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 of Bakoulev National Medical Research Center for Cardiovascular Surgery for 2020. 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 th 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 PAH-specific therapy.
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About the authors
- Sergey V. Gorbachevskiy, Dr. Med. Sci., Professor, Head of Department; ORCID
- Anton A. Shmalts, Dr. Med. Sci., Leading Researcher; ORCID
- Mikhail A. Grenaderov, Deputy Head of Department; ORCID
- Marianna V. Belkina, Cand. Med. Sci., Senior Researcher; ORCID
- Komoliddin Kh. Rakhmonov, Cand. Med. Sci., Сardiovascular Surgeon; ORCID
- Ruslan A. Aybazov, Junior Researcher; ORCID
- Аmirullo A. Sabitov, Сardiovascular Surgeon; ORCID
- Fozildzhon K. Zokirov, Physician-Resident; ORCID
