[Early and long-term results after the Norwood procedure]. / Rannie i otdalennye rezul'taty posle protsedury Norvud.

OBJECTIVE: To assess the early and long-term results after the Norwood procedure and to identify predictors of aortic recoarctation and arterial hypertension. MATERIAL AND METHODS: We have operated on 2789 infants in the department of congenital heart diseases of the Meshalkin National Medical Research Center between January 2015 and December 2018. The current single-center prospective cohort study included 39 (1.4%) patients with hypoplastic left heart syndrome who underwent the Norwood procedure. RESULTS: In-hospital mortality was 15.3% (n=6). An inter-stage mortality was 10.2% (n=4). Recoarctation of the aorta and Sano shunt stenosis in inter-stage period occurred in 8 (24.2%) and 4 patients (12.1%), respectively. Body mass <3 kg was the only risk factor of recoarctation (OR 7.08, 95% CI 1.17; 42.79, p=0.033). We found no risk factors of Sano shunt stenosis. There were no signs of recoarctation and Sano shunt dysfunction in the early postoperative period. Arterial hypertension developed in 14 (48.3%) patients. We found the correlation between systolic blood pressure and ventricular ejection fraction (ß coefficient -0.88, 95% CI -1.33; -0.44, p=0.001). The only risk factor of arterial hypertension was increased stiffness of the aorta. CONCLUSION: The early and inter-stage mortality are still the issues after the Norwood procedure. Postoperative reduced ejection fraction of single ventricle is one of the most common complications that could be related with residual arterial hypertension.

[Diverticula and Congenital Aneurysms of the Left Ventricle: Anatomical Features, Pathophysiology, Clinical Presentation and Treatment Strategy].

Congenital aneurysms and diverticula of the left ventricle represent a rare group of anomalies in the spectrum of congenital heart disease. Although natural histories of these anomalies are considerably different and characterized by different rates of lifethreatening events, similarity of their clinical presentation and diagnostic criteria do not allow to differentiate this anomalies at routine examination. Data on etiology, methods of diagnosis and treatment published by various authors is controversial. In this review we present relevant aspects of etiology, pathophysiology and treatment strategy of patients with left ventricular diverticula and congenital aneurysms.

[Transarterial and transvenous embolization of deep binodal arteriovenous malformation of the brain].

INTRODUCTION: The multimodal approach to treatment of arteriovenous malformations yields good results. However, small and deep malformations still pose a big problem for surgeons. Transvenous embolization was designed as an alternative for the cases when endovascular treatment is required and conventional transarterial embolization is not available. CASE STUDY: A 41-year-old patient with binodal malformation in the subcortical nuclei of the left hemisphere of the brain, which had previously become a source of massive parenchymal ventricular hemorrhage, was operated on using the transarterial and, for the first time in our clinic, transvenous approaches. Transarterial embolization of the thalamic node of malformation was performed as the first step. After 6 months, transvenous embolization of the hypothalamic node of malformations was performed as the second step. Successful operation was ensured by using a stable coaxial guiding catheter system with the maximum distal approach and intranidal positioning of a microcatheter with detachable distal portion upon temporary occlusion of afferent vessels of the malformations using a balloon catheter. The operation resulted in total thrombosis of the malformation. No perioperative complications were observed. Control examination in 6 months did not reveal recanalization of the malformation. CONCLUSION: The transvenous approach can be successfully used in endovascular treatment of small and deep arteriovenous malformations with a single drainage vein, which are inaccessible to direct surgery. It can also be used when radiosurgery is associated with a high risk in cases where transarterial embolization is infeasible.

[Surgical treatment of aortic arch malformations in infants under cardiopulmonary bypass].

AIM: To evaluate long-term results and the causes of complications in congenital obstructive pathology of the aortic arch. MATERIAL AND METHODS: Retrospective study enrolled 62 patients aged 55 ± 14 days who underwent aortic arch surgery under cardiopulmonary bypass. It was compared two methods of aortic archplasty: use of xenopericardial material in group 1 and Rajasinghe's autoplastic method in group 2. RESULTS: Follow-up was 42 ± 14 months. In the long-term recoarctation occurred in 7 (13.7%) cases including 6 (18.75%) patients in group 1 and one (3.3%) patient in group 2. Residual hypertension was observed in 12 (23.5%) cases including 10 (37%) patients in group 1 and 2 (8.3%) patients in group 2. Six (50%) patients receive antihypertensive therapy, 5 (41.6%) patients who receive antihypertensive drugs have persistent increase of blood pressure without evidence of anatomic aortic obstruction. Hypertensive response to functional tests was observed in one patient. CONCLUSIONS: Aortic arch reconstruction using autoplasty is associated with lower risk of recoarctationand residual hypertension compared with xenopericardial patch application.

[Results of surgical treatment of the anomalous origin of the left coronary artery from the pulmonary trunk].

The experience of the federal medical center of the surgical treatment of small patients with the anomalous origin of the left coronary artery from the pulmonary trunk was analyzed. The early surgical treatment, directed at the reconstruction of the two sources of myocardial blood supply together with the standard use of "calcium sensitizer" ("Levosimendan") decrease the lethality to 6.6% without the use of extracorporeal membrane oxygenation. The restoration of the ischemized left ventricle after the correction and improvement of the concomitant mitral valve insufficiency were dynamically assessed in early postoperative terms.