Clinical case. A patient after mitral valve replacement surgery for infective endocarditis was hospitalized with a new coronavirus infection. The examination revealed a left ventricular-right atrial communication. The complex treatment with a good clinical effect was performed at the N.V. Sklifosovsky Research Institute for Emergency Medicine. Conclusions In the context of a pandemic of a new coronavirus infection, patients with a new coronavirus infection who have undergone a history of heart surgery are subject to greater clinical vigilance regarding the development of postoperative complications, including rare ones.
INTRODUCTION Transposition of the great arteries is the second most common cyanotic congenital heart defect after tetralogy of Fallot. The arterial switch procedure (А. Jatene, 1975) is the surgical treatment of choice. Neoaortic root dilatation and valve regurgitation are quite common among the patients who underwent surgery for transposition of the great arteries. However, there are a lot of conflicting data about their direct connection.CLINICAL CASE This article describes surgical repair of neoaortic bicuspid valve regurgitation, by it successful implantation, in an 18-year-old patient after arterial switch operation for transposition of the great arteries in the neonatal period.CONCLUSION Neoaortic valve insufficiency can develop primarily as well as secondary to neoaortic root dilatation, however, the questions about valve repair or aortic root replacement with or without neoaortic valve implantation remains debatable. At this stage, decision making is based only on unsystematic clinical experience, surgeon’s intuition, the basics of anatomy and pathophysiology, as well as close interaction of “pediatric” and “adult” cardiac surgeons.
BACKGROUND Acute proximal aortic dissection (Stanford type A) remains the most common fatal pathology of the thoracic aorta. Despite the improvement of surgical technologies, hospital mortality after emergency surgical interventions is 17–25%, in complicated cases it can reach 80–90%.AIM OF STUDY Description of the perioperative treatment tactics adopted at the N.V. Sklifosovsky Research Institute for Emergency Medicine as well as the evolution of approaches that make it possible to obtain satisfactory hospital and long-term results in the treatment of aortic dissection.MATERIAL AND METHODS the study included 278 patients operated on from 2015 to 2021 in the acute stage of aortic dissection (less than 48 hours from the moment of manifestation of the disease). The operated patients were divided into two groups, depending on the presence of complicated forms: group A, 102 patients with uncomplicated course of the disease; group B, 176 patients with complicated course of the disease. Additionally, patients were divided depending on the level of distal reconstruction performed: group I, 83 patients, surgery was limited to prosthetics of the ascending aorta, without removing the clamp; group II, 137 patients who underwent hemi-arch surgery; group III, 58 patients, with distal reconstruction involving the aortic arch.RESULTS Total hospital mortality was 28.1%: 25.3% in group I, 29.1% in group II, 29.3% in group III. In the group of uncomplicated dissection, postoperative mortality was 18.6%, while in the group of complicated dissection it was 33.5%.CONCLUSION An integrated multidisciplinary approach with the formation of an “aortic team”, an individual approach to surgery, depending on the anatomy of the dissection and the clinical status of the patient, will improve the results of the treatment of acute aortic dissection, as the most severe and multiple organ pathology of the aorta.FINDING 1. Hospital mortality of complicated forms of dissection remains significantly higher — 33.5% versus 18.5% of uncomplicated course. 2. The most optimal method of distal reconstruction in patients with the peracute stage of dissection is an open anastomosis with the aorta using the “hemi-arch” technique. 3. If it is necessary to extend the surgical intervention on the aortic arch, a distal anastomosis in areas 0, 1, 2 with the possibility of a subsequent endovascular stage is the priority.
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