[The surgical treatment of heart defects in active infectious endocarditis]. / Khirurgicheskoe lechenie porokov serdtsa pri aktivnom infektsionnom éndokardite.

AIM: To elucidate significance of early diagnosis and results of surgical treatment of valvular defects in active infectious endocarditis (AIE). MATERIALS AND METHODS: Surgical outcomes were analyzed for 437 AIE patients with active AIE. The operation was made 10 months, on the average, after AIE onset. RESULTS: Total hospital lethality made up 11.2%. Total 5-year survival with account for hospital death was 77-80% in replacement of one valve and 61.6% in replacement of two valves (mitral and aortic). In natural course of the disease it was 16%. CONCLUSION: There was a direct relationship between hospital lethality and admission condition of the patients, advance of the inflammation. This urges early AIE detection and performance of operation before development of irreversible changes in the myocardium and other organs.

[Active valvular infective endocarditis: problems of surgical treatment]. / Aktivnyi klapannyi infektsionnyi éndokardit - voprosy khirurgicheskogo lecheniia.

The authors analyze the results of surgical treatment of patients suffering from active endocarditis with impairment of the mitral, aortal and tricuspid valves and their combinations in 242 patients operated on during 1969 to 1989. The total hospital mortality is at the level of world statistics and constitutes 15.3% (37 patients died). The main cause of the hospital mortality was acute progressive heart failure (48.6%). The long-term results of the surgery were examined in 202 patients. By the 5th observation year the total survival was 73.2%, the stability of good results 83.6%. The defined grades of the activity of infectious process play an important role in the diagnosis and treatment of patients with active valvular infectious endocarditis.

[Surgical treatment of mitral and tricuspid valve defects]. / Khirurgicheskoe lechenie mitral'no-trikuspidal'nykh porokov serdtsa.

The results of surgical treatment of 265 patients with mitral-tricuspid valvular diseases are analysed. The operations were carried out in the period from Jan. 1, 1977 to Jan. 1, 1990 with various plastic procedures on the tricuspid valve. Hospital mortality was 13.2%. The late-term results were studied in follow-up periods of 6 months to 12 years in 207 (90%) patients. The results were good in 187 (75.9%), satisfactory and poor in 28 (13.5%) patients; 22 (10.6%) patients died. With the hospital losses taken into account, 5-year survival came to 73% and 10-year survival to 54%. Stability of good postoperative results was 79% by the 5th year and 49% by the 10th year. Among the surviving patients 85% are related to functional classes I and II and lead an active life. Plastic operations on the tricuspid valve can be undertaken in 92% of patients with mitral-tricuspid valvular diseases; they produce good late-term results in most cases, ensure stable normalization of hemodynamics, and should be performed more often in clinical practice.

[Reoperations after insertion of heart valve prosthesis]. / Povtornye operatsii posle protezirovaniia klapanov serdtsa.

The authors analysed 167 repeated operations after heart valve prosthetics, which were conducted from 1978 to 1988. The operations were undertaken for the second time mainly in a severe contingent of patients. The reasons for the repeated operations were specific complications according to which 2 groups of patients were set apart: with dysfunction of the prosthesis of noninfectious origin and with prosthetic endocarditis. Study showed that repeated operative intervention undertaken in time reduces considerably its risk and produces a stable positive effect in most cases.

[Choice of the correction method and results of surgery in patients with mitral, aortic and tricuspid defects of the heart]. / Vybor metoda korrektsii i rezul'taty operatsii u bol'nykh s mitral'no-aortal'no-trikuspidal'nymi porokami serdtsa.

The article analyses the results of surgical correction of tri-valvular heart diseases in 132 patients who were operated on between January, 1973 and March, 1986. Total hospital mortality was 20.4%. Among the last 72 operations conducted from January, 1980 hospital mortality amounted to 14.0% (10 patients died). The results of the operations were approximately the same in the different methods of correction: 105 patients were studied in late follow-up periods (from 6 months to 14 years). With consideration for the hospital losses, by the 7th year of follow-up the survival after prosthetic replacement of 3 valves was 61.8%, after replacement of the mitral and aortic and valvuloplasty of the tricuspid valve--60.6 degrees. The stability of good results was 59.6 and 58.1%, respectively. Among and analogous group of patients who received drug treatment survival by the 7th year was 28.1%, which is evidence of the obvious advantages of the surgical method of treatment. The results were best in patients subjected to plastic operations on two and three valves.

Surgical treatment of infective endocarditis in the active stage.

The study summarizes the results of surgical treatment of active infective valvular endocarditis (IE) in two cardiac surgical centres in Hungary and the Soviet Union between 1969-1987. Most (92.9%) of the 241 patients operated on were in severe condition pre-operatively (NYHA Class III and IV), their mean age was 38.2 years. The infectious process was localized predominantly on the aortic valve (169 patients), and developed on previously normal valves in 151 patients. Hospital mortality was 17%, the underlying cause of death was often heart failure, sometimes associated with sepsis. Late mortality was 12.5% (25 patients), only six of these patients died of recurrent infection. The authors stress the high efficacy of surgical treatment of active valvular IE.

[Possibilities of cardiac surgery in the treatment of active valvular infectious endocarditis]. / Vozmozhnosti kardiokhirurgii v lechenii aktivnogo klapannogo infektsionnogo éndokardita.

The results of surgical treatment of 142 patients with active valvular infectious endocarditis are reviewed. Hospital mortality was 15.5% (22 patients died). Follow-up covered 6 months to 14 years (with an average of 3.5 years) in 108 patients. Ten (9.3%) patients died over this period, and 11 (10.2%) showed indifferent or poor results of surgery. Within 5 years, total survival rate was 74.4%, including hospital mortality, and good late results were seen in 76.8% of the discharged patients. Surgical treatment of active valvular infectious endocarditis is shown to be a fairly effective method and should be used on a larger scale in clinical practice.

[Surgical treatment of multiple heart valve defects]. / Khirurgicheskoe lechenie mnogoklapannykh porokov serdtsa.

The article deals with the study of problems of the surgical treatment of patients with multivalvular heart diseases. Problems of myocardial protection, the methods for correcting tricuspid disease, and the attitude towards attendant valvular diseases depending on their severity are discussed on the grounds of the analysis of hospital fatality rate in a group fo 505 patients who underwent one-stage correction of two or three defective heart valves and the appraisal of late results. Analysis of the late results indicates that a more radical approach to the surgical treatment of mitral valvular disease is necessary and that marked relative insufficiency and all forms of organic tricuspid disease must be corrected without fail.