[Repair of ventricular septal defects with pericardial xenografts in infants]. / Plastika defekta mezhzheludochkovoi peregorodki zaplatoi iz ksenoperikarda u grudnykh detei.

The article deals with the experience in the clinical use of pericardial xenografts in surgical correction of large ventricular septal defects in babies. Primary closure of the VSD under conditions of hypothermic perfusion at a low volume rate was carried out in 202 children whose ages ranged from 6 weeks to 12 months and body weight from 3.5 to 10 kg. The aorta was not clamped. In 142 patients the defect was closed with xenogenous pericardium treated with 0.6% glutaraldehyde solution on HEPE buffer and 1% sodium dodecyl sulfate solution. A pericardial xenograft treated by Carpantje's method was used before 1985 (59 patients). The hospital mortality rate was 6.4% (13 patients). The mortality rate was 5.1% among patients over 6 months of age and 11% among those under 6 months of age, which is explained by their initially extremely grave condition. The long-term results were studied in 133 patients by bidimensional and Doppler echocardiography. The pressure in the right ventricle was found to be normal (26 +/- 4.3 mm Hg) in all patients. The right- and left-ventricular end-diastolic volumes were normal, just like the ejection fractions (55.4 +/- 6.6 and 57.3 +/- 6.8%, respectively). A small escape of blood at the level of the graft was found in only 5% of patients. Mild incompetence of the tricuspid valve without clinical manifestations was revealed in 18% of patients. In none of the cases, signs of calcinosis or aneurysm of the graft were found, fatal outcomes in the long-term postoperative periods were not encountered.(ABSTRACT TRUNCATED AT 250 WORDS)

[Cardiac function after radical correction of tetralogy of Fallot in infants]. / Funktsiia serdtsa posle radikal'noi korrektsii tetrady Fallo u grudnykh detei.

A total of 20 patients (mean age 8.9 months) were examined after total correction of Fallot's tetralogy, 9 of them underwent transannular plasty and 11, separate right ventricular outflow tract plasty. Two-dimensional and Doppler echocardiographies were used to measure cardiac index, end-diastolic and end-systolic volumes, ejection fraction of the left and right ventricles, regurgitation fraction on the pulmonary and tricuspid valves, right ventricular-pulmonary artery pressure gradient. The study of the immediate postoperative period indicated that the pattern of its course was affected by the type of right ventricular outflow tract plasty, however, its function (ejection fraction) remained diminished in the periods up to 12 months of the operation. Pulmonary valve regurgitation was found to be one of the factors contributing to its diminution.

[Radical correction of tetralogy of Fallot in infants under 1 year of age]. / Radikal'naia korrektsiia tetrady Fallo u detei pervogo goda zhizni.

The article generalizes the experience in surgical treatment of Fallot's tetrad in 20 infants. Radical correction of the anomaly was carried out under extracorporeal circulation and deep hypothermia with reduced volume rate of perfusion. Plastics of the conus arteriosus alone was performed in 6 patients, transanulus and the pulmonary trunk in 4 patients. Two patients died, the hospital lethality was 10%. A clinical effect was produced in all the other patients. The relation of systolic pressure in the left ventricle to that in the right ventricle was 0.56 +/- 0.1, the systolic pressure gradient between the right ventricle and the pulmonary artery was 18 +/- 4.2 mm Hg. Various degree of regurgitation at the pulmonary valve was revealed after the operation in all patients. It was maximum (34 +/- 10%) in transanulus plastics.

[Echocardiographic evaluation of hemodynamics and myocardial function in children under 1 year of age following surgery under conditions of artificial blood circulation]. / Ekhokardiograficheskaia otsenka gemodinamiki i funktsii miokarda u detei pervogo goda zhizni posle operatsii v usloviiakh iskusstvennogo krovoobrashcheniia.

Left and right ventricular myocardial contractility was assessed, using two-dimensional echocardiography in the earliest postoperative period after cardiopulmonary bypass surgery in 60 children under 1 year of age. It has been shown that a hemodynamically smooth postoperative period is characterized by a 36 to 40% decrease in left ventricular ejection fraction depending on the type of heart valve defect and the variant of its correction. Such a decrease in contractility required a slight inotropic support in the first 24 hours after the operation; in this case cardiac index exceeded 2.5 l.min-1.m-2 already in the first postoperative hours. By day 15 after the operation cardiac index and ventricular contractility are fully normalized, but for cases when correction is of hemodynamic and not of anatomic nature or is accompanied by myocardial injury.

[Surgical treatment of congenital heart defects with pulmonary hypertension in children during their 1st year of life under the conditions of extracorporeal circulation]. / Khirurgicheskoe lechenie vrozhdennykh porokov serdtsa s legochnoi gipertenziei u detei pervogo goda zhizni v usloviakh isskusstvennogo krovoobrashcheniia.

In the period between 1983 and 1987 operations were carried out on 204 children aged from 25 days to 12 months (body weight of 3 to 10 kg) for congenital heart diseases and pulmonary hypertension. Surgery for ventricular septal defect was undertaken on 173 patients (total mortality 6.9%), transposition of the major vessels with concurrent ventricular septal defect was corrected by Senning's method in 9 patients (mortality 11%), total anomalous pulmonary vein drainage was relieved in 14 patients (mortality 28.6%). No fatal outcomes occurred in correction of an aorto-pulmonary fistula, origin of the aorta and pulmonary artery from the right ventricle, and a common ventricle. In all patients, with the exception of 4 (2 with secondary and another 2 with primary pulmonary hypertension), pressure in the pulmonary artery reduced significantly.

[The surgical treatment of congenital heart defects in neonates and infants without using invasive study methods]. / Khirurgicheskoe lechenie vrozhdennykh porokov serdtsa u novorozhdennykh i grudnykh detei bez invazivnykh metodov issledovaniia.

Echocardiographic analysis of 328 closed operations for aortic coarctation, patent ductus arteriosus, and congenital heart disease of the blue type with lower pulmonary flow in infants of the first year of life revealed diagnostic errors in 6 (2%) patients, this resulting in death of two patients. Surgery for congenital heart disease, which is based on the echocardiographic data without invasive diagnostic methods, requires proper patient selection. Quantitative two dimensional echocardiography allowed for higher accuracy of the preoperative diagnosis. Introduction of Doppler echocardiography made it possible to perform successful operations with assisted circulation in 16 patients for ventricular septal defects, atrial septal defect, transposition of great arteries, atrioventricular communication.