"Temporary prosthesis" of the fibrotic ring for relative insufficiency of the tricuspid valve.

BACKGROUND: De Vega type suturing dosage plasty is the intervention most widely used for relative insufficiency of the tricuspid valve (TV). In fact, this operation may be considered as an equivalent of prosthetic reconstruction of the fibrotic ring, shaping a fixed orifice for passage. Intrapulmonary pressure normalized as early as during the first months after surgery in patients with the mitral-tricuspid cardiac valvular disease. Under such conditions a rigid suture (prosthesis of the anulus) at the interface of the right atrium and ventricle is not physiological. METHODS: We used Maxon CV 2-0 (D+G) suture absorbable for 6 months. Xenopericardial pads were fixed at the edge of the suture. The pads were prepared by enzymatic and chemical processing. RESULTS: Operations were performed in 7 patients, the results were followed for up to 28 months. The size of the TV fibrotic ring was measured by transesophageal ultrasonography (Hewlett-Packard SONOS 1500; OMNIPLANE) on the operating table and for 2 years postoperation. No signs af tricuspid insufficiency were detected.

[Autoarterial grafts for myocardial revascularization and their morphological assesment in coronary heart disease]. / Autoarterial'nye transplantaty dlia revaskularizatsii miokarda i ikh morfologicheskaia otsenka u bol'nykh ishemicheskoi bolezn'iu serdtsa.

A comparative analysis of arterial grafts used for myocardial revascularization has been done. The morphology of arteries, rate and degree of atherosclerotic process were evaluated. 55 thoracic internal arteries, 52 right gastro-epipiolcal arteries, 34 epigastrical inferior arteries have been tested in cadavers of people with signs of coronary heart disease. Arteria thoracica interna appeared to be a vessel with prevalence of elastic elements, while arteria gastro-epiplocia and arteria epigastrica inferior are predominantly muscle-type. Arteria thoracica interna and arteria epigastrica inferior appeared to be rarely affected with atherosclerosis in people under 60 years of age. Atherosclerotic lesions have been found more often in arteria gastro-epiploica without stenotic lesions. In people over 60 years of age the stenotic lesions in arteria thoracica interna and arteria epigastrica are found much more often than in arteria gastro-epiploica. Arteriography should be done in selecting the proper graft for myocardial revascularization.

[Arteriosclerosis of the right gastro-omental artery]. / Ateroskleroz pravoi zheludochno-sal'nikovoi arterii.

The right gastroepiploic artery is most frequently used for direct myocardial revascularization. In this connection, its histological study was performed to reveal the atherosclerosis incidence in persons from different age groups who had apparent signs of coronary atherosclerosis. Twenty one arteries taken from adult cadavers at the age of 35-85 years were examined. The arteries with normal were 28.6%, those with Degree I alterations were 52.4%, those with Degree II alterations were 19%. Degrees III and IV alterations were not detected. Morphological studies indicated that hemodynamically significant right gastroepiploic artery lesions were found in 19% of cases, mainly in subjects above 60 years. The artery may be used in coronary surgery as a shunt with a good prognosis of its performance.

[The topographic-anatomical rationale for using the right gastro-epiploic artery for direct revascularization of the myocardium]. / Topografoanatomicheskoe obosnovanie ispol'zovaniia pravoi zheludochno-sal'nikovoi arterii dlia priamoi revaskuliarizatsii miokarda.

The topographic anatomy of the right gastroepiploic artery was studied on anatomical material and a model of an operation was elaborated for direct revascularization of the myocardium with the use of the right gastroepiploic artery as a pedicled shunt. The study showed that the anatomical characteristics of the artery (length, diameter) allow it to be used as an autoarterial shunt to the coronary arteries. The authors discuss two methods for installing the vascular graft by means of which shunting of the coronary arteries of both the anterior and the posterior myocardial wall can be accomplished with a graft of the right gastroepiploic artery.