "coma-like" shape of the mitral orifice.

[Effect of molsidomine on cardiac function in experimental transitory coronary insufficiency]. / Vliianie mol'sidomina na funktsiiu serdtsa pri éksperimental'noi tranzitornoi koronarnoi nedostatochnosti.

Increased resistance of the heart to acute transitory coronary insufficiency under conditions of prophylactic use of molsidomin was demonstrated in experiments on dogs and rats. The agent prevents electric destabilization of the heart. Reduction of pre- and postexertion of the heart is one of the main factors of the protective action of molsidomin. It is suggested that the drug may be included in the complex of measures used in the treatment of patients suffering from anginal and anginal-arrhythmic forms of stable and unstable angina pectoris.