[Surgical treatment of pediatric hypertrophic obstructive cardiomyopathy using an original approach].

The authors offer an original technique of surgical correction of pediatric hypertrophic obstructive cardiomyopathy (HOCM), which allows excision of the hypertrophied area and elimination of the obstruction from the cone part of the right ventricle (RV) without penetrating into the LV cavity. 15 children aged 5 to 15 years have been operated on in Bakulev Scientific Center for Cardiovascular Surgery using this technique. 8 of the patients had simultaneous obstruction of the left and right ventricular outflow tract (LVOT and RVOT), 1 patient had RV obstruction. Medical therapy had failed in all cases. The follow-up period was 28 +/- 7 months. EchoCG examination, performed after the surgical treatment, found a decrease of the intraventricular gradient in LV from 72.9 +/- 8.9 to 12.7 +/- 5.5 mmHg; the mean gradient in RVOT also reduced from 43.6 +/- 5.7 to 4.3 +/- 2.7 mmHg. According to the EchoCG, septal thickness reduced from 31.5 +/- 6.5 to 16.5 +/- 4.1 mm. Sinus rhythm was noted in all the patients after the surgery and during the follow-up. The method proposed by the authors is preferable in surgical treatment of children with various forms of hypertrophic cardiomyopathy unresponsive to medical treatment and is a method of choice in a significant number of cases.

[Architectonic characteristics of the heart ventricles in a perimembranous defect of the interventricular septum]. / Osobennosti arkhitektoniki zheludochkov serdtsa pri okolopereponchatom defekte mezhzheludochkovoi peregorodki.

The results of quantitative morphological macro-, micro-, and ultrastructural (myocardial biopsies) studies of the ventricles with perimembranous septal defect in 135 infants under the age of one year have been compared. In newborns there appeared ventricular myocardial hyperplasia and low absolute and relative values of all the myocardial parameters versus normal control. At the age of 3 months the parameters were similar to or above the control ones exceeding them considerably by the age of 10-12 months. The comparison of the parameters of the septal parts showed predominant abnormality of the sinus part indicating that the perimembranous ventricular septal defect entity is a sinus one.

[Anatomical types of the conduction system in congenital heart defects]. / Anatomicheskie tipy provodiashchei sistemy pri vrozhdennykh porokakh serdtsa.

A correlation is demonstrated between the fully formed conduction system and the anatomical type of the so-called normal and abnormal heart. Changes in the anatomy of the conduction system in congenital heart diseases are interpreted as a consequence of respective changes in the anatomy of the heart. New principles are formulated for the classification of congenital heart diseases on the basis of the anatomical types of the conduction system. They permit simultaneous systematization of types of ventricular septal defects and complex congenital heart diseases with ventricular septal defects.

[Types of anatomic correspondence between the conducting system and the heart]. / Tipy anatomicheskogo sootvetstviia provodiashchei sistemy i serdtsa.

The principles of a quantitative determination of characteristics concerning the types of anatomical correspondence between the conduction system and the heart at its congenital malformations are presented. This makes it possible to establish that the topographoanatomical type of the conduction system depends on the peculiarities of the heart structure at its congenital malformations rather than from changes in the structure and position of the parts of the conduction system, or the conduction system as a whole according to the types of congenital heart malformations. The mechanism of the left-sided position of the atrioventricular bundle (His bundle) in some congenital malformations of the heart is explained.

[Dissection of the heart in congenital defects]. / Vskrytie serdtsa pri vrozhdennykh porokakh.

The paper describes a method for opening the heart at autopsy and for pathological examinations of normally formed hearts, both with acquired and congenital diseases. The method is based on leaving the cardiac fibrous skeleton nondissected. This preserves the anatomical integrity of the intracardiac structures and their natural connections which is extremely important for pathological examination of the heart and its major vessels in congenital heart diseases, particularly in their complicated and rare types.

[Blood supply and the atrioventricular conduction system of the dog heart]. / Osobennosti krovosnabzheniia i predserdno-zheludochkovoi provodiashchei sistemy serdtsa sobaki.

In 30 experiments in order to specify the blood supply and conducting system in the dog heart, coronal arteries were injected with a contrasting mass that was followed by roentgenography and preparation of the coronal arteries. The topography and blood supply of the atrioventricular conducting system with application of prevital blood supply, and the left coronal artery is the main source of blood supply for all the parts of the cardiac atrioventricular conducting system.