[Stenting in obstructive pathology of pulmonary artery in patients with various forms of congenital heart failure].

A total of 124 stents were implanted to 91 patients with various forms of congenital heart failure for the resolution of obstruction of 111 segments in pulmonary arteries. All these patients were treated in A. N. Bakulev Research Centre of Cardiovascular Surgery in the period from 1994 to 2007. Analysis of observations in early and late postoperative periods indicates that the efficiency of stenting of obstructed pulmonary arteries was 96.4% and the restenosis rate in the follow-up period 3.9%. It is concluded that stenting of pulmonary arteries is an effective and safe method for the management of obstruction problems. In the majority of patients it allows to avoid surgical intervention on pulmonary arteries.

[Quality of life and late outcome of radical correction of Fallot's tetrade after reconstruction of outflow tracts from the right ventricle without plastic surgery on the interventricular septum defect].

Results of radical correction of the Fallot tetrade after reconstruction of outflow tracts from the right ventricle (RV) without plastic surgery on the interventricular septum defect were evaluated in 25 patients aged 5-30 (mean 12.3 +/- 3.8) years in the late postoperative period (1-10, mean 6.5 years). Clinical condition of the patients on the moment of examination was satisfactory, they had no complaints. 14 (56%) patients needed second operation within 2.9 +/- 1.9 (mean) years after primary surgery. It significantly increased the number of patients referred to 1-2 functional classes NYHA (from 56 to 60% and from 28 to 32% respectively). The number of patients of functional class 3 decreased from 12 to 8%). The were no FC-4 patients. Survival rate estimated by the actuarial method was 92% by year 9 postoperatively. 84, 76, 72, 60, and 56% of the patients did not need second operation 1, 2-3, 4, 7, and 9 years respectively after primary surgery due to adequate care in the early postoperative period, timely diagnosis of complications, and their rapid management. It is concluded that radical correction of Fallot's tetrade after reconstruction of outflow tracts has good or satisfactory outcome in 92% of the patients.

[Causes of second operations after surgical treatment of congenital tricuspid valve abnormalities].

Main causes necessitating replacement of tricuspid valve (TV) prosthesis were calcinosis and infectious endocarditis of the bioprosthesis. Second operations after primary reconstructive surgery for the replacement of TV prosthesis were needed when medical indications did not fully justify the use of valve salving surgery by the Danielson's method and in case of procedural errors during surgery by the method of Carpentier in the initial period of mastering these approaches.

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 hepatic Glisson's capsule and bovine pericardium in heart valve bioprostheses.

BACKGROUND AND AIM OF THE STUDY: The optimal material for heart valve bioprostheses remains disputable. This investigation was initiated to compare the properties of hepatic Glisson's capsule, clinical experience of which in cardiovascular surgery is minimal, with those of bovine pericardium. METHODS: Hepatic Glisson's capsule was harvested from bull calves and used to create composite pulmonary arterial monocusp grafts and bioprostheses. Comparison of the strength and elastic properties of Glisson's capsule and bovine pericardium, as well as the hydrodynamic characteristics of valves made from these materials, was performed. Late results of operations using these materials were estimated echocardiographically. RESULTS: Although Glisson's capsule tissue is thinner than the bovine pericardium, its elasticity modulus is greater. However, the hydrodynamic characteristics of heart valves made from either tissue are similar. Moreover, valves made from Glisson's capsule have a lower systolic pressure gradient on the prosthesis and a higher effective orifice area. Composite pulmonary arterial xenopericardial grafts with a monocusp of Glisson's capsule were used in 30 patients during tetralogy of Fallot repair. Glisson's capsule was also used for tricuspid valve reconstruction and as a bioprosthesis in six patients with Ebstein's anomaly. At 1-2 years after surgery, the Glisson's capsule tissue remained thin and flexible, with no calcification. CONCLUSIONS: Although the hydrodynamic properties of hepatic Glisson's capsule and the bovine pericardium are similar, the capsule tissue is thinner and has a greater elasticity modulos. Thus, Glisson's capsule may be used for bioprosthesis construction both independently and in combination with bovine pericardium.