[PULMONARY AUTOGRAFT OPERATION IN PEDIATRIC PATIENTS].

Experience of performance of a pulmonary autograft operation (PAO, оperation of Ross) was analyzed, results were estimated, the ways of overcoming a procedure conduction problems were determined. Remote result was investigated in 151 patients: the aortal valve stenosis was diagnosed in 99 (65.6%) patients, insufficiency - in 42 (27.8%), combined aortal valve failure - in 10 (6.6%). Hospital lethality have constituted 3.6%, and a general one ­ 7.9%. Reoperations were performed in 52 patients. PAO constitutes one of surgical procedures for the aortal valve failure in children of different age. Improvement of surgical technique and application of a new procedures have promoted improvement of the investigation results ­ lethality lowering from 15.1 to 0.8%. Application of surgical modifications with the aortal radix strengthening have reduced the reoperations on neaortal valve risk trustworthy.

[RESULTS OF THE TOTAL CAVA-PULMONARY CONNECTION PROCEDURE WITH CORRECTION OF ATRIO-VENTRICULAR VALVES IN PATIENTS OF DIFFERENT AGE, SUFFERING SINGLE CARDIAC VENTRICULUS].

The investigation objective was to improve the patients' management, suffering a single cardiac ventriculus, in whom a total cavа-pulmonary connection (ТСРС) operation was performed together with correction of the atrio-ventricular valves (AVV) insufficiency, basing on analysis of immediate and middle-term results. From 2005 to 2015 yrs in the clinic the ТСРС operation was performed in 132 patients. Of them 24 patients were choosed , in whom moderate and pronounced insufficiency of systemic AVV was diagnosed. Good early and middle-term results were achieved in 92% patients. In 8 observations, while the AVV correcting, in every patient two and more procedures of plasty were applied. Complex approach, using combination of various procedures of plasty, has guaranteed the optimal result. Application of procedures for the fiber ring stabilization have promoted achievement of best results.

Tissue perfusion in neonates undergoing open-heart surgery using autologous umbilical cord blood or donor blood components.

BACKGROUND: This study evaluates the hemoglobin-oxygen relationship and tissue perfusion during cardiopulmonary bypass (CPB) in neonates undergoing open-heart surgery using autologous umbilical cord blood or donor blood components. METHODS: We compared perioperative hematocrit (Hct), fetal hemoglobin (HbF), p(50)O(2), pH, pCO(2), serum lactate, duration of mechanical ventilation and intensive care unit (ICU) length of stay in neonates undergoing open-heart surgery using autologous umbilical cord blood (Group I, N=45) or donor blood components (Group II, N=65). The groups were similar with respect to diagnosis, weight, type of procedure, duration of CPB and duration of myocardial ischemia. RESULTS: Mean p(50)O(2) was significantly lower in Group I during CPB (19.7 vs. 22.3 mmHg, p=0.004) and at the end of CPB (20.1 vs. 22.8 mmHg, p=0.003). Median peak lactate during CPB was higher in Group I (4.8 vs. 2.2 mmol/l, p<0.001). Carbon dioxide tension was identified as an independent predictor of higher p(50)O(2) during CPB in Group I (ß=0.88, p=0.002), but not Group II. Bodyweight, Hct, duration of CPB, pre-CPB lactate level and pCO(2) affected peak lactate level during CPB. Although mean duration of ventilation was longer in Group II (mean 51 vs. 43, p=0.004), the groups experienced similar duration of ICU stay (5.8 vs. 5.9 days, p=0.280). CONCLUSIONS: Despite the fact that the oxyhemoglobin dissociation curve is shifted leftward in patients who receive autologous umbilical cord blood, tissue oxygen delivery appears to be preserved in neonates who undergo open-heart surgery using autologous umbilical cord blood.

Pulmonary valve replacement late after repair of tetralogy of Fallot.

BACKGROUND: Pulmonary valve incompetence is usually well tolerated after tetralogy of Fallot repair but may result in late progressive right heart failure as manifested by increasing fatigue, dyspnea, and frequently arrhythmias. METHODS: All patients who underwent pulmonary valve replacement in our center late after repair of tetralogy of Fallot were reviewed. RESULTS: Eighty-five patients had elective pulmonary valve replacement late (median, 9.3 years) after repair. Operative risk was low (1.1%). Ninety percent of survivors are in New York Heart Association class I. Survival 10 years after pulmonary valve replacement is 95%, with 86% of the patients free of reoperation for valve failure. CONCLUSIONS: Pulmonary valve replacement is infrequently required after repair of tetralogy of Fallot. Pulmonary valve replacement may be performed electively with little risk; it improves symptoms of right heart failure and provides satisfactory long-term survival with low risk of early valve failure. As the population of patients who have had repair of tetralogy of Fallot ages, pulmonary valve replacement will become a more frequent consideration.

Experience with repair of congenital heart defects using adjunctive endovascular devices.

The use of endovascular devices as an adjunct to repair of congenital heart anomalies represents a novel but unproven therapeutic approach. Intraoperative implantation of pulmonary arterial stents (5 to 15 mm diameter) was done in 11 patients with pulmonary atresia with ventricular septal defect (n = 4), classic tetralogy of Fallot (n = 2), truncus arteriosus (n = 1), hypoplastic left heart syndrome (stage II [n = 1] and stage III [n = 1] Norwood procedure), and miscellaneous pulmonary arterial stenoses (n = 3), as well as in patients with congenital (n = 1) and postoperative (n = 3) pulmonary venous obstruction and in 1 patient with combined pulmonary arterial and venous obstruction. The stents were effective at achieving immediate patency in all patients. There were two early deaths, one related to acute thrombosis of a small-diameter left pulmonary artery stent. Reintervention because of stent-related pulmonary arterial stenosis was frequently necessary. In five of seven patients who survived more than 1 month after implantation of stent size 8 mm or smaller severe stent-related pulmonary arterial obstruction developed. In four of the five patients with pulmonary vein stent implantation intractable obstruction developed, resulting in death in all three patients who had bilateral pulmonary vein stent implantation. Intraoperative occlusion of apical muscular ventricular septal defect with use of a clamshell device inserted from the right atrial approach was accomplished in four patients. One patient who underwent associated aortic arch reconstruction died as a result of left ventricular hypoplasia. The results in the remaining three patients were favorable on the basis of absence of significant late residual intraventricular shunting, left ventricular dysfunction, or arrhythmia. We conclude that recurrent intraluminal obstruction as a result of neointimal hyperplasia appears to be an eventual certainty in currently designed small-diameter endovascular stents. For this reason, we would recommend standard surgical techniques for repair of obstructive lesions of the pulmonary arterial confluence to maximize growth potential. Device occlusion of muscular ventricular septal defects is feasible but probably only indicated for complex cases of ventricular septal deficiency that otherwise necessitate a left ventriculotomy.