[Transluminal balloon valvuloplasty in the treatment of congenital critical aortic valve stenosis in infants in the 1st year of life]. / Transliuminal'naia ballonnaia val'vuloplastika v lechenii vrozhdennogo kriticheskogo klapannogo stenoza aorty u detei 1-go goda zhizni.

Balloon valvuloplasty was performed in 14 patients with congenital valvular aortic stenosis. Their age was 28 days to 12 months. All the patients had severe heart failure. Balloon valvuloplasty was successfully conducted in 8 patients. The systolic pressure gradient between the aorta and the left ventricle decreased, on the average, from 81.2 +/- 21.4 to 31.3 +/- 8.2 mm Hg, i.e. by 61.5%. Only 2 patients developed moderate aortic insufficiency after balloon valvuloplasty. The left ventricle could not be catheterised in 6 infants: in 4 patients due to critical valvular stenosis, in 2 due to a. lusoria. One of them died when the guide was attempted to be introduced through the narrowed aortic valve, which resulted in aortic sinus perforation. Long-term results were studied in 4 patients 3 to 24 months after surgery. Their clinical condition improved. The systolic pressure gradient between the left ventricle and the aorta was in agreement with the values obtained just after transluminal balloon valvuloplasty. Transluminal balloon valvuloplasty can be successfully performed in 1-year-old infants with congenital critical aortic valvular stenosis and yields good immediate results. A further accumulation of clinical findings, development of procedures for transluminal balloon valvuloplasty and study of long-term results will allow indications for this tool to be worked out in this group of patients.

[Surgical tactics in critical stenosis and atresia of the pulmonary artery with intact interventricular septum in infants under 1 year of age]. / Khirurgicheskaia taktika pri kriticheskom stenoze i atrezii legochnoi arterii s intaktnoi mezhzheludochkovoi peregorodkoi u detei 1-go goda zhizni.

The article analyses experience in surgical treatment of critical stenosis and atresia of the pulmonary artery with an intact interventricular septum in 53 infants. The patients were divided into two groups: group A--26 patients with a hypoplastic cavity of the right ventricle (RV), and group B--27 patients with a normal RV cavity. In group A, 15 patients underwent transpulmonary valvulotomy in combination with subclavian-pulmonary anastomosis by means of a Gortex prosthesis, 6 were subjected to isolated transpulmonary valvulotomy, and 5 patients underwent reconstruction of the RV outlet tract under conditions of extracorporeal circulation. In group B, 3 patients were treated by transpulmonary valvulotomy and subclavian-pulmonary anastomosis with a Gortex prosthesis, 16 by isolated valvulotomy, and 8 patients by reconstruction of the RV outlet tract under extracorporeal circulation. Six (22.2%) patients in group B died; 18 (69.2%) patients in group A died. Experience shows that in patients with critical stenosis of the pulmonary artery without RV hypoplasia preference is given to transpulmonary valvulotomy with occlusion of the venae cavae or, in marked infundibular stenosis of the RV--to reconstructive operation on the RV outlet tract under conditions of extracorporeal circulation. Transpulmonary valvulotomy in combination with subclavian-pulmonary anastomosis is advisable in patients with atresia or critical stenosis of the pulmonary artery and RV hypoplasia.

[Repair of ventricular septal defects with pericardial xenografts in infants]. / Plastika defekta mezhzheludochkovoi peregorodki zaplatoi iz ksenoperikarda u grudnykh detei.

The article deals with the experience in the clinical use of pericardial xenografts in surgical correction of large ventricular septal defects in babies. Primary closure of the VSD under conditions of hypothermic perfusion at a low volume rate was carried out in 202 children whose ages ranged from 6 weeks to 12 months and body weight from 3.5 to 10 kg. The aorta was not clamped. In 142 patients the defect was closed with xenogenous pericardium treated with 0.6% glutaraldehyde solution on HEPE buffer and 1% sodium dodecyl sulfate solution. A pericardial xenograft treated by Carpantje's method was used before 1985 (59 patients). The hospital mortality rate was 6.4% (13 patients). The mortality rate was 5.1% among patients over 6 months of age and 11% among those under 6 months of age, which is explained by their initially extremely grave condition. The long-term results were studied in 133 patients by bidimensional and Doppler echocardiography. The pressure in the right ventricle was found to be normal (26 +/- 4.3 mm Hg) in all patients. The right- and left-ventricular end-diastolic volumes were normal, just like the ejection fractions (55.4 +/- 6.6 and 57.3 +/- 6.8%, respectively). A small escape of blood at the level of the graft was found in only 5% of patients. Mild incompetence of the tricuspid valve without clinical manifestations was revealed in 18% of patients. In none of the cases, signs of calcinosis or aneurysm of the graft were found, fatal outcomes in the long-term postoperative periods were not encountered.(ABSTRACT TRUNCATED AT 250 WORDS)

[Cardiac function after radical correction of tetralogy of Fallot in infants]. / Funktsiia serdtsa posle radikal'noi korrektsii tetrady Fallo u grudnykh detei.

A total of 20 patients (mean age 8.9 months) were examined after total correction of Fallot's tetralogy, 9 of them underwent transannular plasty and 11, separate right ventricular outflow tract plasty. Two-dimensional and Doppler echocardiographies were used to measure cardiac index, end-diastolic and end-systolic volumes, ejection fraction of the left and right ventricles, regurgitation fraction on the pulmonary and tricuspid valves, right ventricular-pulmonary artery pressure gradient. The study of the immediate postoperative period indicated that the pattern of its course was affected by the type of right ventricular outflow tract plasty, however, its function (ejection fraction) remained diminished in the periods up to 12 months of the operation. Pulmonary valve regurgitation was found to be one of the factors contributing to its diminution.

[Radical correction of tetralogy of Fallot in infants under 1 year of age]. / Radikal'naia korrektsiia tetrady Fallo u detei pervogo goda zhizni.

The article generalizes the experience in surgical treatment of Fallot's tetrad in 20 infants. Radical correction of the anomaly was carried out under extracorporeal circulation and deep hypothermia with reduced volume rate of perfusion. Plastics of the conus arteriosus alone was performed in 6 patients, transanulus and the pulmonary trunk in 4 patients. Two patients died, the hospital lethality was 10%. A clinical effect was produced in all the other patients. The relation of systolic pressure in the left ventricle to that in the right ventricle was 0.56 +/- 0.1, the systolic pressure gradient between the right ventricle and the pulmonary artery was 18 +/- 4.2 mm Hg. Various degree of regurgitation at the pulmonary valve was revealed after the operation in all patients. It was maximum (34 +/- 10%) in transanulus plastics.

[Angiocardiographic and echocardiographic diagnosis of complete transposition of great vessels in association with pathology of the aorta]. / Angiokardiograficheskaia i ékhokardiograficheskaia diagnostika polnoi transpozitsii magistral'nykh sosudov v sochetanii s patologiei aorty.

The article analyses experience in the diagnosis of a pathological condition of the aorta in complete transposition of the great vessels (CTGV) in infants. Pathology of the aorta was revealed in 9 (2.6%) of the 350 patients who were examined. Six patients with CTGV had coarctation of the aorta (CA), 2 had subaortic stenosis, and one patient had complete interruption of the arch of the aorta. Our experience provides evidence that two-dimensional echocardiography allows the region of the thoracic aorta to be located from a suprasternal or a high right parasternal approach. Subaortic stenosis was diagnosed in 2 patients during autopsy. Retrospective analysis of the echocardiograms and angiocardiograms revealed characteristic signs of subaortic obstruction. Absence of the continuity of the arch and descending aorta is an echocardiographic sign of interruption of the arch of the aorta which was recognized retrospectively only after angiocardiography. Right and left ventriculography must be performed for precise anatomical diagnosis of CTGV with an intact interventricular septum combined with coarctation of the aorta. In patients with concomitant interventricular septal defect this examination is supplemented by antegrade and retrograde aortography from the ascending aorta to exclude patent ductus arteriosus and for better visualization of CA. Catheterization of all heart cavities, right and left ventriculography, aortography, and pulmonary arteriography must be carried out in all patients with total interruption of the continuity of the arch of the aorta.

[Assessment of the state of pulmonary circulation in infants of the 1st year of life with complete transposition of great vessels and ventricular septal defects]. / Otsenka sostoianiia malogo kruga krovoobrashcheniia u detei pervogo goda zhizni s polnoi transpozitsiei magistral'nykh sosudov i defektom mezhzheludochkovoi peregorodki.

The condition of pulmonary circulation in children of the first year of life with complete transposition of the great vessels (CTGV) and interventricular septal defect (IVSD) was evaluated by comparing the complex of hemodynamic and angiometric values obtained in catheterization of the heart cavities and angiocardiography. All patients were divided into two hemodynamic groups according to the blood flow in the lungs: group 1 - with the ratio of pulmonary to systemic circulation (PC/SC) greater than 1; group 2 - with the PC/SC ratio less than 1. In group 1 patients the ratio of effective pulmonary circulation (EC) to PC is always less than the ratio of EC to SC both in normal and in increased total pulmonary resistance (TPR); in group 2 patients, in contrast, EC/PC greater than EC/SC when TPR is above 10 mu/m2. The evaluation of the degree of pulmonary hypertension in infants with CTGV and IVSD should therefore be based not only on the absolute values of PC, EC, and TPR but also on such differential-diagnostic signs as the PC/SC, EC/SC, and EC/PC ratios.

[Surgical treatment of congenital heart defects with pulmonary hypertension in children during their 1st year of life under the conditions of extracorporeal circulation]. / Khirurgicheskoe lechenie vrozhdennykh porokov serdtsa s legochnoi gipertenziei u detei pervogo goda zhizni v usloviakh isskusstvennogo krovoobrashcheniia.

In the period between 1983 and 1987 operations were carried out on 204 children aged from 25 days to 12 months (body weight of 3 to 10 kg) for congenital heart diseases and pulmonary hypertension. Surgery for ventricular septal defect was undertaken on 173 patients (total mortality 6.9%), transposition of the major vessels with concurrent ventricular septal defect was corrected by Senning's method in 9 patients (mortality 11%), total anomalous pulmonary vein drainage was relieved in 14 patients (mortality 28.6%). No fatal outcomes occurred in correction of an aorto-pulmonary fistula, origin of the aorta and pulmonary artery from the right ventricle, and a common ventricle. In all patients, with the exception of 4 (2 with secondary and another 2 with primary pulmonary hypertension), pressure in the pulmonary artery reduced significantly.