[One and a half ventricular correction in the surgical treatment of congenital heart failure].

Fifty four operations of one and a half ventricular correction were made for the treatment of congenital heart failure (CHF) in 1999-2006. Age of the patients varied from 1 yr 3 mo to 29 yr. Indications to the use of this method are discussed along with analysis of its role in the surgical treatment of CHF. Two-directional cavopulmonal anastomosis in certain complex forms of CHF reduced volume load on the right ventricle and thereby promoted success of its radical correction. One and a half ventricular correction involved the hypoplastic and functionally compromised right ventricle and pulmonary circulation and therefore created more favourable conditions for circulation.

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.

Comparative assessment of Fontan operation in modifications of atriopulmonary and total cavopulmonary anastomoses.

OBJECTIVES: The optimal technique of the Fontan operation remains disputable. This investigation was aimed at the comparison of atriopulmonary and total cavopulmonary anastomoses. METHODS: The results of 81 operations of total cavopulmonary and 69 operations of atriopulmonary anastomosis, performed from 1983 to 1995 were analysed. A control study was carried out 1-10 (3.7 + 0.2) years after the operation in 80 patients (36 after total cavopulmonary and 44 after atriopulmonary anastomoses). 70 patients were studied several times. Cardiac catheterization was done in 70 patients. In 78 patients central hemodynamical indices were studied during exercise. RESULTS: Preoperative hemodynamical indices were not reliably different in the two groups. Early mortality after total cavopulmonary anastomosis was 15%, after atriopulmonary anastomosis 23%. The highest mortality was seen when the criteria of Choussat et al. (Choussat et al. Pediatric Cardiology. Edinburgh: 1977:559-566) were surpassed. In the early postoperative period after total cavopulmonary anastomosis circulatory insufficiency was less marked, transsudation from pleural cavities was reliably lower (15.3 + 1.2 versus 25.5 + 1.8 ml/kg/day, P < 0.01). Arrhythmias were more common after total cavopulmonary anastomosis (18.5 versus 12%). Late mortality after total cavopulmonary anastomosis was 6%, after atriopulmonary anastomosis 12%. 82% of patients after atriopulmonary anastomosis and 81% after total cavopulmonary anastomosis were in NYHA classes 1 and 2.7% of patients after total cavopulmonary anastomosis and 11% after atriopulmonary anastomosis were reoperated. Physical tolerance rose stepwise in both groups and by the third post-operative year reached 75% of normal level. At this time we saw the most optimal hemodynamical indices during exercise. However, the best hemodynamics during exercise were seen after atriopulmonary anastomosis. CONCLUSIONS: Total cavopulmonary anastomosis is accompanied by lower mortality rate and a more favourable course of early postoperative period. However, the best long-term functional results are obtained after atriopulmonary anastomosis.

Surgical reinterventions after modified Fontan operations.

BACKGROUND: Surgical reinterventions after Fontan operations are still associated with high mortality. This investigation aims to summarize our experience with such repeated operations and to assess their efficacy. METHODS: In 1983 through 1995 we performed 162 different modifications of Fontan operation. Repeated interventions were needed in 15 cases (9%). An analysis of all these cases is presented. RESULTS: Repeated operation consisted of the closure of residual interatrial communication (3 patients), atrioseptostomy (4), subaortic stenosis resection (1), pulmonary balloon valvuloplasty (1), embolization of residual right ventricular-pulmonary arterial communication (1), pericardectomy (2), pleurectomy (1), pacemaker implantation (1), and takedown of the Fontan operation (1). The results of operation were judged as good in 6 cases (40%) and as satisfactory in 5 (33%); 4 patients (27%) died. CONCLUSIONS: Repeated interventions aimed at the elimination of technical errors of the Fontan operation are successful in most cases. Atrial septostomy gives good results in the absence of anatomic causes of cardiac failure such as subaortic obstruction and atrioventricular valve insufficiency.

[Bidirectional cava-pulmonary anastomosis in complex congenital heart defects]. / Dvunapravlennyi kavapul'monal'nyi anastomoz pri slozhnykh vrozhdennykh porokakh serdtsa.

An operation for bidirectional cava-pulmonary anastomosis was performed in 11 patients. Anatomical correction could not be made due to the multiple pattern and complexity of the malformation. None of them was, however, an ideal candidate for hemodynamic correction either. The authors took into account not only anatomical and hemodynamic contraindications for Fontana's operation, but the latter was not performed when the patient's status was grave (severe hypoxemia). The operation was made under extracorporeal circulation and hypothermia. In addition to bidirectional cava-pulmonary anastomosis, dilation of the intraatrial junction, pulmonary artery plasty, etc. were conducted in some cases. Bilateral bidirectional cava-pulmonary anastomosis was performed when an accessory vena cava superior was present. Nine patients benefited from the operation. There was a significant health improvement and a substantial increase in arterial blood oxygen saturation. Four patients underwent a repeated examination one year after surgery. The anastomosis was found to function well.

[Assessment of patients' condition by noninvasive methods of examination in the follow-up after Fontan's operation in atresia of the right atrioventricular ostium]. / Otsenka sostoianiia bol'nykh s pomoshch'iu neinvazivnykh metodov issledovaniia v otdalennye sroki posle operatsii Fontena pri atrezii pravogo atrioventrikuliarnogo otverstiia.

The article discusses the results of using noninvasive methods to study the condition of patients (20) in late-term periods after Fonten's operation in atresia of the right atrioventricular orifice. All patients were subjected to physical examination, electro-, phono- and echocardiography, radiological examination, radioisotope scintigraphy, and left ventriculography. Most patients change to functional class I in the late-term periods after the operation. Though the patients have a sense of well being, the left-ventricular pumping and contractile functions remain disturbed. A tendency towards gradual improvement of these parameters is noted, however. The right atrium is enlarged and its myocardium hypertrophied. Its overexertion increases significantly in physical loading. The blood flow in the lungs becomes normal gradually. The results of various noninvasive methods correlate with one another and with the results of angiocardiography. This allows in some cases to avoid intracardiac examination which presents a certain risk, especially in the first one-two years after Fonten's operation when the mechanisms of cardiac activity compensation are still weak.

[Functional assessment of the state of patients after Fontan's operation]. / Funktsional'naia otsenka sostoianiia bol'nykh posle operatsii Fontena.

A bicycle ergometric test was performed in 27 patients 2.5 months to 5 years after Fontana's operation in order to study their physical working capacity and major parameters for cardiac pump and contractile functions by tetrapolar chest rheography and those for external respiration. In the early periods following the surgery, the patients showed a low physical working capacity with a respective reduction in the pump and contractile functions of the heart. In the late periods, in addition to positive clinical dynamics, there was an improvement of functional parameters for the cardiorespiratory system. The status in the majority of patients was steady-state for more than 2 years after the surgery.

Fontan-type operation for correcting complex congenital defects in a criss-cross heart.

Three cases of criss-cross heart with severe and complex congenital defects are reported. Precise preoperative diagnosis of the morphologic abnormalities made it possible to choose an optimal method of surgical treatment: all patients successfully underwent a Fontan-type surgical procedure.

[Total cavo-pulmonary anastomosis in the surgery of complicated congenital heart defects]. / Polnyi kavopul'monal'nyi anastomoz v khirurgii slozhnykh vrozhdennykh porokov serdtsa.

The authors discuss experience in 8 operations for total cavo-pulmonary anastomoses in patients with various complicated congenital heart anomalies in which radical or anatomical correction could not be undertaken. The operation for total cavo-pulmonary anastomosis is an alternative of Fonten's method since many authors claim that the last-named has some shortcomings. Total cavo-pulmonary anastomosis was established in 4 stages under conditions of extracorporeal circulation. End to side cavo-pulmonary anastomosis was formed in the first stage; the proximal end of the divided superior vena cava was joined to the pulmonary artery in the second stage; the communication between the heart and pulmonary artery was closed in the third stage, and, finally, a tunnel was formed between the inferior and superior venae cavae by means of a xenopericardial flap in the fourth stage. Six patients tolerated the operation successfully. The immediate postoperative period was more favourable than after Fonten's operation. However, to come to a deeper general conclusion and compare the two methods clinical material must be accumulated and the long-term results of the operations studied.

[Risk factors in Fontan's operation]. / Faktory riska pri operatsii Fontena.

The results of Fontan's procedure performed in 51 patients with various congenital heart defects were analysed. The procedure was found to have the following risk factors: the total lung resistance is above 4 mu/m2, the ejection fraction of the arterial ventricle, under 55%, serious concomitant heart defects, and additional surgical procedures that increase the scope of surgical interventions. The best results were obtained after creating a valveless atriopulmonary anastomosis; the poorest results were associated with a right atrium-pulmonary trunk anastomosis possessing its own valve.

[Methods for the hemodynamic correction of the single heart ventricle]. / Metody gemodinamicheskoi korrektsii edinstvennogo zheludochka serdtsa.

Experience with hemodynamic correction of the only heart ventricle is presented. Four operations have been performed: plastic closure of the right atrioventricular opening and formation of a direct right atrial--pulmonary anastomosis using a pericardial autograft patch in 3 patients, and the suture of atrioventricular opening with the formation of an anastomosis between the right atrium and the pulmonary artery, using an avalvular prosthesis, in 1 patient. The results are quite satisfactory in all cases.

[Correction of tricuspid valve atresia using direct right atrium to right ventricle and right atrium to pulmonary artery anastomoses]. / Korrektsiia atrezii trekhstvorchatogo klapana s pomoshch'iu priamykh anastomozov pravogo predserdiia s pravym zheludochkom i pravogo predserdiia s legochnoi arteriei.

Some aspects of the surgical control of tricuspid valve atresia by means of establishing direct communication between the right atrium and the right ventricle or the right atrium and the pulmonary artery are discussed. Six operations have been performed: atrioventricular anastomoses in 3 cases and atrio-pulmonary anastomoses in the other 3, with the pulmonary trunk being joined to the right atrium sparing the pulmonary-arterial valves in one of the latter cases. One patient with a complex of congenital valvular defects died postoperatively from acute heart failure, which may have developed as a result of the newly-established anastomosis being compressed by the breast bone. In the rest, surgical results were quite satisfactory.