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The authors demonstrate the results of treatment (16 patients) with giant paraesophageal and posttraumatic diaphragmatic hernia. The article represents the main principles of operation management, key moments of the choice of access, operative techniques and also the features of the usage of modern reticular implants.

The experience of surgical treatment of high risk group patients with ischemic mitral regurgitation of different degree of manifestations was analyzed. The basic approaches to the management and the choice of treatment strategy are reported in this article. The authors suggested the priority strategy on the background of completed investigation: 1) the performance of the annuloplasty on pressure ring in combination with coronary bypass surgery in surgical treatment of ischemic mitral regurgitation of Ill degree, as most effective kind of intervention; 2) the performance of operation of isolated coronary bypass surgery on working heart for high risk patients with the presence of moderate ischemic mitral regurgitation, that allows the significant improvement of indices of postoperative period and the decrease of evidence of mitral regurgitation at the expense of a salvage of myocardial contractility.

The relapse of ischemia was detected in 127 patients in clinical series after coronary bypass surgery. It was noted in terms from 1 month till 204 months. The basic clinical manifestation or the relapse of ischemia was the recurrence of heart stroke in 74.8%. According to the data of coronary bypass angiography, the main cause of the ischemia relapse appears to be the dysfunction of early formed shunts in 64.6% patients. The development of early thrombosis of autografts is substantially determined by the pool and degree of stenosis of shunt coronary arteries.

The article presents a technique of performing coronary bypass operations on the beating heart used by the authors in 847 patients which is based on high thoracic epidural anesthesia, primary formation of proximal anastomoses of the aorto-coronary bypasses and specified succession of the formation of distal, stabilization of the local part of the heart in the field of placing distal anastomosis and access to the lateral and posterior surface of the heart with vacuum stabilizers, using blower-humidifier and intracoronary shunts.

Determination of the necessary length of the bypass is one of the principal stages of operation of the aorta-coronary bypass. The greatest difficulty of the determination of the bypass length is the first-priority applying of proximal anastomoses. It requires the surgeon to have great experience, the operation to be longer. It also makes it necessary to prepare a conduit of deliberately excessive length. A device is proposed for the determination of the necessary bypass length during operation of aorta-coronary bypass consisting of a crocodile grip with a fixed to it polymer tube.

The features of preoperative status, course of the perioperative period and immediate results of coronary shunting were compared and analyzed in 523 patients, 56 of them were women. In female patients there were more often factors negatively influencing the course of the postoperative period. No additional intraoperative risk factors were found. The direct results of coronary shunting proved to be similar in men and women. No significant difference in the frequency of the development of early postoperative complications and hospital lethality, considerable correlation between the gender and frequency of postoperative complications were established by the methods of correlative analysis.

Diffuse lesions of the anterior interventricular artery (AIVA) at different levels were diagnosed in 27 out of 417 patients operated for post-infarction aneurysm of the left ventricle (PIALV). During the preoperative period coronography, ventriculography, ultrasonic examination of the heart were made in all the patients, one-photon emission computed tomography with 123I-iodopent was used for radioisotope investigation of perfusion and metabolism of the myocardium. The presence of PIALV, diffuse atherosclerotic lesion of AIVA and viable myocardium in its basin was taken as an indication for autovenous plasty of the artery with the following shunt of the left intrathoracic artery and resection of PIALV.

The authors have analyzed results of treatment of 18 patients with postinfarction aneurysms of the left ventricle (PALV) and postinfarction insufficiency of the mitral valve (PIMV) operated upon after examination. It is considered that both the mitral valve (MV) replacement and some kind of plasty, which is more preferable, can be used in patients with PALV and PIVM in order to recover the closing function of MV. Dosed resection of PALV and its plasty by the Dor-II Jatene method allowed the LV cavity geometry to be reestablished and thus the MV fibrous ring sizes to be reduced as well as the degree of the valve insufficiency. It is expedient to use the method of cardioplagia in such patients and to fulfill proximal anastomoses with the aorta at the lateral pulled position on the working heart and then to start extracorporeal circulation.

The article presents results of using the method of intraoperative autotransfusion in surgical treatment of IHD. It was shown that in patients with IHD intraoperative reservation of 400 ml of autoblood at the stage of surgical access (prior to infusion of heparin) during coronary shunting did not lead to disturbances of hemodynamics, gas exchange and oxygen-transporting function of blood. The following transfusion of predonated autoblood at the final stage of operation promotes the early reestablishment of the circulating erythron and allows to reduce the requirement of transfusion of the donor erythrocyte concentrate by 26.1%, and chilled plasma--by more than 1.5 times.

Some literature data are presented on the problem of cardiac surgery in patients with chronic renal insufficiency under regular hemodialysis and on the specificity of performing operations on such patients under conditions of artificial circulation. The authors describe their first experience of a one-step prosthezing of the aortal valve and plication of the dissecting aneurysm of the ascending part of the aorta in the patient receiving the regular hemodialysis during 5 years as well as the positive results of this original operation in dynamics of the first year of observations.