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Biomedical subjects

A N Korostelev

Publications and source records attributed to A N Korostelev.

7 recordsLinked to original sources

[Dislocation of the closing element of the disk mechanical graft at aortic valve replacement].

Presented herein is the first case of dislocation of the closing element of the artificial low-profile aortic valve to the abdominal aorta, which happened during replacement. Toward completion of extracorporeal circulation a 37-year-old man showed the signs of aortic insufficiency because of dislocation of the closing element. After resumption of extracorporeal circulation repeated replacement was accomplished. To detect the site of graft cusp embolism, transesophageal echocardiography and duplex scanning of the abdominal aorta were employed. On the 18th day following the first intervention the patient developed thromboembolism to the distal arterial bed. Emergency thrombectomy from the arteries of the right lower extremity was performed and a foreign body was removed from the abdominal aorta, using left-sided thoracophrenolumbotomy. The patient was discharged from the clinic in a satisfactory condition.

Adult↗

[Roentgeno-endovascular occlusion and surgical correction of patent ductus arteriosus].

To establish the indications to classical surgical correction and roentgenoendovascular occlusion (REO) of patent ductus arteriosus (PDA) results of treatment of patients with PDA were compared. Immediate results of treatment of 209 patients with PDA were analyzed. 110 patients underwent classical surgical operations which were performed successfully in 109 (99%) patients. Complications in early postoperative period were the following: incomplete expanding of the left lung in 1 (0.9%) patient, reactive exudation into left pleural cavity--in 1 (0.9%), and chylothorax--in 1 (0.9%). REO of PDA was performed in 99 patients. Gianturco coils (COOK, Denmark) and Saveliev--Prokubovsky occluders were used. REO was successful in 93 (93.9%) patients. It failed in 6 (6%) cases including 3 cases with coils and 3--with Saveliev--Prokubovsky occluders. According to the results, PDA with diameter less than 4 mm in the narrowest part can be closed by REO with Gianturco coils. In PDA with diameter 4-10 mm Saveliev--Prokubovsky occluders are recommended. In case of PDA with diameter more than 10 mm, aortopulmonary defect or septic botallitis it is necessary to perform thoracotomy and surgical correction.

Balloon Occlusion↗

Recanalization and thrombectomy of internal anastomosis in a patient with tetralogy of Fallot using the AngioJet rheolytic catheter.

The modified Blalock-Taussig shunt is the palliative treatment of choice for tetralogy of Fallot. Shunt thrombosis is a potential complication, requiring high-risk reoperation. The use of percutaneous rheolytic devices for thrombus removal in such occluded shunts has not been previously reported. We describe a case in which use of a rheolytic catheter resulted in significant thrombus removal and rapid reversal of cyanosis and dyspnea in a 5-year-old patient. The patient remains free of symptoms at 30-day follow-up.

Anastomosis, Surgical↗

[Opportunity of operative traumatism decrease in patients with complicated tricuspid valve defect].

This study examined the results of surgical trivalve of 44 patients with trivalve heart defect. In all the patients the heart defect was combined with two and more complicating factors: advanced III-degree calcinosis of the valves, cardiomegaly, cardiac fibrillation, left atrium thrombosis, high pulmonary hypertension. In 20 patients the operative intervention on the heart was repeated. The analysis of the results allowed to recommend some surgical techniques which allowed to decrease surgical traumatism in patients with complicated trivalve heart defect. Low traumatism was possible because of incomplete removal of the calcium masses extending on the fibrotic ring and outside, use of two-row counter U-suture on linings for the prosthesis fixing, transdoubleatrial approach without isolation of the heart from the adhesions in dense pericardial obliteration, correction even insignificant trivalve heart defect or relative valve incompetence.

Adult↗

[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.

Adult↗