[Endoprosthetic repair of the abdominal aorta in patients with infrarenal aneurysm and unfavourable anatomy of its proximal neck]

Analysed herein are immediate and remote results of endoprosthetic repair of the abdominal aorta in patients with unfavourable anatomy of its proximal neck. Group I (Study Group) was composed of 31 patients with unfavourable anatomy of the proximal neck, the control group (Group II) comprised a total of 52 patients with no unfavourable anatomical factors. The criteria of assessment were as follows: technical success, adequate position of the endograft, frequency of the development of various endoleaks, duration of the operation and hospital stay, lethality in the remote period, and necessity of secondary interventions. Technical success of endoprosthetic repair was achieved in 100% of patients in the both groups. An adequate position by the proximal end of the coated portion of the endograft was observed in 27 (87.1%) patients of Group I and in 51 (98.1%) patients of the control group (p=0.08). Secondary postdilatation of the endograft's body in the proximal neck was statistically more often performed in the study group of patients. The duration of the operation and hospital stay in the compared groups had no statistically significant differences. In the remote period, patients with unfavourable morphology of the proximal neck were found to develop type I-A endoleaks into the cavity of the aneurysm. By other evaluated criteria such as the total survival rate, secondary interventions, graft migration, type I-B, II and V endoleaks no statistically significant differences were revealed. It was concluded that endoprosthetic repair of the abdominal aorta in patients with unfavourable anatomy of the proximal neck of the aneurysm is associated with admissible immediate, short- and long-term outcomes. Longer follow up is required in order to more adequately asses the reliability of the obtained findings.

[Twelve months results of percutaneous coronary interventions in patients with ischemic heart disease combined with diabetes mellitus using sirolimus and everolimus covered stents]

We included into this study 112 patients with ischemic heart disease (IHD) and concomitant type 2 diabetes mellitus (DM) subjected to percutaneous coronary interventions with stenting. Everolimus and sirolimus eluting stents (EES and SES) were implanted in 54 (group 1) and 58 (group 2) patients, respectively. After 12 months in groups 1 and 2 rates of repeat target lesion revascularizations (TLR) were 5.5 and 8.6% (odds ratio - OR - 0.62, 95% confidence interval - CI - 0.14- 2.74, p = 0.72); acute myocardial infarctions (MI) - 3.7 and 5.2% (OR 0.71, 95% CI 0.11- 4.4, p = 0.94); deaths - 1.85 and 1.7% (OR 1.1, 95% CI 0.1- 17.6, p = 1.0), respectively. There was no significant difference between groups by rate of unfavorable cardiac events (composite of cardiac death, nonfatal MI, and clinically indicated TLR) - 11.1 and 15.5% in groups 1 and 2, respectively (OR 0.68, 95% CI 0.225- 2.059, p = 0.69). Rates of stent thrombosis also did not differ (1.85 and 3.4% in groups 1 and 2, respectively; OR 0.53, 95% CI 0.05- 6.0; p = 0.94). Thus the use of EES and SES in patients with IHD and type-2 DM was equally effective.

[The thoracic aorta aneurism stenting]

27 patients with thoracic aortic aneurism with dissection type III were operated on and stented. The mean age was 56±11,17 years. Men were 24, women 3. 1 patient developed intraoperative stent-graft leakage type IV, and 1 - type II. Both cases needed no additional manipulations. Minimal invasiveness of the procedure and pain absence allowed early activisation of patients. 2 patients had postoperative paraplegia, which was successfully treated by spinal drainage. There were no lethal cases. The long-term follow-up showed no leakage on CT scans; 11 patients demonstrated complete closure of false canal of the stented segment. The overall survival rate was 92.6% after 60 months of follow-up. Unfavorable results were registered in 29.6%.

[Surgical and endovascular treatment of lung arteriovenous malformations]

The article summarizes the experience of surgical treatment of 47 patients (1964-2012 yy) with lung arteriovenous malformations (LAVM). Men were 29, women - 18. Age varied from 6 to 49 years. 20 patients had solitary lung arteriovenous malformations, the rest 27 had multiple malformations. Before 1983 the main diagnostic means was the angiopulmonography, since that the multyspiral computed tomography has been used. Before 1980 all patients received major surgical treatment, i.e., lobectomy (n=29), pneumonectomy (n=1) and 1 explorative thoracotomy. After 1980 the endovascular embolisation under the X-ray control took the leading place among the treatment options for these patients. 11 patients had 17 embolisations; the lung resection was performed only in 3 cases. All negative outcomes (4 lethal and 8 complications) were registered before the 1980. The were no lethal outcomes after the endovascular embolisation; only 3 patients had complications. All patients demonstrated satisfactory and good outcomes, considering objective parameters and quality of life early and long after the endovascular embolisation.

[Coronary stenting in patients with ischemic heart disease with multivessel involvement of coronary vascular bed and low Syntax score]

MATERIAL AND METHODS

We followed 619 patients with ischemic heart disease (IHD) and multivessel involvement of coronary arteries: 317 patients subjected to coronary artery bypass grafting (CABG, group 1) and 302 patients subjected to multivessel percutaneous coronary intervention (PCI, group 2) with implantation of drug eluting stents. Both groups had comparable clinical characteristics. During hospitalization we registered deaths and unfavorable cardiological and cerebrovascular events. In remote period after revascularization we assessed survival, angina recurrences and related repeat revascularizations, and rate of severe cardiovascular complications (composite of deaths, acute myocardial infarctions [AMI], stroke, and repeat myocardial revascularizations).

RESULTS

During hospitalization there were no significant differences between groups by parameters studied: death rate was 1.7 and 0.9%, that of AMI 2.6 and 1.9%, of stroke 0.9% and 0, of composite of death, AMI, and stroke 5.1 and 1.9% (p = 0.37) in groups 1 and 2, respectively. Survival in remote period was 90.2 (group 1) and 92.7% (group 2). Comparison of Kaplan-Meier survival curves also revealed no significant differences between groups. Angina recurrence/repeat revascularization took place in 54 (17.0%) and in 64 (21.2%) patients in groups 1 and 2, respectively (p = 0.128). Repeat revascularization was carried out in 32 of 54 patients (59.3%) in group 1 and in 58 Of 64 patients (90.6%) in group 2. Rate of severe unfavorable events during whole period of follow up was 33.1% in group 1 and 30.5% in group 2 (p > 0.05).

CONCLUSION

In IHD patients with multivessel coronary artery involvement and low Syntax Score immediate and long term (5 year) results of stenting with drug eluting stents are not inferior to results of CABG.

Hybrid surgical management of a patient with an aneurysm of the arch and descending portion of the right-sided aorta combined with type B dissection and decompensated tracheal stenosis

The right-sided aorta is a rare congenital abnormality of the cardiovascular system encountered in 0.05-0.1% of cases during roentgenological examinations and in 0.04-0.1% of cases of autopsy series. Given utterly low prevalence of this pathology, we considered it wise to present herein our own case report dealing with hybrid surgical management of a patient suffering from an aneurysm of both the arch and descending portion of the right-sided aorta combined with type B dissection thereof and decompensated tracheal stenosis. The first stage of the operation consisted in prosthetic repair of the distal third of the arch and the descending portion of the aorta with the "Vascutek" stent graft 20 mm with type 1 haemodynamical correction (i. e., re-establishing the blood flow into the true channel in the zone of the distal anastomosis) in the conditions of extracorporeal circulation (EC) and bihemispheric antegrade cerebral perfusion ACP, followed by replantation of the left subclavian artery ostium into the left common carotid artery. An aneurysmal growth rate of more than 1 cm a year was considered an absolute indication for the second stage of correction of the aortic pathology concerned. The second stage included stenting of the thoracic portion of the aorta. The TF262C150X Valiant thoracic stent graft was implanted into the area of the distal anastomosis with a conduit, followed by positioning the TF 323C150X Valiant thoracic system inserted into the distal end of the first stent. The use of hybrid techniques (a combination of open and endovascular interventions) predetermined the success of surgical management of the patient presenting with dissection of the right-sided aorta.

[The endovascular approach to the open arterial duct surgery]

There are different ways of the open arterial duct treatment, based on its anatomical form. Endovascular occlusion is considered to be the safest. The morphometric protocol was developed for the adequate choice of the occluder. The first-stand results of the endovascular occlusion of the open arterial duct with the use of two types of guided occluders (Flipper and Amplatzer ductus occluder) are presented in the article.

[Use of Amplatzer septal occluder system for atrial septal defect closure]

Short-term results of minimally invasive transcatheter closure of atrial septal defect using Amplatzer septal occluder system (AGA Medical Corporation, USA) at 72 patients are analyzed. Technique of surgical procedure is described in detail. Morphometric protocol used for determination of indications and contraindication for endoscopic closure is also described. The causes of impossibility of endovascular procedures are established. The rate of transoccluder blood bypasses in postoperative period is demonstrated.

[Short- and long-term results of balloon dilatation of aorta coarctation]

Balloon dilatation is an alternative method of aorta coarctation (AC) treatment, and it may be effective in 80 - 90% cases with appropriate indications. Arterial hypertension is one of the symptoms of AC and frequent complication of short- and long-term postoperative period. Surgical correction does not guarantee regress of pathological symptoms in all the cases, and method of surgery does not influence the rate of postoperative arterial hypertension. The study reviews CA balloon dilatation experience and analyses cases of late arterial hypertension rate in long-term period after balloon dilatation procedure.

[Endovascular balloon valvuloplasty of pulmonary artery valvular stenosis]

Summarized experience of balloon valvuloplasty in isolated stenosis of pulmonary artery valve is analyzed. This procedure was performed in Russian Research Center of Surgery in 53 patients from 1980 to 2006. The technique of balloon valvuloplasty is described; short- and long-term results are analyzed. Complications and unsatisfactory results of this surgery are outlined.

[Results of point stenting of extended coronary stenoses in patients with ischemic heart disease]

The paper analyzes the immediate and long-term results of point stenting in patients with extended (more than 30 mm) coronary stenoses and compares them with those obtained by routine stenting. The study included 177 patients with varying extent stenoses who underwent traditional implantation of intracoronary stents. Thirty-seven patients undergone the so-called point stenting formed a separate group. There was no significant difference in clinical and angiographic success rates between the patients of all three groups. Significant difference was also absent in subacute stent thrombosis between the patients of Groups 2 and 3 and those of the point stenting group. Thus, acute or subacute stent thrombosis was noted in 4 (2.3%) patients from the routine stenting groups, all the patients being from Groups 2 and 3, and in 2 (5.4%) from the point stenting group. No significant difference was found in the incidence of recurrent angina pectoris (restenosis) between Groups 1 and 2 and between Groups 2 and 3. At the same time, recurrent angina (restenosis) significantly more frequently developed in the patients of Group 3 than those of Group 1. As compared with Groups 2 and 3 patients, there was no significant difference in the incidence of recurrent angina (restenosis).

[Indications to balloon angioplasty and intracoronary stenting in patients with ischemic heart disease]

Four hundred and ten patients with ischemic heart disease (IHD) were treated. The study group consisted of 197 patients with IHD who have undergone intracoronary stenting (IS). The control group consisted of 213 patients treated with traditional balloon coronary angioplasty (BCA). All the patients in both groups were divided in four subgroups depending on a type of stenosis by classification ACC/AHA. A positive angiographic and clinical result straight away after IS was seen in all 197 patients. Any links with a stenosis type or with construction of the stent were not revealed. In 5 (2.5%) patients on day 5-7 after IS acute coronary occlusion in the place of stenting was seen. In 2 (1%) patients attempt of recanalization was unsuccessful, in both cases transmural myocardial infarction has developed. Thus, in further study 195 (98.98%) patients were included. Out of 213 patients after traditional BCA immediate good angiographic and clinical results were achieved in 191 (89.7%). There were no differences in rate of good immediate results of IS and BCA of types A and B1 stenoses. In types B2 and C stenosis immediate good results were achieved more often in group with IS. Good immediate results after BCA were better in patients with type A stenosis than with B2 and C stenoses. Rate of the "stent-like" result after BCA of types A and B1 stenosis was higher than after dilatation of types B2 and C stenosis. There was no difference in rate of restenosis after traditional BCA and IS of types A and B1 stenosis. In BCA of types B2 and C stenosis restenosis was seen more often than in IS. It is concluded that in patients with types A and B1 stenoses "stent-like" result is achieved more often after traditional BCA than in patients with types B2 and C stenosis. In patients with type A stenosis and "stent-like" result stenting does not improve significantly long-term results. In patients with types B2 and C stenosis and "stent-like" result IS is tustified. Good immediate results of angioplasty in these patients don't reduce the rate of restenosis, white IS does reduce its rate.

[Immediate and long-term results of coronary stent implantation without predilatation (direct stenting) in patients with coronary heart disease]

The paper assesses the immediate and long-term results of direct stenting (without the stage of predilation) and compares with the outcomes of conventional stent implantation. A prospective study included 183 patients. All the patients were divided into two groups according to the procedure of stent implantation. In 85 (46.7%) patients, the stent was implanted without preliminary predilation of stenosis (direct stenting). These patients formed Group 1. Group 2 comprised 97 (53.3%) patients in whom the stent was placed by using the routine procedure. All the patients enrolled into the study had types A, B1, and B2 stenoses according to the ACC/AHA classification and received the conventional antiaggregatory and anticoagulant therapy. The technical success of direct stenting was 97.7%. There were no cases of stent dislocation and loss during direct stenting or expansion of a balloon and stent. Analyzing the immediate results in all the patients of the both groups showed a positive angiographic success. Thus, a primary angiographic and clinical success of direct stenting was achieved in all (100%) patients. Recurrent angina pectoris with restenosis was observed in 8 (9.4%) patients in Group 1 and in 21 (21.6%) in Group 2 (p < 0.05). Direct stenting significantly differs from the routine stent implantation in all procedure parameters. Thus, direct stenting in patients with uncomplicated stenoses is a safe and feasible procedure.

[Comparison of the results of stenting ans balloon angioplasty of coronary arteries in relation to the type of stenosis]

Based on the comparison of the immediate and late results of stenting and balloon angioplasty (BA), the authors consider whether it is expedient to perform stenting of coronary arteries (CA) in all cases of BA in patients with coronary heart disease (CHD) and different types of CA stenosis. The study included 410 patients: a group of stenting (n = 197) and a group of traditional BA (n = 213). All the patients in both groups were divided into four subgroups in relation to the type of detected stenosis according to the classification of the American Association of Cardiologists (ACC/AHA). The positive angiographic and clinical results were observed in all 197 patients after stenting. This was associated neither with the type of dilated stenosis nor with the design of an implanted stent. In dilation of types A and B1 stenoses, a stent-like result was significantly more frequently observed than in dilation of types B2 and C stenoses. There was no significant difference in the development of restenosis in patients after routine BA and stenting of types A and B1 stenoses. At the same time, after BA of types B2 and C stenoses, restenosis developed significantly more frequently than in stenting. Thus, on the basis of this study, it may be stated that the traditional BA yields the so-called stent-like result significantly more frequently in patients with uncomplicated forms of CA stenoses than in those with complicated ones. Once the stent-like result is achieved in patients with type A stenoses, stenting should not be performed since the latter fails to improve the immediate and late results of angioplasty. Despite that the stent-like result is achieved in patients with complicated forms of CA stenoses, it is expedient to make stenting. Our findings indicate that the obtained good immediate result reduces the incidence of restenosis.

[Results of point stenting of extended coronary stenosis in patients with ischemic heart disease]

The paper analyzes the immediate and long-term results of point stenting in patients with extended (more than 30 mm) coronary stenoses and compares them with those obtained by routine stenting. The study included 177 patients with varying extent stenoses who underwent traditional implantation of intracoronary stents. Thirty-seven patients undergone the so-called point stenting formed a separate group. There was no significant difference in clinical and angiographic success rates between the patients of all three groups. Significant difference was also absent in subacute stent thrombosis between the patients of Groups 2 and 3 and those of the point stenting group. Thus, acute or subacute stent thrombosis was noted in 4 (2.3%) patients from the routine stenting groups, all the patients being from Groups 2 and 3, and in 2 (5.4%) from the point stenting group. No significant difference was found in the incidence of recurrent angina pectoris (restenosis) between Groups 1 and 2 and between Groups 2 and 3. At the same time, recurrent angina (restenosis) significantly more frequently developed in the patients of Group 3 than those of Group 1. As compared with Groups 2 and 3 patients, there was no significant difference in the incidence of recurrent angina (restenosis).

[Immediate and long-term outcomes of coronary stenting in relation to stent implantation pressure in patients with coronary heart disease]

The paper evaluates the pressure impact of implantation of intracoronary stents of different designs on the immediate and long-term outcomes of stenting. A retrospective study included 192 patients. Matrix and wire stents were implanted in 97 (50.5%) and 95 (49.5%) patients, respectively. In one part of the patients, the coronary stent was implanted under nominal pressure, in the other, the stent after implantation was extended with a balloon by using high pressure. Good immediate angiographic and clinical results were obtained in all 192 patients. Thirty three (17.2%) patients were found to have coronary spasm at the site of a stent. There was no significant difference in the development of coronary spasm, which was associated with the type of an implanted (matrix or wire) stent and with the pattern of its implantation (under high or nominal pressure). Dissection along the stent edges developed in 17 of the 192 patients, which amounted to 8.8%. It significantly more frequently developed in patients from Subgroup IA than in those from Subgroup IB. There was no significant difference in the development of restenosis in patients after implantation of matrix or wire stents and in the relation to the stent implantation pressure.

[Chronic occlusions in patients with coronary heart disease: results of recanalization]

The paper analyzes the results of endovascular treatment in 298 patients with chronic occlusions or subtotal stenoses of coronary arteries. The authors show that balloon coronary angioplasty for chronic coronary occlusions is an effective and relatively safe techniques of myocardial revascularization. Successful endovascularization has been achieved in 68.1% of patients with chronic coronary occlusions and in 97.5% of those with subtotal coronary stenoses. The results show a high incidence of restenosis and asymptomatic reocclusion.

[Outcomes of balloon coronary angioplasty of bifurcation stenoses in patients with ischemic heart disease]

The study included 322 patients with bifurcation lesion of the coronary bed who had angioplasty by the conventional procedure by employing one balloon. The authors analyze whether there is a correlation of balloon coronary angiographic findings with the following X-ray morphological characteristics: the origin of a lateral branch from the stenotic segment of the coronary artery, that of the branch at a distance of no more than 10 mm proximal or distal to stenosis, the angle of branch origin. Based on the findings, it was concluded that the origin of the branch from the stenotic segment is a factor that limits an angiographic success of dilatation of the great coronary vessel. The origin of the branch 10 mm proximal or distal to stenosis does not affect the angiographic success of the procedure. The risk factors of lateral branch lesion include the origin of the branch from a stenotic segment, an angle of branch origin of over 45 degrees.

[A comparative analysis of the immediate and late results of coronary balloon angioplasty in bifurcation stenoses performed by the traditional method and by the "2-guide" method]

To evaluate the efficiency of balloon coronary angioplasty (BCA) for bifurcation stenoses, which had been made by the two-guide method, the results of the angioplasties were examined in 147 patients with coronary heart disease. BCA had been performed routinely in 54 patients and by the two-guide method in 32. Sixty-one patients undergone angioplasty for nonbifurcation lesions served as a control group. In the group of routine BCA procedure, poor results with residual stenosis of the major vessel were seen in 13% of cases, the incidence of complication (dissection of unfavourable types, thrombosis of the major vessel) was 29.6%. In the two-guide BCA, these indices were 15.6 and 2%, respectively, the incidence of restenosis was 46.9% and that of branch lesions was 6.3%. The findings have led to the following conclusions that routine angioplasty of bifurcation stenoses yields poor early and late results of dilatation of lateral branches. The use of the two-guide method substantially reduces the risk of damage to a lateral branch, improves immediate dilatation of the major vessel, yet fails to affect the number of restenosis in the late period.

[Catheter balloon valvuloplasty: new possibilities in the surgical treatment of mitral stenosis]

A total of 170 catheter balloon valvuloplastic (CBV) operations for rheumatic mitral stenosis were carried out in patients aged 19 to 68, 30 of these in pregnant women, at A. V. Vishnevsky Institute of Surgery, Russian Academi of Medical Scients, from 1988 to 1994. Characteristic features of such operations are a minor surgical trauma and no necessity in deep narcosis and artificial circulation. Analysis of the immediate results and of the data of five-year follow-up brings the authors to a conclusion about the efficacy of the new method of treatment of this heart disease and about the physiological nature of forming an adequate route of blood flow into the right ventricle with a balloon. Comparing various balloon catheters for valvuloplasty and methods to carry out this procedure, the authors emphasize the advantages of the instruments and method developed by professor V. A. Silin et al. (St. Petersburg). The possibility of correction of mitral stenosis by CBV in pregnant women appears to be particularly important. Retrospective analysis of the immediate results and follow-up data helped the authors not only formulate the indications for this intervention, but permitted them to develop an original system of comprehensive clinical and instrumental assessment of the degree of involvement of the mitral valve and subvalvular structures, and of hemodynamic disorders.

[Catheter balloon valvuloplasty in mitral stenosis (choice of surgical methods and evaluation of its results)]

Clinico-experimental study was undertaken for the choice of the optimal method for radiosurgical correction of the disease. Catheter balloon valvuloplasty (CBV), suggested by V. A. Silin and V. K. Sukhov with the use of balloon catheters of their design was found to be the most effective and safe method. This method was used to operate on 265 patients with mitral stenosis and various degree of affection of the valvular apparatus and complications in the form of calcinosis of the valve and cardiac fibrillation. Thirteen of the patients were operated on in pregnancy. CBV produced a positive therapeutic effect in more than 95% of patients. Increase of the mitral orifice area by 2.2-3.4 times was attended by a corresponding reduction of the diastolic pressure gradient at the mitral valve and systolic pressure in the pulmonary artery. The increase in the area of the mitral orifice and the positive changes of the hemodynamics values were more marked in patients with severe stenosis. The small number of complications (up to 9.5%) and the low lethality (up to 0.86%) allow the CBV method to be recommended as one of the main methods of surgical correction of mitral stenosis.

[Treatment of mitral valve stenosis in pregnant women by the method of balloon valvuloplasty]

Catheter-balloon mitral valvuloplasty was performed in 7 females with rheumatic mitral stenosis on the 19th-32nd week of pregnancy. Four patients were operated on with signs of cardiac insufficiency, two--in a state of pulmonary pre-edema. Edema of the lungs in one patient continued developing on the operating table. The results of the treatment were good in all cases. The area of the mitral orifice increased from 0.9-1.75 to 2.4-3.5 cm2. The pressure gradient between the left atrium and the left ventricle dropped from 25-40 to 2-8 mm Hg. This was attended by the disappearance of the diastolic murmur and the clinical manifestations of stasis in pulmonary circulation in all patients. The development of mitral regurgitation after the operation was not encountered in any of the patients. The period of roentgenoscopy lasted 17.5 min. on the average. Screens were used to protect the fetus from the direct effect of the X-rays. Pregnancy ended in delivery in 6 patients; spontaneous labor at term occurred in 4, cesarean section had to be performed in one patient with placenta previa; one woman gave birth to twins on the 36th week of pregnancy. All the babies were healthy. Catheter-balloon valvulotomy does not yield to closed mitral commissurotomy in efficacy. The fact that it is only mildly injurious and does not need general anesthesia make this intervention preferable for pregnant women suffering from mitral stenosis.

[Catheter-balloon valvuloplasty in mitral valve stenosis (selection of the method of procedure, immediate results and the criteria of patient selection]

Catheter-balloon valvuloplasty (CBV) was carried out in 80 patients with rheumatic mitral stenosis, whose ages ranged from 22 to 68 years. Seventeen of these patients were operated on for mitral valve restenosis; I-II degree calcinosis of the mitral valve was revealed in 18 patients; seven women underwent surgery in the 24th-32nd week of pregnancy. After applying various methods (19 cases) the authors used in the last series of operations (61 cases) the Silin-Sukhov method using an original dilatation catheter with a balloon measuring in diameter up to 34 mm, which allowed pressure of up to 8 atm. to be produced during a working cycle no longer than 8 sec. As the result of CBV, the area of the mitral orifice was enlarged by no less than twice in all patients, the pressure gradient through the mitral valve and systolic pressure in the pulmonary artery reduced. The total number of complications which called for operative treatment was 3.75%. CBV is a still developing method, but already today it may be considered the method of choice in the treatment of uncomplicated forms of mitral stenosis, in I-II degree calcinosis, and when the risk of the traditional surgical intervention on the heart is increased.

[Changes in intracardiac hemodynamics after percutaneous catheter balloon valvuloplasty in different types of valvular stenosis of the pulmonary artery]

Percutaneous catheter balloon valvuloplasty was carried out in 75 patients with valvular pulmonary stenosis (VPS), whose ages ranged from 18 months to 38 years. In 40 of them (53.3%) VPS was complicated by infundibular stenosis of the right ventricle. After percutaneous catheter balloon valvuloplasty 13 patients received out-patient treatment with beta-adrenergic blocking agents in doses of 20 to 120 mg/24 hours. Control examination in periods of 6 months to 2 years after the operation was conducted in 35 patients among whom 10 patients had been given beta-adrenergic blocking agents in the postoperative period. A stable reduction of the right ventricle-pulmonary artery (RV-PA) gradient and positive dynamics of the cardiac volume indices were recorded in 25 patients after correction of isolated VPS and in 6 patients after percutaneous catheter balloon valvuloplasty and treatment with beta-adrenergic blocking agents. The residual RV-PA gradient in 4 patients after treatment with beta-adrenergic blocking agents remained within a range of 30 mm Hg. Percutaneous catheter balloon valvuloplasty is an effective method for the correlation of isolated VPS. Coexistence of VPS with infundibular right-ventricular stenosis is not a contraindication for the use of this method for correcting the anomaly. In such a case the roentgenosurgical intervention should be supplemented by treatment with beta-adrenergic blocking agents in individual doses.

[Laser surgery in occlusive diseases of peripheral arteries]

The first experience with the use of an excimeric laser in the treatment of 24 patients with segmental occlusion of the peripheral arteries is discussed. It proved possible to recanalize the obstructed segment of the vessel for its whole distance in 13 patients. Analysis of the complications shows that further technological development of the method is necessary. Hemodynamic adequacy of restoration of the vascular lumen by laser recanalization in combination with balloon dilatation is demonstrated. Significant decrease of the risk of operative intervention, accelerated rehabilitation of patients, and an essential economical effect may be the advantages of the method.

[Debatable problems of intravascular dilatation of the brachiocephalic artery]

Roentgen--guided endovascular dilatation (RED) was conducted in 23 patients with atherosclerotic stenoses of branches of the arch of the aorta, in 20 with stenoses of the subclavian artery, and in 3 with stenoses of the brachiocephalic trunk. Before dilatation the patients had a systolic pressure gradient of 25 to 55 mm Hg in the region of the stenosis and constriction of the arterial lumen by 40 to 80%. Systolic pressure gradient disappeared completely in 17 cases and persisted at a level of 10 to 40 mm Hg in 7 cases. During RED of the left subclavian artery a complication, acute thrombosis of the distal part of the artery, occurred in one case. Indications for dilatation of stenosed subclavian arteries were elaborated on the basis of the accumulated experience.

[Evaluation of the blood supply to the bronchial stump following resection of the lungs using a mechanical suture in the diagnosis and treatment of pulmonary hemorrhage]

The authors analysed angiograms of 34 patients who had been operated on the lungs with the use of mechanical suturing instruments to determine the effect of the mechanical suture (MS) of the bronchial stump on the development of hemoptysis and pulmonary hemorrhage. They studied the possibility of applying transcatheter endovascular occlusion (TEO) of the bronchial arteries (BA) in the management of hemoptysis of this etiology. In 70% of patients hyperplasia of the BA developed in the MS region in the late postoperative period; which was the source of pulmonary hemorrhage in 75% of cases. Among the patients, 19 were subjected to BA TEO for pulmonary hemorrhage. In 13 cases the bronchial stump with MS was the source of hemorrhage. Hemoptysis is a late complication of lung resection with the use of MS. Preference should be given to BA TEO in the management of this complication.