Abstract
Purpose: to show the possibilities of endovascular treatment methods in patients with various pathological communications of the heart and vessels using occluders.
Material and methods. In the period from 1998 to 2017 in the Bakoulev Center for Cardiovascular Surgery for attempt to close 71 pathological messages was subjected to 70 patients aged 2 months to 72 (averaging 23.2 ± 10,0) years; weight – from 4 to 106 (average 34.8 ± 12.3) kg. Interventions were performed to close the antegrade blood flow in the trunk of the pulmonary artery after Fontaine’s surgery and bidirectional cavopulmonary anastomosis; paraprosthetic fistulas of the aortic valve (AV) and mitral valve (MV); coronary arterial fistulas; large aorto-pulmonary collateral arteries; veno-venous fistulas; defect of the aortopulmonary septum; communication between the left ventricle and the right atrium; vertical veins after Tucker surgery; a rupture of the Valsalva sinus in the right ventricle; arteriovenous fistulas; fenestration between conduit and right atrium after Fontaine's surgery; recanalized systemic pulmonary anastomosis; giant aneurysm of the right vertebral artery.
Results. The occluder was successfully implanted in 68 (97.1%) patients. In 2 (2.9%) cases, the technical failure was caused by the inability to perform atrial septal (AS) puncture in a patient with paraprotective MV fistula (interatrial septum > 3 mm) and due to the size of the tricuspid valve parapropedic fistula initially incorrectly determined by echocardiography in a patient with Ebstein's anomaly (diameter defect during intraoperative measurement was 19 mm and was lunar in shape). After closure, minimal blood discharge was noted only in 3 (4.4%) cases. Three (4.4%) patients, despite a successful intervention, died due to initially severe heart and multiple organ failure.
Conclusion. The good results of the intervention show that the endovascular method is an effective alternative to open surgery, avoiding repeated thoracotomies using cardiopulmonary bypass.
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About the authors
- Bagrat G. Alekyan, Dr. Med. Sc., Professor, Academician of Russian Academy of Sciences, Deputy Director for Science and Innovative Technologies, ORCID
- Vladimir P. Podzolkov, Dr. Med. Sc., Professor, Academician of the Russian Academy of Sciences, Head of Department, ORCID
- Elena Z. Golukhova, Dr. Med. Sc., Professor, Academician of the Russian Academy of Sciences, Director, ORCID
- Konstantin V. Shatalov, Dr. Med. Sc., Professor, Head of Department, ORCID
- Manolis G. Pursanov, Dr. Med. Sc., Professor, Specialist in X-ray endovascular diagnostics and treatment, ORCID
- Karen V. Petrosyan, Dr. Med. Sc., Head of Department, ORCID
- Goar A. Brutyan, Specialist in X-ray endovascular diagnostics and treatment, ORCID
- Gulamzhan M. Dadabaev, Cand. Med. Sc., Specialist in X-ray endovascular diagnostics and treatment, ORCID
