[Post Radiotherapy Lesions of the Heart Valves. Principles of Diagnosis and Results of Treatment].

BACKGROUND: The use of radiation therapy for the treatment of tumors of the chest сan lead to the development of cardiac pathology, including that of the valves and coronary arteries. STUDY AIM: to analyze the specifics of post-radiation lesions of the valvular apparatus and coronary arteries, and to assess the immediate results and risks of surgical correction of detected defects. Materials and  methods. In the Emergency department of surgery of acquired heart disease of A. N. Bakulev National Medical Research Center of Cardiovascular Surgery in the period from 2004 to 2017 were examined and operated 46 patients aged 35-81 years (mean age 56±12.4 years, 80 % women). The period from primary irradiation of the chest to surgical treatment of valvular pathology ranged from 4 to 40 years. Indications for thoracic radiotherapy were Hodgkin's lymphoma in 23 patients (50 %), breast cancer - in 20 (43 %). RESULTS: Stenosis of the aortic valve was the leading defect in 42 patients (91 %). According to coronary angiography, coronary artery disease was diagnosed in 31 patients (67 %). Isolated aortic valve prosthesis was performed in 14 (30 %) patients, other operations were combined. Hospital mortality was 11 % (5 patients). There were no deaths among patients who underwent radiation therapy after mastectomy. Main nonlethal complications were: pericardial effusion in 6 patients (13 %), hydrothorax requiring repeated pleural punctures in 5 patients (11 %). CONCLUSION: The variety of clinical manifestations of radiation heart disease and its progressive nature emphasize the need for long-term dynamic observation of patients after thoracic irradiation in order to timely identify the pathology and eliminate the risk of sudden cardiac complications and the development of severe heart failure decompensation.

[Low-traumatic approach in secondary surgery on the aortic valve].

The possibility of a second operation on the aortic valve and root using a minimally invasive approach is considered along with discussion of its traumaticity and peculiarities of the postoperative period.

[Clinical aspects, diagnosis and surgical treatment of rupture of the mitral valve chordae]. / Klinika, diagnostika i khirurgicheskoe lechenie razryva khord mitral'nogo klapana.

The authors generalize experience in surgical treatment of 121 patients with mitral incompetence caused by rupture of the chordal threads. Prosthetics of the mitral valve was conducted in 103 patients, plastic correction--in 18 patients. Study of the etiomorphological aspects of the problem showed destruction of the fibrous framework of the chorda to be a compulsory component of rupture of the chordae of various origin. At the same time, there are some similar clinico-diagnostic manifestations of rupture of the chordae, which allows this form of mitral valvular disease to be set apart as an independent syndrome. Echocardiographic study is the most informative method in the diagnosis of the disease, it reveals rupture of the chordae in over 95% of cases. The immediate and late-term results of plastic operations and prosthetics were compared. Plastic operations are preferable in a favorable situation because survival after them is higher and thromboembolism does not develop even if anticoagulant therapy is not applied.

[Cardiac myxoma recurrence with the formation of tumors in both atria]. / Retsidiv miksomy serdtsa s formirovaniem opukholei oboikh predserdii.

A case of heart myxoma recurrence 1.5 years after the removal of the left atrium primary tumour is described. Recurring tumour was represented by myxoma of both atria which was removed as a single block with a part of the interventricular septum. Both primary tumour and those of the left and right atrium have the structure of benign heart myxoma. However, the presence of the infiltrative growth into the interventricular septum allows one to consider the recurrent tumour as a borderline, locally destructive one.

[Results of surgical treatment of aortic coarctation in patients over 35 years of age]. / Rezul'taty khirurgicheskogo lecheniia koarktatsii aorty u bol'nykh starshe 35 let.

The authors studied the immediate and late-term results of surgical treatment of aortic coarctation in patients after the age of 35 years. The complications in surgical treatment, arterial pressure dynamics, the causes of deterioration in the patient's condition and the mortality were analysed. The main causes of deterioration of the patients' condition in late-term periods after surgery were: residual arterial hypertension (41.2%), ischemic heart disease (39.2%), aortic and/or mitral valvular diseases (25.5%), aneurysms of the thoracic aorta (11.8%). The expediency and efficacy of surgical treatment of coarctation of the aorta in patients over 35 years of age with stable regional arterial hypertension are proved.