Abstract
The article presents the results of the scientific and practical work of the Department of Surgical Treatment of Heart
Diseases with Progressive Pulmonary Hypertension in Bakoulev National Medical Research Center for
Cardiovascular Surgery for 2019. Conclusions and practical recommendations on the diagnosis, surgical, interventional and medical treatment of various nosological forms of pulmonary hypertension (PH) are given.
In particular, it was shown that pulmonary endarterectomy in patients with chronic thromboembolic PH can eliminate or reduce PH and improve the functional state. The improvement of the results of pulmonary endarterectomy
itself was significantly improved by the development of risk-benefit criteria for the intervention. A low risk of surgery
with a predictable good long-term result can be expected in the presence of deep vein thrombosis or pulmonary
embolism in the anamnesis, the absence of severe right ventricular failure, II–III of the initial functional class of PH,
the presence of obvious pulmonary artery obstruction with various imaging methods (computed tomography, scintigraphy, angiography), the presence of obstruction of the lower lobe pulmonary arteries (supplying a significant portion
of the lungs) and with a relatively small increase in the lungs the vascular resistance. However, a higher risk with a less
predictable long-term outcome is not a contraindication for pulmonary endarterectomy.
It has also been shown that atrioseptostomy with stenting is safe in experienced hands and is effective in idiopathic
and similar forms of PH. In moderate and high risk groups, significant clinical and hemodynamic improvement will
be achieved, however, in the high risk group it may be accompanied by immediate and greater than mortality risk.
Atrioseptostomy with stenting allows you to create a message of a given diameter and exclude its occlusion in a distant period. The configuration of the stent in the form of an hourglass ensures its stable position and does not cause
any complications. In the Russian Federation, atrioseptostomy can be a "bridge" not only of Potts pulmonary aortic
anastomosis and lung transplantation, but also to pulmonary aortic hypertension specific therapy.
Keywords: pulmonary hypertension, pulmonary arterial hypertension, congenital heart diseases, chronic thromboembolic pulmonary hypertension.
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About the authors
- Sergey V. Gorbachevsky, Dr. Med. Sc., Professor, Head of Department, ORCID
- Anton A. Shmalts, Dr. Med. Sc., Leading Researcher, ORCID
- Mikhail A. Grenaderov, Deputy Head of Department, ORCID
- Marianna V. Belkina, Cand. Med. Sc., Senior Researcher, ORCID
- Komoliddin Kh. Rakhmonov, Cand. Med. Sc., Cardiovascular Surgeon, ORCID
- Ruslan A. Aybazov, Junior Researcher, ORCID
- Nosrulo A. Nishonov, Cardiovascular Surgeon, ORCID
- Amirullo A. Sabitov, Postgraduate, ORCID
