[MODERN VIEWS OF MITRAL INSUFFICIENCY OF ISCHEMIC ORIGIN].

Recent data on the prevalence, mechanisms of development, clinical course, and methods of treatment of mitral insufficiency of ischemic origin are presented.

[Successful correction of congenital heart defects: multiple defects and atrial septal aneurysm].

A case of congenital cardiac disorder with multiple defects in the secondary interventricular septum and atrial septum aneurysm in a young serviceman is reported. Plastic surgery of the atrial septum with a good clinical outcome included closure of the defect with a flap harvested from the autopericardium under conditions of artificial blood circulation and warm blood cardioplegia.

[Successful correction of arterial fistula between coronary arteries and pulmonary trunk].

A case of congenital heart disease (fistula between left coronary artery and right pulmonary artery, right coronary artery and pulmonary trunk) diagnosed accidentally during planned medical examination is reported. Corrective surgery included disconnection of left coronary and right pulmonay arteries, right coronary artery and pulmonary trunk under artificial circulation and warm blood cardioplegia.

[Surgical treatment of coronary heart disease in elderly patients].

Current approaches to the provision of effective medical aid to elderly patients with cardiovascular diseases are discussed. Clinical characteristics of such patients, concomitant pathologies, the strategy and extent of cardiosurgical treatment and postoperative therapy are described The original observations are compared with literature data concerning the immediate postoperative outcomes, clinical features, and peculiarities ofsurgical intervention in the patients of this age group.

[Plastic surgery of the mitral valve in patients with coronary heart disease].

Modern approaches to cardiosurgical plastic intervention on the mitral valve in case of its ischemic insufficiency are discussed. Etiology of this condition, indications for surgery, and the history of such operations are described. It is concluded that plastic surgery of the mitral valve is the method of choice for the treatment of patients with coronary heart disease.

[Stenosis of the trunk of left coronary artery: state-of-the-art].

Coronary artery bypass grafting (CABG) is traditionally considered to be the "golden standards" of treatment for patients with the affected trunk of left coronary artery (LCA) due to its good early and late outcome, low mortality rate and frequency of repeat surgery. This fact is well documented as reflected in relevant guidelines of European and American scientific societies. However, the recent years have witnessed markedly extended application of drug-coated stents despite the fact that immediate and delayed results of such treatment need more comprehensive verification. This review is focused on the evaluation of advisability of using drug-coated stents to manage lesioned LCA based on the results of randomized studies in comparison with CABG and percutaneous transluminal coronary angioplasty. An optimal method for the treatment of the affected LCA trunk is proposed based on the available data. It is concluded that CABG remains the method of choice for the treatment of this pathology (in the absence of contraindications) ensuring good early and late outcome, low mortality rate and necessity of repeat surgery.

[Revascularization of myocardium: coronary artery bypass grafting or stenting?].

The aim of the study was comparative analysis of long-term results (5 years) after coronary angioplasty and stenting (CAS) and coronary artery bypass grafting (CABG). The results of the treatment of 1100 patients with coronary heart disease, operated since 1999 to 2006 year, were analyzed. 720 (65.5%) patients had undergone CABG (group 1), 226 (20.5%) had had an implantation of stents with pharmaceutical coverage (group 2) 154 (14%) had been implanted with stents without pharmaceutical coverage (group 3). Clinical examination as a rule had occurred before operation, 29-30 days after operation and in every 12 months after discharge from the hospital. Five years survival rate in group of CABG patients was 85.9% and in groups of CAS patients it was 84.1% and 70.8% respectively. Restenosis occurred more frequently in CAS patients: in group 2 in 18.1% patients, in group 3--in 70.1% In group of CABG patients acute myocardial infarction occurred in 11.9% cases to the end of 5th year, in groups 2 and 3 this index was 10.9% and 18.3% respectively. Angina pectoris was absent in 1 year in CABG patients (62%) than in CAS patients (46.7% and 24.3% in groups 2 and 3 respectively; p < 0.05). Comparing results of CAS with use of stents with and without pharmaceutical coverage, the best clinical result was in the group with implanted stents of new generation. Relatively better clinical effect during 5 years occurred in CABG patients.

Virtual reality simulator training equals mechanical robotic training in improving robot-assisted basic suturing skills.

BACKGROUND: This study aimed to investigate the effect of a virtual reality simulator on the learning of basic robotic suturing skills. METHODS: Two randomized groups of students underwent a controlled training program. Both groups completed an identical test before and after training. The increase in the number of stitches placed during the pretest and posttest was used as an objective measure of the training effect. To evaluate the subjective feeling of understanding and mastering, the students indicated this on a visual analog scale. RESULTS: Both groups showed a significant increase in the number of stitches placed during the posttest, and an increase in subjective feeling of understanding and mastering. The increase did not differ between the groups, indicating that the virtual reality simulator equaled the mechanical trainer in training of robotic suturing technique. CONCLUSIONS: Training in basic robot-assisted suturing skills using a virtual reality simulator without additional training equaled training using a mechanical simulator.

[Surgical treatment of aneurysms of unpaired visceral branches of the abdominal aorta]. / Khirurgicheskoe lechenie anevrizm neparnykh vistseral'nykh vetvei briushnoi aorty.

Aneurysms of unpaired visceral branches of the abdominal aorta are rare diseases but they are dangerous for life. Russian Research Center of Surgery RAMS has an experience of diagnosis and surgical treatment of 23 patients with aneurysms of the celiac trunk (2), superior mesenteric artery (4), inferior mesenteric artery (1), hepatic artery (4), splenic artery (7), gastroduodenal artery (2), inferior pancreatoduodenal artery (1), multiple aneurysms of celiac trunk and superior mesenteric artery (2). 21 of 23 patients were operated. 20 patients were discharged with complete recovery. 1 (4.8%) patient died due to gastroduodenal bleeding 4 months after surgery. The results show that patients with aneurysms of unpaired visceral branches of abdominal aorta require surgical treatment.