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According to the results of modern researchers, the main techniques used in congenital pathology of the aortic valve in children include balloon catheter dilatation of the aortic valve, surgical valvuloplasty, the Ross procedure and replacement of the aortic valve with a mechanical prosthesis. Many surgeons point out that these techniques in congenital pathology of the aortic valve yield suboptimal results. This is often due to the lack of a clear-cut definition between surgeons as to what operation should be performed in a particular age group. According to the reports of the majority of researchers, biological prostheses undergo early degeneration and structural changes in paediatric cardiac surgery and yield the worst results. Comparing the main techniques, optimal haemodynamics is observed after the Ross procedure. A disadvantage of this operation is the necessity of repeat intervention on the right ventricular outflow tract, which is required in 20 to 40%. Concomitant surgery of the mitral valve and/or aortic arch during the Ross procedure significantly increases the lethality and the risk of postoperative complications. Compared with an adult cohort of patients, children after prosthetic repair of the aortic valve using a mechanical prosthesis are more often found to have postoperative complications and a higher mortality rate. Yet another problem encountered in paediatric valve surgery is the unavailability of commercial prostheses sized ?19 mm. The duration of the intraoperative parameters for reconstructions of the aortic valve, the Ross procedure, and replacement of the aortic valve by the results of many studies averagely amounts to 74±34 min, 100±56 min, and 129±71 min, respectively. Yet another method which can be used for neocuspidization of the aortic valve in reconstructive surgery of the aortic root in paediatric patients is the use of glutaraldehyde-treated autologous pericardium. In our opinion, given the simplicity of the procedure, duration of the intraoperative parameters, and acceptable initial results reported by some researchers, the Ozaki procedure may be performed in children.

Elderly and aged patients appear to have a significantly increased risk from a cardiosurgical intervention combining three-valve reconstruction and prosthetic repair of the ascending portion of the aorta. Triple-valve pathology in pronounced mitral insufficiency is often accompanied by concomitant dilatation of the left atrium, i. e., atriomegaly. With the aim to eliminate the syndrome of compression of surrounding tissues and normalize intracardiac haemodynamics, reduction of the left atrium should become an inherent procedure for atriomegaly in patients with multiple-valve pathology.

The authors performed clinical studies based on modelling of an ascending aortic aneurysm in 37 patients and 10 apparently healthy subjects. Echocardiography was carried out in the B-mode using the Vivid E9 device (USA, GE). The linear dimensions of the aorta were assessed at three points - in the immediate vicinity of the valves, in the area of the maximum dilatation and in the area of decreased dilatation with registration of blood flow velocity in the aorta. The aortic walls were contoured with the division of equal intervals into 4 portions in order to obtain longitudinal shear deformation velocity during the cardiac cycle. We worked out a system of assessing the velocity vector fields with the help of transthoracic echocardiography in patients with an ascending aortic aneurysm, based on registration of blood flows, which made it possible to obtain the components of velocity. We also determined an optimal method of assessing turbulence in the aorta taking into account the direction of the vectors. Obtained were the numerical data of aortic wall deformation velocity in the longitudinal direction and calculation of the weighting function with the distinction between pathology and the norm. Based on the deformation, the distance between the registered points, and the movement of the vascular wall, we determined the reference values of blood flow velocity inside the aorta and immediately close to its walls.

Aim: To analyze prognostic value of different factors in postoperative atrial fibrillation prediction., Material and Methods: Study included 39 patients with coronary artery disease without previous paroxysmal atrial fibrillation. Multiple correlation, logistic regression and ROC-analysis were performed to create predictive model of postoperative atrial fibrillation prognosis. Authors have analyzed most of described in literature preoperative predictors of atrial fibrillation to define the role of different risk factors. Prognostic role of N-terminal pro-brain natriuretic peptide (NT-proBNP) is assessed., Results: We revealed high informativeness of NT-proBNP to predict postoperative atrial fibrillation after on-pump coronary artery bypass grafting.

Aim: To analyze clinical-diagnostic and surgical aspects of cardiac valve solid lesions as well as long-term results of surgical treatment., Material and Methods: Clinical, diagnostic and surgical aspects of treatment of 51 patients with tumorous and pseudotumorous lesions of cardiac valves were analyzed., Results and Discussion: Hospital complications were observed in 17.7% of patients. Mortality rate was 3.9%. 1- and 28-year overall survival was 100% and 94.1% respectively. Quality of life was good, satisfactory and unsatisfactory in 73.5%, 20.4% and 6.1% of cases respectively., Conclusion: Timely diagnostics of tumorous and pseudotumorous lesions of cardiac valves is very difficult but possible based on short history, positional dependence of symptoms, embolic events without rhythm disturbances. Additional instrumental methods including TTE, TEE, CT and MRI are necessary to define diagnosis. Intraoperative diagnostics and immediate histological survey are useful to determine volume of surgery in each case. Successful surgical treatment implies urgency, hypothermic perfusion and pharmaco-cold cardioplegia during operation.

We present early results and long-term follow-up after reduction aortoplasty with external wrapping of the ascending aorta. From December 1993 to February 2008, 32 consecutive patients who had reduction aortoplasty were compared with 47 consecutive patients who underwent prosthetic graft replacement of the ascending aorta. The groups were similar in baseline characteristics. Patients in the reduction aortoplasty group had significantly shorter aortic crossclamp times (18.78 +/- 1.91 vs. 34.04 +/- 3.25 min) and cardiopulmonary bypass times (30.16 +/- 2.36 vs. 60.83 +/- 2.05 min), and they received fewer transfusions. There was no significant enlargement of the aortic diameter at the level of the sinus of Valsalva in the reduction aortoplasty group during the follow-up period (from 38.84 +/- 3.10 to 39.48 +/- 2.72 mm). Reduction aortoplasty with external wrapping of the ascending aorta is a simple and promising surgical method. Our experience shows that this technique is the procedure of choice in patients without aortic dissection and with an appropriately sized sinus of Valsalva.

A modified muscle-sparing high approach to the thoracoabdominal aorta is described, which improves surgical access for thoracoabdominal aortic aneurysm repair. Since 2000, 16 patients with type I and II thoracoabdominal aortic aneurysms have undergone aortic graft replacement using this approach via the 3(rd) intercostal space. There were no hospital deaths. Three (18.8%) patients had severe postoperative pain requiring prolonged analgesia. This approach is a good alternative to the standard approach via the 6(th) intercostal space.

Posture disorders and morphofunctional defect were studied in 44 patients with cerebral insult using computer anthropometry. Typical changes in anthropometric parameters in postinsult patient before and after restoration treatment are considered. It is shown that computer anthropometry provides adequate monitoring of the dynamics of posture disorders and morphofunctional defect in general. The changes in anthropometric parameters should be taken into account in diagnosis of motor disorders. Their monitoring can also be used to assess the quality of treatment of postinsult patients.

Presented herein are the data on the condition of central and cerebral hemodynamics in 98 patients with chronic stage III-IV lower limb ischemia and coexistent CAD as dependent, on the severity of painful syndrome as well as on the necessity of preparing patients at a high surgical risk for reconstructions under prolonged epidural anesthesia. The prognostically dangerous changes in central and cerebral hemodynamics were revealed in persons with severe painful syndrome. In 87% of patients, circulation was hypokinetic. Twenty-six patients with unremovable pain and severe coexistent diseases underwent, as preoperative preparation, prolonged epidural anesthesia. It has been proven that prolonged epidural anesthesia allows to reach not only a good analgetic effect but also to refine the indicators of central and cerebral hemodynamics whereby preventing intra- and postoperative ischemic events.

The results of autovenous femoro-popliteal shunting performed in 106 patients with infrainguinal atherosclerotic arterial occlusion were investigated. All the patients were divided into 3 groups: younger than 50, from 50 to 60 and older than 60 years of age. The most favorable results were registered in the group of patients aged from 50 to 60. In 3 years these results made up 52.2%, in 5 years--17.4%. The lowest indices of shunt functioning were noted in patients younger than 50, and 3 and 5 years later they were 38.5 and 7.7% respectively. In 70% of this age group patients there were injuries of the main crural arteries and significant changes in the phospholipid fraction level. The main cause of unsatisfactory results of shunting operations in the femoro-popliteal area is though to be the injuries of the main crural arteries and the progressing course of the atherosclerotic process.

The paper presents the 10-year outcomes of treatment of 260 patients with combined vascular atherosclerotic lesions of the heart, brain, and lower extremities. Pandopplerography of peripheral vessels, ECG, EchoCG revealed combined lesions to the major vascular basin in 12% of all the patients with atherosclerosis. The lower extremity vascular basin was surgically corrected in 134 patients. Both one-stage operations making up 19% of all interventions and providing evidence for their high efficiency and multistage or isolated reparative operation on the abdominal aorta and leg arteries. The total mortality was 7.5% when the lower extremity vascular basin was corrected in three-region lesions; amputations were performed in 3% of patients.

208 patients with primary chronic critical ischemia of lower extremities (CCILE) were operated on from 1988 to 1995. The criteria of CCILE were the following: ischemia of an extremity in rest with specific ischemic pain for more than 2 weeks; existence of ulcernecrotic changes in distal parts of the extremity; brachiommalleous index (BMI) less than 0.35; malleous systolic pressure less than 50 mm Hg. Functional condition of the patients corresponded to class 3A, B and 4. The share of patients with CCILE among patients with lower extremities arterial lesions was 35%. In 150 (72%) of them there were lesions of aorto-illo-femoral-tibio-popliteal segment; in 58 (28%)-damage of a femoral-popliteal-tibial segment. The number of patients with trophic changes appear in early stage. 154 reconstructive operations have been performed in patients with multiple arterial lesions higher and lower of the Poupart's ligament, and only one primary amputation and sympathectomy. In 63 (42%) of the patients the "two-floor" reconstruction has been performed. In 142 (92%) of the cases positive results have been achieved. In 78.5% cases the grafts were competent a year after the surgery and the extremities were saved in 88% of the patients. 60 reconstructive operations, 3 primary amputations and 1 sympathectomy have been performed in patients with the lesions, located lower than Poupart's ligament. In 58 (96%) of the patients positive results were achieved. One year after surgery the grafts patency was 63.5%, and extremities were saved in 79% of the patients. The immediate and long-term follow-up results of femoral-politeal and femoral-tibial grafting did not differ significantly. Long-term follow-up results were better in case of less duration of CCILE before surgery. Adequate revascularisation of the extremity is an optimal method of treatment of patients with CCILE.