Plastic surgery for cardiac valves: 15 years' experience.

We suggest that all patients with heart valve diseases should be considered for reconstructive plastic surgery, regardless of the numerous modern mechanical and biological prostheses available in a cardiac surgeon's arsenal. We have 15 years of experience, with 903 plastic surgical procedures with cardiopulmonary bypass for acquired mitral (636), aortic (51), and tricuspid (216) valve diseases. The 15-year survival rate for patients with mitral stenosis was 68% +/- 5%, and the 8-year survival rate for patients with mitral insufficiency was 81% +/- 3%. The 10-year survival rate for patients with mitral and tricuspid valve disease was 59% +/- 3% because of the initially grave condition of such patients. For the correction of acquired aortic valve disease we advocate a new type of operation: a method of stent plasty of the aortic root with two circular sutures placed on the level of the arch and fibrotic ring. In combination with gradual commissurotomy, parietal resection of leaflets and parocommissural plication are performed. This procedure is an effective method for the plastic reconstruction of the aortic valve, and it provides a good hemodynamic effect.

[Doppler echocardiographic study of patients with mitral insufficiency]. / Doppler-ékhokardiograficheskoe issledovanie bol'nykh s mitral'noi nedostatochnost'iu.

Possibilities of dopplerography have been examined with respect to mitral incompetence in 20 apparently normal subjects and 24 patients with mitral incompetence documented by surgical or left-ventriculographic findings. Spectrograms and analogue curves of blood flow around the left atrioventricular orifice were assessed. Unlike normal subjects, 21 of 24 patients exhibited turbulent systolic flow in their left atrial cavities, behind mitral cusps, regarded as evidence of mitral regurgitation. Left-atrial blood flow investigation demonstrated a relationship between the distance of recorded systolic flow from mitral cusps and manifestation of mitral incompetence. Therefore dopplerography can detect mitral regurgitation and give an approximate idea of its manifestation in patients with mitral incompetence.

[Role of echocardiography in preoperative diagnosis of organic defects of the tricuspid valve in patients with rheumatic mitral heart defects]. / Mesto ékhokardiografii v predoperatsionnoi diagnostike organicheskogo poroka trikuspidal'nogo klapana u bol'nykh s ravmeticheskim mitral'nym porokom serdtsa.

The results of investigations by echoCG, ECG, FCG, sphygmography, roentgenography, including cardiac catheterization, of 16 patients with rheumatic mitral-tricuspid disease of the heart were compared. The organic injuries of the tricuspid valves (OITV) were confirmed during operation. With respect to preoperative diagnosis of OITV the sensitivity of echoCG was equal to 94 %, polycardiography--81 %, roentgenography--54 %, cardiac catheterization--94 %. Thus, echoCG proved to be the most accurate method of the primary asanguineous diagnosis of an organic injury of the tricuspid valve. The echocardiographic diagnosis of OITV included the symptoms of constriction of the right atrioventricular orifice and fibrous alterations of the valve cusps. Possible technical errors of the methods in respect to the detection of OITV are discussed.

[Results of the lst 100 open-heart operations for mitral valve annuloplasty]. / Rezul'taty pervykh 100 operatsii annuloplastiki mitral'nogo serdtsa na otkrytom serdtse.

The paper describes the results of 100 annuloplastic operations for the mitral valve with the aid of support rings of varying constructions. Hospital mortality rate was 10%, late mortality rate 4.6%. Five-year survival was 85.5%. In 87.1% of patients the result was good or satisfactory. Unsatisfactory results are due to the initial state of the valve (gross fibrosis, subvalvular adhesions, calcinosis), exacerbation of rheumatic carditis, septic endocarditis. Six patients with unsatisfactory results were reoperated. In 5 the valve was replaced by artificial prosthesis, in one case additional sutures were placed on the fixing ring.

[Mobility of the mitral valve cusps in mitral stenosis studied by 2-dimensional echocardiography]. / Izuchenie podvizhnosti stovorok mitral'nogo klapana u bol'nykh s mitral'nym stenozom s pomoshch'iu dvukhmernoi ékhokardiografii.

The object of the work was to disclose the possibilities of bimetric echocardiography in appraising the mobility of the mitral valve cusps in patients with mitral stenosis. The shape of the mitral cusp movement was studied in the longitudinal and transverse planes of the heart section. The results of the ultrasonic examinations were compared with the operative findings in 68 patients operated on for mitral stenosis. In satisfactory mobility of the valve, "sail-shaping" of the cusps is recorded in the longitudinal plane of the heart section and a concavity in the transverse plane in the period of diastole. In coarse fibrosis of the cusps, the diastolic movement of the surface of the anterior cusp is recorded as a displacement of a straight line which moves parallel to its initial position in the period of systole. Bimetric echocardiography makes it possible to determine exactly the character of the mitral valve lesion and determine the degree of mobility of the cusps in patients with mitral stenosis. This information may be decisive in choosing the method of surgical correction of the disease.

[Annuloplasty with a semi-rigid supporting ring for correction of mitral insufficiency]. / Anuloplastica con anello di sostegno semirigido per la correzione dell'insufficienza mitralica.

The paper presents an anatomic and physiologic substantiation and an analysis of the initial clinical experience of mitral annuloplasty with the aid of original semi-rigid metallic supporting rings. The authors' experience comprises 33 operations with 2 cases of hospital mortality (6.2%). The problems of diagnosis and surgical technique are discussed, with special reference to the rationale of annuloplasty in cases of combined mitral diseases (stenosis and insufficiency). The obtained results demonstrate the efficacy of the introduced method of annuloplasty ensuring a stable restoration of the function of the mitral valve.