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Background: Management of patients with acquired heart malformations, including aortic valve disease, is still challenging. Due to ageing of population, patients undergoing valve surgery are older than in the past. The 3F Therapeutics, conducting a programme of construction of heart valves for transarterial or transapical implatation, prepared the 'Enable' bioprosthetic valve for sutureless insertion in the aortic position. The first world implantation was performed in our Department on 13 January 2005., Aim: To present our experience, qualification criteria and methods of implantation of sutureless bioprosthesis of aortic valve 'Enable'., Methods: The 'Enable' valve is a tubular structure, tailored and sutured of equine pericardium, treated with glutaraldehyde, and mounted on an openwork Nitinol" alloy stent. It consists of two distal rings connected with three vertical sticks. The characteristic property of nitinol is thermoplaticity: due to refrigeration it becomes elastic and easy to bend, after rewarming returns to the initial dimensions and shape, remaining stable at the body temperature. Distension of the nitinol ring make possible strong mounting of the valve in aortic annulus. The examined group consised of 27 patients (16 males, 11 females), aged 60-78 years (average 69.5), with advanced aortic valve disease, left ventricular hypertrophy, and aortic gradient up to 102 mmHg. Exclusion criteria were: severe annular deformations or bicuspid aortic valve, other valves' malformations, coronary disease, severe other comorbidities or no agreement for 'Enable' valve implantation. The patients were operated using extracorporeal circulation, general moderate hypothermia and cold crystalloid cardioplegia. Care was taken to remove calcifications, estimate of aortic annulus geometry, valve size selection, and orientation of the valve toward coronary ostia The mounting time was approximately one min, and the aorta cross-clamp time was reduced to 26-56 min, mean 30 min., Results: There was no mortality in the perioperative period, and during 3 months to 4.5 years of follow-up. No severe complications were present after surgery. One patient needed reoperation on post operative day 4 due to severe perivalvular leak. One other patient presented discrete leak with no need for intervention. The clinical improvement of one to three NYHA classes was observed. Echocardiographic and MSCT examinations confirmed adequate position of the valves, no structural deteriorations, normal movement and coaptation of the leaflets. The average maximal transvalvular gradient was 11.6 mmHg and the mean gradient--6.8 mmHg, which remained stable during the follow-up period. No thromboembolic or infective complications were present., Conclusions: (1) The 'Enable' aortic bioprosthetic valve has very good hemodynamic properties. (2) Self-expanding thermoplastic nitinol-made ring allows permanent stable mounting. (3) The quick fixation (about 1 min) significantly shortens the operation time. (4) The 'Enable' valve seems to be suitable for patients with increased periopertive risk.

During a period of 25 years (1979-2004), 24060 operations with extracorporeal circulation were performed. Of them 9536 (39.6%) were valvular procedures and 763 were combined with coronary bypass grafting. 4315 pts were operated (45.3% of valvular operations) because of mitral valve disease 5559 mitral valves were corrected, including multivalvular and combined procedures. Initially, mitral surgeries were predominant, but currently aortic valves are operated two times more frequently. In 85.5% of cases mitral valve replacement was necessary (with prosthetic valve), but 803 pts underwent reconstructive surgery (445 commissurotomies and 358 valvo/annuloplasties, including 135 implantations of annuloplasty rings). Additionally, 421 DeVega tricuspid valve annuloplasties were performed, and 15 tricuspid rings were implanted. Because of infective endocarditis 182 mitral valves were corrected, including the replacement of 78 infected prostheses. The pts age varied between 10 and 85. In 1980 the mean age was 40, but currently it has increased to 55, and the pts with coronary artery disease are approximately 10 years older. The general mortality among pts with ECC was 4.2% in 2003, and after valvular procedures 4%. The mortality after mitral valve replacement diminished from 12% to 4.5-5%, and after reconstructions was two times lower. The mortality among pts with endocarditis was 11.8%. Several characteristic trends were observed: increase of the number of elder pts, decrease of mitral valve procedures in comparison with aortic ones, more common coincidence of coronary artery disease, better preoperative status of the pts, and decrease of the operative risk.

A case of a 70-year-old female with hypertension, atrial fibrillation and angina pectoris, admitted to the hospital due to echocardiographically detected left atrial tumour, is presented. Differential diagnosis included thrombus, myxoma, infectious or neoplastic tumour. The patients underwent surgery. Histopathological examination revealed the presence of an abscess in the left atrium. This report underlines the difficulties in the diagnosis of cardiac tumours.

At present the most frequent cause of cardiac tamponade is neoplasma. A case of a 32-year-old male with recurrent cardiac tamponade caused by pericardium mesothelioma is described. Despite advanced neoplastic process in the pericardium, pleura and mediastinum, neither radiologic examinations of the chest, echocardiography, nor repeated cytologic examination of the pericardial exudate, could establish the etiology of the tamponade. Only after a pericardial window had been performed was it possible to: 1) establish the diagnosis and introduce causal treatment; 2) prevent recurrence of the tamponade; 3) perform cytoreduction of the tumor. It seems that in cases of chronic exudative pericarditis of unknown cause it is proper to perform an early pericardial window as a diagnostic and therapeutic procedure.