[Ways to improve the results of mitral valve prosthesis by preservation of the posterior cusp with the subcuspal structures]. / Puti uluchsheniia rezul'tatov protezirovaniia mitral'nogo klapana sokhraneniem zadnei stvorki s podstvorchatymi strukturami.

Prosthesing the mitral valve with preservation of the posterior cusp was performed in 156 patients. The domestic disk prostheses "Liks", "Emiks" and the bicuspid prosthesis "Medinzh" were used for the implantation. An additional correction of the tricuspid valve was made in 22 patients. The aortal valve needed the correction in 16 patients. The intrahospital lethality was 2.6%. The preservation of the posterior cusp prevents rupture of the posterior wall of the left ventricle, decreases risk of paraprosthetic fistulas and reduces frequency of the development of acute heart failure.

[Rupture of the posterior wall of the left ventricle after mitral valve prosthesis]. / Razryv zadnei stenki levogo zheludochka posle protezirovaniia mitral'nogo klapana.

Rupture of the posterior wall of the left ventricle took place in 17 (1.2%) out of 1447 patients operated upon for the replacement of the mitral valve. Among them there were 13 13 early and 4 delayed ruptures. The methods used for liquidation of this complication are described. Four patients recovered (2 patients with early, 1 with a delayed rupture and 1 with a developed false aneurysm of the left ventricle). Literature data concerning the prevention of ruptures of the left ventricle and methods of their liquidation are presented.

[The results of the surgical treatment of recurrent mitral stenosis under artificial circulation]. / Rezul'taty khirurgicheskogo lecheniia retsidiva mitral'nogo stenoza v usloviiakh iskusstvennogo krovoobrashcheniia.

A total of 533 operations for recurrent mitral stenosis have been performed since 1987. Two hundred and twenty-six patients were operated on under extracorporeal circulation. Indications for open correction of the abnormality as an alternative to transventricular commissurotomy were defined by echocardiographic studies. In 86 patients, mitral restenosis was accompanied by involvement of other valves: aortic, tricuspid. Mitral prosthesis was required in 216 cases. Valve-preserving operations were made in 10 cases. The hospital mortality was 12.8%, it decreased from 17.5 for the first 126 operations to 7% for the last 100 operations. In isolated restenosis, the hospital mortality rate was 7.8%, it has reduced by 1.8% in the past 2 years. The hospital mortality was 2.4% for 327 transventricular recommissurotomies. There were 20.9% fatal outcomes in restenosis concurrent with other valvular diseases. In mitral-tricuspid stenosis, deaths reduced from 23.8% to 9.5%. The mortality rates decreased from 35.7 to 15.4% in mitral-aortic stenosis and from 33.3% to 18.2% in tricuspid stenosis. High mortality rates in restenosis concurrent with involvement of other valves are mainly related to the baseline status of the patients operated on.

[Plastic correction of aortic stenosis in two- and three heart valve diseases]. / Plasticheskaia korrektsiia aortal'nogo stenoza pri dvukh- i trekhklapannykh porokakh serdtsa.

Plastic correction of aortic stenosis with simultaneous intervention on the mitral and, in some cases, on the tricuspid valve was performed on 50 patients whose ages ranged from 25 to 53 years (average age 43.2 years); 15 were in NYHA functional class III and 35 in class IV. There were 38 females and 12 males. Correction of the aortic stenosis was achieved by open valvulotomy and additional plane resection of the cusps, suture plastic was conducted whenever necessary. In 6 cases calcinates were removed form the cusps simultaneously. Mitral valve prosthetics was undertaken in 42 patients, and open mitral commissurotomy in 8 patients. In 17 patients aortic and mitral stenoses were attended by defect of the tricuspid valve which called for plastic correction. Among the 50 patients who underwent operation 8 (16.0%) died. there were no fatal outcomes among patients related to the NYHA functional class III. In 41 cases the result of aortic stenosis correction was satisfactory, which was confirmed by clinical and echocardiographic data. After the operation, opening of the aortic valve cusps during echocardiography in the M-regimen increased, on average, from 12 +/- 2.0 to 18 +/- 2.6 mm. According to doppler-echocardiogram, the gradient on the aortic valve reduced, on average, from 45 +/- 5.0 to 26.5 +/- 4.0 mm. Only in one female patient aortic incompetence started progressing after the operation and called for prosthetics 6 months later.

[Surgical correction of mitral valve stenosis and its recurrence]. / Khirurgicheskaia korrektsiia mitral'nogo stenoza i ego retsidiva.

The article analyses the results of surgical treatment of 1,394 patients with mitral stenosis who were operated on in the period between January 1, 1986 and April 1, 1989. Hospital mortality was 2.0%. Distinct indications for transventricular commissurotomy and mitral valve prosthetics were determined. The choice of the method for mitral stenosis correction was based on the character of the morphological changes in the cusps and subcuspal structures, which were determined during echocardiographic examination. With proper indications transventricular commissurotomy presents a small risk. Hospital mortality was 0.8% in mitral stenosis (among 1,039 patients who underwent operation 8 died) and 2.5% in recurrent stenosis (among 197 patients 5 died). Lethal outcomes were not encountered in stage 11, the mortality rate was 0.6% in stage III and 2.2% in stage IV. Mitral valve prosthetics was performed in 158 patients with 15 (9.5%) lethal outcomes. Hospital mortality was 4.5% in stage III and 10.3% in stage IV of the disease. In the group of patients with mitral stenosis hospital mortality was 7.5% (93 patients underwent operation). Hospital mortality after operations for recurrent mitral stenosis (65) was 12.3%. The initial severity of the patients' condition is still the main factor which influences unfavorably of the immediate results of mitral valve prosthetics.

[MKCh-25 ball prosthesis in correction of isolated defect of the mitral valve]. / Sharovoi protez MKCh-25 v korrektsii izolirovannogo poroka mitral'nogo klapana.

The article analyses the immediate and late-term results of mitral valve replacement by a MK4-25 ball prosthesis in 605 patients with mitral valvular disease. Operative lethality for the last 100 operations was 6%. The late-term results of valve replacement were studied in 381 patients in follow-up periods of 6 months to 17 years. 17-year survival was 69% among patients who underwent operation in functional class III and 48.8% among those operated on in class IV. The survival of patients and the late-term functional results depended on the duration of the disease and the degree of circulatory insufficiency before the operation. Timely implantation of a ball prosthesis corrects the hemodynamic disorders satisfactorily and improves the survival of patients.

[Results of 30 years' surgical treatment of acquired defects and diseases of the heart]. / Itogi 30-letiiu khirurgicheskogo lecheniia priobretennykh porokov i zabolevanii serdtsa.

A total of 11085 patients have been operated on for rheumatic heart diseases over thirty years, 85.4% of those, for mitral stenosis or its relapse, using the "closed" method (total mortality was 2.7%). In recent years, the mortality rate has dropped to 1.5% in that group of patients. Prevention of heart failure and thromboembolic complications still are the principal problem of mitral commissurotomy. Traumatic regurgitation was seen in 2%. The operation was performed under extracorporeal circulation in 6.2% of patients. Mortality, associated with mitral prosthesis implantation, has decreased threefold (to 10.8%) over 15 years. A total of 131 patients have been operated on for constrictive pericarditis, the mortality rate was 10.7%. Primary implantation of electric pacemaker for complete transverse heart block has been performed in 196 patients, and the generator was replaced in 143 patients.

[Surgical treatment of mitral valve insufficiency]. / Khirurgicheskoe lechenie nedostatochnosti mitral'nogo klapana.

The paper reports on 127 operations on the open heart for mitral incompetence, including 112 prostheses and 15 annuloplasties on the support ring. After operation 28 (22.0%) patients died. Among the operated on patients with stage II-A circulatory insufficiency mortality was 9.3%, in those with stage II-B it was 28.5%. Mortality with mitral valve prosthesis was 24.1%, with annuloplasties 6.7%. The use of hypothermia and pharmaceutical agents for myocardium protection permitted the mortality decrease to 12.1%. The ten-year survival among patients subjected to prosthesis for mitral incompetence was 54.6%, the mortality in patients with stage II-A circulatory insufficiency was 75.4%, and in those with stage II-B it was 40%. The operations for mitral incompetence must be undertaken before the degenerative changes in the myocardium and other organs develop. In mitral competence prosthesis is indicated only in cases where the valve sparing operation is impossible.

[Current problems in the surgical treatment of acquired mitral heart defect]. / Sovremennye problemy khirurgicheskogo lecheniia priobretennogo mitral'nogo poroka serdsta.

The experience of 22 years in the surgical management of patients with mitral valvular disease is discussed. A total of 7,122 operations was carried out, among which 6,810 were performed by the closed method and 244 under conditions of extracorporeal circulation. The principal ways for improving the immediate and late postoperative results are discussed.

[Late results of mitral valve prosthesis]. / Otdalennye rezul'taty protezirovaniia mitral'nogo klapana.

The late results of mitral valve prosthetics were studied in 100 patients one to six years after surgery. Survival which was estimated by the actuarial method was 79.4% (15 patients died 2 to 34 months after the operation). The data obtained confirm the effectiveness of mitral valve prosthetics by means of the Soviet made MKch--25 and MKch--27 protheses. The operation ensures normalization of hemodynamics. Thromboembolic complications and bacterial endocarditis still present a serious problem. Patients with an implanted mitral valve prosthesis should be kept under dispensary surveillance.