Right ventricular outflow tract reconstruction with decellularized human pulmonary valves in congenital heart diseases

Universitatea de Stat de Medicină și Farmacie “Nicolae Testemiţanu”, Spitalul Clinic Republican “Timofei Moşneaga”, Chișinău, Republica Moldova, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Matricea valvulară obţinută prin metodele ingineriei tisulare crează posibilitate de regenerare a ţesutului, un factor important în înlocuirea valvulară la copii. Scopul: Studierea eficacităţii detergenţilor în decelularizarea valvelor pulmonare umane şi a rezultatelor clinice la pacienţii care au suportat implantarea acestor valve. Material şi metode: Au fost prezervate 20 de homogrefe de la donatori cu timpul ischemiei calde cuprins între 2,5 şi 8,5 ore. Pentru decelularizare au fost utilizaţi doi detergenţi pentru 36 ore. În următoarele 96 ore homogrefele au suportat 8 cicluri de spălare în soluţie Ringer cu antibiotice şi antimicotice în condiţii de vibraţie continuă la temperatura de 37 0C. La un termen de 55,8±18,7 luni au fost investigaţi 32 pacienţi la care au fost implantate homogrefele valvulare pulmonare (HVP) decelularizate . Rezultate: În rezultatul preparării HVP cu utilizarea detergenţilor s-a obţinut înlăturarea totală a celulelor de pe matricea valvulară. Semne de degenerare, îngroşarea cuspelor, reducerea mobilităţii lor, dilatarea sau stenozarea valvulară n-a fost depistată în dinamică. Gradientul transvalvular mediu a rămas stabil (4.35±2.54 la 4.66±2.63 mmHg), iar diametrul end-diastolic al ventriculului drept nu s-a schimbat în comparaţiie cu suprafaţa corporală a pacienţilor. Concluzie: Prelucrarea HVP cu detergenţii SDS şi ND a demonstrat înlăturarea totală a celulelor donor de pe homogrefă, cu păstrarea optimală a integrităţii matricei şi membranei bazale. Corecţia chirurgicală a malformaţiilor cardiace congenitale utilizînd HVP decelularizate au arătat un rezultat bun la pacienţii pediatrici cu un potenţial de a se remodela în paralel cu creşterea fiziologică a copilului.Introduction: Non-immunogenic cell-free valvular scaffolds obtained by methods of tissue engineering have provided to induce in/vivo guided tissue regeneration and present a promising valve substitute especially for children. Aim: To investigate the efficacity of detergent treatment in decellularization of HPV tissue and clinical results in patients with implanted cell-free valvular grafts. Material and methods: Twenty PV allografts were harvested from nonbeating heart donors with warm ischemic time from 2,5 to 8,5 hours. Two detergents for 36 hours and eight washing cycles in Ringer solutions with antibiotics during 4 days were used to remove cellular remnants at 370C temperature under continuous shaking conditions. 32 patients with cell-free valvular grafts were investigated mean follow-up 55,8±18,7 months. Results: Treatment of PV with detergents resulted in complete loss of cusps, wall and myocardial cuff cellularity. No signs of pulmonary dilatation or stenosis, valve degeneration, cusps thickness, or reduction of cusp’s mobility were observed during follow-up. Mean transvalvular gradient remained stable (4.35±2.54 to 4.66±2.63 mmHg). End-diastolic diameter of the right ventricle remained unchanged in contrast to physiological increase to BSA of the patients Conclusions: Treatment of the HPVC with ND and SDS solution demonstrated the efficiency in a complete removal of the cells from the human valve tissue with optimal preservation of the scaffold fibres and basal membrane. Surgical correction of congenital heart diseases using “fresh” decellularized PV homografts provides good early postoperative results and has the potential to remodel in parallel with the somatic growth of the child

Mediastinal cavernous hemangioma in a child with pulmonary hypertension

Department of Radiology, State University of Medicine and Pharmacy Republic of Moldova, Moldova, Department of Cardiac Surgery, Clinical Republican Hospital, State University of Medicine and Pharmacy Republic of Moldova, Moldova, Department of Pathology, Clinical Republican Hospital, State University of Medicine and Pharmacy Republic of Moldova, MoldovaAbstract We present a rare case of mediastinal cavernous hemangioma in a 9-year old girl with advanced pulmonary hypertension. Dynamic contrast enhanced computed tomography of the chest revealed a heterogeneous mass in the antero-superior mediastinum with multiple scattered calcifications, gradually increasing puddles of contrast enhancement and a dilated central vein draining into the superior venae cavae. Surgical resection was performed via median sternotomy. The central vein was ligated in close proximity to its draining point and the entire mass was carefully dissected and excised. The histopathological findings were consistent with cavernous hemangioma. Her postoperative course was uneventful and she was subsequently discharged. The cause of her pulmonary hypertension, however, remained uncertain and required further investigation

Efficacy of sildenafil therapy in children with pulmonary hypertension secondary to congenital heart disease

Mother and Child’s Institute, Department of Cardiology, Republic of MoldovaPurpose: pulmonary hypertension (PH) resulting from congenital heart disease (CHD) remains one of the most difficult childhood illness to treat. Sildenafil, a selective inhibitor of phosphodiesterase-5, is known as an effective and promising pulmonary vasodilator, with minors and insignifi cant reverse effects. Methods: we have evaluated the efficacy and the tolerability of sildenafil in chidren with advanced PH secondary CHD with shunts (simple (14 pts), mixed (35 pts) and complex (28 pts). In this monocentric, double-blind, placebocontrolled study we randomly assigned 77 pts with advanced PH (35 with repaired shunts, 31-palliative procedure and 11 inoperable pts) to placebo or Sildenafil orally, with the dose of 1-2 mg/kg/day each 8h for 6-12 months. The Sildenafil group consisted of 38 pts (mean age 19,9±5,3 months: 16 boys/22 girls) and the placebo group – 39 pts (mean age 21,7±7,8 months: 22 boys/17 girls). The study protocol included: functional class (FC) NYHA/Ross; O2 saturation; 6-min walk test; transthoracic echocardiogram (mean PAP, tricuspid annular plane systolic excursion (TAPSE), myocardial performance index (MPI or Tei index), right cardiac catheterisation, measuring pulmonary vascular resistance (PVR). In addition a special questionnaire of evidence of adverse reactions was available. Results: at the patients treated with Sildenafil was observed an improvement of FC NYHA/Ross from 3,16±0,1 to 2,15±0,1 (p<0,001); O2 sat (+3,1±0,5%) comparing with placebo (+0,6±0,3%), (p<0,001); an effort tolerance estimated by 6-minute walk test (+152,5±17,4 m at 6 months and +184,3±21,2m at 12 months of treatment), (p<0,001); the decreasing of mean PAP, with 22,0±2,22 at 6 months and with 19,03±2,3 mmHg at 12 months (p<0,001) and PVRI had decreased with 2,45±0,19 UW·m2 (p<0,001); the improvement of the systolic function, TAPSE from 16,55±0,34 to 20,7±0,64 mm/m2 (p<0,001) and global function of RV (Tei index) with 0,15±0,01(-31%) to initial (p<0,001). In placebo group the respective signs slightly changed and only PVR diminished from 6,4±0,1 to 5,7±0,3 UW/m2 (p<0,05). There was no death in the sildenafil-treated cases, contrary to 5 in the placebo group. Conclusions: Sildenafil is efficient in treating PH secondary to congenital systemic-to-pulmonary shunts, but even more effective in corrected surgical shunts. Sildenafil improves FC, tolerability at effort, O2 sat, systolic and global function of RV, diminishing PAPm and PVRI comparing with placebo. This remedy has good tolerability, with minors and insignifi cant adverse reactions and favourable impact on the quality of life

Association of ACE gene polymorphisms with cardiovascular events in patients after elective percutaneous coronary interventions

Aim. To reveal the association of the INS/DEL polymorphism of the angiotensinconverting enzyme (ACE) gene with acute and long-term complications of elective percutaneous coronary interventions (PCI).Material and methods. This prospective study included 286 patients with chronic coronary artery disease who underwent elective endovascular myocardial revascularization in accordance with current guidelines. The ACE gene INS/DEL (I/D) polymorphism was determined in patients using polymerase chain reaction. Acute periprocedural complications were recorded. Acute myocardial injury (AMI) was detected in 30,4% of patients. Type 4a acute myocardial infarction developed in 3,1% of patients. A significant decrease in the glomerular filtration rate by more than 30% due to periprocedural acute kidney injury (AKI) was diagnosed in 6,5% of patients. Outcomes of elective PCIs were assessed after 4 years via telephone interviews. Cardiovascular and any-cause mortality was 3,6% and 5,1%, respectively. Acute coronary syndrome during the follow-up period developed in 15,2%, while cerebrovascular accident — in 5,4% of patients. Any-stent thrombosis was detected in 10%, and restenosis ≥30% — in 21,8% of patients. Statistical analysis was carried out using the STATISTICA 10. The odds ratio (OR) was calculated with a 95% confidence interval.Results. Analysis of the association of ACE gene I/D polymorphism with acute and long-term complications of the PCI revealed that the presence of I allele is associated with the risk of periprocedural AKI (p=0,017; OR, 2,627 (1,161- 5,947)), as well as long-term cardiovascular events, vascular complications such as acute coronary syndrome (p=0,045; OR, 1,610 (1,007-2,573)) and stent thrombosis (p=0,01; OR, 2,073 (1,178-3,650)). The presence of genotype II further increases the risk of AKI (p=0,029; OR, 5,138 (1,022-25,824)), any acute clinical complications of PCI (p=0,041; OR, 1,996 (1,024-3,980)), and stent thrombosis (p=0,018, OR, 3,498 (1,178-10,392)).Conclusion. In patients with chronic coronary artery disease, the carriage of allele I and genotype II of the ACE gene I/D polymorphism is associated with the risk of acute clinical complications of elective PCI, periprocedural AKI, as well as the risk of stent thrombosis and acute coronary syndrome within 4-year follow-up period after PCI

Congenital supravalvular aortic stenosis: surgical outcomes

Departamentul Chirurgie Cardiacă, IMSP Spitalul Clinic Republican, Catedra Radiologie și Imagistică, USMF „Nicolae Testemițanu”, Chișinău, Republica Moldova, Conferința stiințifică „Nicolae Anestiadi – nume etern al chirurgiei basarabene” consacrată centenarului de la nașterea profesorului Nicolae Anestiadi 26 august 2016Introducere. Stenoza aortică supravalvulară congenitală (SASC) este cunoscută prin implicarea întregii rădăcini aortice. Ca urmare, unii chirurgii au schimbat tactica de diminuare a obstrucției prin aplicarea uni singur patch în favoarea tacticii de reconstrucție simetrică cu tehnica de aplicare a două patch-uri ori trei. Avantajul declarat, privind durabilitatea păstrării funcției valvei aortice și posibilitatea de creștere, este nedovedit. Scopul studiului. Constă în evaluarea comparativă a diverselor tactici şi metode de corecţie chirurgicală a SASC şi elaborarea algoritmului optimal de tratament al acestor bolnavi. Materiale şi metode. În lotul de bolnavi cu SASC, operaţi pe parcursul anilor 1992-2016, au fost incluşi 17 de pacienţi cu vârsta cuprinsă între 1 și 19 ani. Sindromul Williams a fost diagnosticat la 10 pacienţi. La toți pacienții a fost măsurat gradientul presional sistolic la nivelul stenozei pre- și postoperator. Metoda de plastie cu lărgirea uni sinus Valsalvae a fost folosită în 10 cazuri, tehnica de plastie după Doty la 7 pacienţi. La 2 pacienţi s-a efectuat şi plastia coarctaţiei aortice. Schimbările în aparatul supravalvular aortic au fost documentate prin datele ecocardiografice și ale aortografiei. Rezultate. La etapa postoperatorie precoce şi tardivă nu s-au determinat cazuri letale. Gradientul presional sistolic la nivelul stenozei preoperator a variat intre 50 – 145 mm Hg( media 82,6-17mmHg), în perioada postoperatorie a variat între 8-30mmHg (media 14,6-7 mm Hg) , fără modificări semnificative pe parcursul supravegherii. După datele ecocardiografiei și aortografiei nu s-au depistat diferențe privind incidența regurgitației și mărimea gradientului în raport cu tehnica aplicată. Concluzii. Operaţiile plastice în cazul stenozei aortice supravalvulare congenitale sunt efective, durabile în timp, având ca consecinţă lichidarea completă a obstrucţiei aortice supravalvulare indiferent de metoda de plastie folosită şi reduc necesitatea protezării aortei ascendente practic la zero.Background. Congenital supravalvular aortic stenosis (CSAS) is known to involve the whole aortic root. Some surgeons have therefore changed their approach from relief of obstruction using a single-patch to symmetric reconstruction with two-or three-patch technique. The argued advantages, as preserved long-term aortic valve function and allowance for growth, are unproven. Objective. Benchmarking of various tactics and methods of surgical correction of CSAS and developing optimal treatment of these patients. Methods. Seventeen patients (7 male, 10 female, mean ages of 8.25 years, range 1-19) underwent surgery for CSAS during 1992-2016 years were included in this retrospective analysis. Ten patients had features of Williams syndrome. Two patients had other concomitant procedures. A single patch was inserted into the longitudinal incision, which passed across the stenosis into the non-coronary sinus in 10 cases. A Doty technique was used in 7 patients. In 2 patients aortic coarctation plasty was performed. Changes in aortic root following repair were documented by echocardiography, aortography. Results. There were no operative deaths. The mean preoperative gradient was 82.6 ±17 mmHg (range 50 – 145 mmHg), which decreased to 14.6±7 mmHg (range 8-30 mmHg) early postoperatively. There was no significant difference in the incidence of postoperative aortic regurgitation or gradient across the repair between two techniques according to the echocardiograms and catheterization findings. Conclusion. According to our study, we cannot demonstrate any benefit in reconstructing the whole aortic root for CSAS. Good surgical outcome of CSAS can be achieved with the appropriate method of treatment in patients with both: single- and multiple-sinus reconstruction. The choice of material for the patch does not affect the long-term results of surgical treatment

Surgical treatment of ventricular septal defect associated with tricuspid valve insufficiency

Departamentul Cardiochirurgie, Spitalul Clinic Republican, Chişinău, Republica Moldova, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Insuficienţa tricuspidiană (IT) congenitală izolată se întâlneşte foarte rar şi constituie 0,3-0,6% din toate malformaţiile cardiace congenitale (MCC). Mult mai frecvent IT are caracter secundar ca consecinţă şi complicaţie a altor MCC. După datele literaturii de la 10 pînă la 30% din pacienţii cu defect septal ventricular (DSV) localizat în regiunea perimembranoasă pot dezvolta IT.Scopul: Evaluarea comparativă a diverselor tactici şi metode de corecţie chirurgicală a DSV asociat cu IT şi elaborarea algoritmului optimal de tratament al acestor bolnavi. Material şi metode: În lotul de bolnavi cu DSV asociat cu IT, operaţi în Centrul de Chirurgie a Inimii pe parcursul anilor 2005- 2014, au fost incluşi 35 de pacienţi cu vârsta medie de 80,9±20,5 luni. Greutatea medie a pacienţilor din acest grup a fost 19,3±3,2 kg şi varia în limitele 4-68 kg. Rezultate: În 20 (57,0%) cazuri s-a diagnosticat IT de gradul II, în 8 (23,0%) cazuri – IT de gradul III şi în 7 (20,0%) cazuri – IT de gradul IV. Concomitent cu plastia DSV, la toţi pacienţii s-a efectuat şi repararea VT: la 4 (11,0%) pacienţi s-a efectuat plastia VT De Vega, la 14 (40,0%) pacienţi – comisuroplastia, la 6 (17,0%) pacienți – suturare de cleft, la 1 (4,0%) pacient – plastia VT De Vega şi comisuroplastie, la 10 (29,0%) pacienţi – comisuroplastie şi suturare de cleft. La etapa postoperatorie s-a ameliorat semnificativ tabloul clinic: s-au redus dispneea (de la 91,7% cazuri la 8,3% cazuri), palpitaţiile (de la 91,7% cazuri la 33,3% cazuri) şi edemele periferice (de la 10,8% cazuri la 4,2% cazuri). Numărul de pacienţi cu insuficienţă cardiacă NYHA 1, care la etapa preoperatorie nu s-a determinat nici la un pacient cu DSV asociat cu IT, a crescut postoperator de la 0 la 54,2% pacienţi, NYHA 2 s-a redus de la 60,0% la 41,7% pacienţi, NYHA 3 – de la 36,0% la 4,2% pacienţi. Concluzii: În marea majoritate de cazuri s-a utilizat metoda prin sutură la comisura antero-septală. Această procedura chirurgicală este simplă, necostisitoare, durează nu mai mult de 5-10 min., practic lipsită de complicaţii şi diminuează semnificativ regurgitarea tricuspidiană.Introduction: Isolated congenital tricuspid valve insufficiency is rare accounting 0.3-0.6% of all congenital heart malformations (CHM). More frequently tricuspid regurgitation (TR) is of secondary origin being a consequence or complication of other CHM. According to the literature 10-30% of patients with ventricular septal defect (VSD) localized in the perimembranous region can develop TR. Aim: Comparative evaluation of various tactics and methods of surgical correction of VSD associated with TR and creation of optimized treatment algorithm. Material and methods: Between 2010 and 2014, 35 patients with average age of 80.9±20.5 months underwent tricuspide annuloplasty within correction of VSD in the Center of Cardiac Surgery of Republic of Moldova. The mean patients’ weight was 19.3±3.2 kg with range of 4-68 kg. Results: There were grade II regurgitation of tricuspide valve in 20 (57.0%) of cases, regurgitation of grade III in 8 (23.0%) of cases and regurgitation of grade IV in 7 (20.0%) of cases. Within correction of VSD there was plasty of tricuspide valve performed: in 4 cases (11.0%) of patients plasty of tricuspide valve De Vega, in 14 cases (40.0%) of patients comisuroplasty, in 6 case (17.0%) of patients comisuroplasty and suture of cleft, in 1 case (4.0%) of patients plasty of tricuspide valve De Vega and comisuroplasty, in 10 cases (29.0%) of patients comisuroplasty and suture of cleft. After operation the clinic state of patients improved significantly: asthma reduced from 91.7% of cases till 8.3% of cases, cases of tachycardia reduced from 91.7% till 33.3% of cases and other cardiac failure symptoms from 10.8 % till 4.2% of cases. The number of patients with cardiac failure NYHA classification class I was present after operation in 54.2% of cases comparing with its absence before operation, class II diminished from 60.0% to 41.7% of cases, class III from 36.0% to 4.2% of cases. Conclusions: In majority of cases the sutures were applied to approximate the septal and anterior leaflet close to the commisure. It is simple, reliable, inexpensive method, requiring not more than 5-10 min to perform and in our experience free of complications and effective in correction of TR

Оценка риска отдаленных смертельных сердечно-сосудистых событий у пациентов с хроническим коронарным синдромом после эндоваскулярной реваскуляризации миокарда

Highlights. The frequency of long-term fatal cardiovascular complications in patients with chronic coronary syndrome subjected to selective (non-emergency) percutaneous coronary interventions was estimated.Risk stratification model of long-term fatal cardiovascular complications in patients with chronic coronary syndrome subjected to selective percutaneous coronary interventions has been created.Aim. To determine the frequency of long-term fatal cardiovascular events (CVE) after elective percutaneous coronary interventions (PCI) and to develop a model for stratifying the risk of these events.Methods. 150 patients with chronic coronary syndrome and indications for endovascular myocardial  revascularization  were  included  in  the  research.  After  PCI  the patients were observed on an outpatient basis for year. The frequency of fatal cardiovascular complications was estimated by telephone interview 6 years after the index intervention.Results. Survival in the study group after 6 years was 86.1%. Fatal CVEs were reported in 10.6% of patients. The following baseline variables were significant predictors of cardiovascular death included in the individual risk assessment model: NYHA functional class of chronic heart failure (odds ratio (OR) 0.06, 95% confidence interval (CI) 0.003-1.106), lean plasma glucose level (OR 0.07, 95% CI 0.12-0.43), atrial fibrillation (OR 43.1, 95% CI 2.01–922.01), as well as the value of creatinine in the blood one year after the intervention (OR 1.14, 95% CI 1.0–1.3) and glomerular filtration rate (CKD-EPI) (OR 1.4, 95% CI 1.09–1.81). The area under the curve (AUC) of the developed model was 0.976 [95% CI 0,000–1,000].Conclusion. The proposed risk stratification model of developing long-term fatal cardiovascular complications in patients with chronic coronary syndrome subjected to selective (non-emergency) PCI allows identifying patients with an unfavorable long-term (six-year) prognosis.Основные положения. Оценена частота отдаленных фатальных сердечно-сосудистых осложнений у пациентов с хроническим коронарным синдромом, подвергнутых выборочным (не экстренным) чрескожным коронарным вмешательствам.Создана модель стратификации риска отдаленных смертельных сердечно-сосудистых осложнений у пациентов с хроническим коронарным синдромом, подвергнутых выборочным чрескожным коронарным вмешательствам.Цель. Определить частоту отдаленных фатальных сердечно-сосудистых осложнений у пациентов с хроническим коронарным синдромом, подвергнутых выборочным чрескожным коронарным вмешательствам, и создать модель стратификации их риска.Материалы и методы. В исследование последовательно включено 150 пациентов с хронической ишемической болезнью сердца и показаниями к эндоваскулярной реваскуляризации миокарда. После чрескожного коронарного вмешательства больных в течение года наблюдали в амбулаторно-поликлиническом отделении. Частота фатальных сердечно-сосудистых осложнений оценена посредством телефонного интервью через 6 лет после индексного вмешательства.Результаты. Фатальные сердечно-сосудистые осложнения отмечены у 10,6% включенных в исследование пациентов. Выживаемость через 6 лет после включения в исследование составила 86,1%. Значимыми предикторами сердечно-сосудистой смерти, включенными в модель оценки индивидуального риска, были следующие исходные переменные: функциональный класс хронической сердечной недостаточности по NYHA (отношение шансов (ОШ) 0,06, 95% доверительный интервал (ДИ) 0,003–1,106), тощаковый уровень глюкозы в плазме крови (ОШ 0,07, 95% ДИ 0,12–0,43), фибрилляция предсердий (ОШ 43,1, 95% ДИ 2,01–922,01), а также значение креатинина в крови через год после индексного вмешательства (ОШ 1,14, 95% ДИ 1,0–1,3) и скорость клубочковой фильтрации (CKD-EPI) (ОШ 1,4, 95% ДИ 1,09–1,81). Величина площади под кривой созданной модели AUC (Area Under Curve) составила 0,976 (95% ДИ 0,000–1,000).Заключение. Предложенная модель оценки риска развития отдаленных фатальных сердечно-сосудистых осложнений у пациентов с хроническим коронарным синдромом, подвергнутых выборочным (не экстренным) ЧКВ, позволяет выявить группы больных с неблагоприятным отдаленным (шестилетним) прогнозом

Surgical treatment of ventricular septal defect associated with tricuspid valve insufficiency

Departamentul Cardiochirurgie, IMSP Spitalul Clinic Republican, Chişinău, Republica Moldova, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Insuficienţa tricuspidiană (IT) congenitală izolată se întîlneşte foarte rar şi constituie 0,6 % din toate malformaţiile cardiace congenitale (MCC). Mult mai frecvent IT are caracter secundar ca consecinţă şi complicaţie a altor MCC. După datele literaturii pînă la 30% din pacienţii cu defect septal ventricular (DSV) localizat în regiunea perimembranoasă sau de tip in-let pot dezvolta IT. Scopul studiului constă în evaluarea comparativă a diverselor tactici şi metode de corecţie chirurgicală a DSV asociat cu IT şi elaborarea algoritmului optimal de tratament al acestor bolnavi. Material şi metode: În lotul de bolnavi cu DSV asociat cu IT, operaţi în Centrul de Chirurgie a Inimii pe parcursul anilor 2010-2018, au fost incluşi 52 de pacienţi cu vârsta medie de 85,9±25,5 luni. Greutatea medie a pacienţilor din acest grup a fost 22,3±2,8 kg şi varia în limitele 4-68 kg. În 34 (65,4%) cazuri s-a diagnosticat IT de gradul II, în 10 (19,2%) cazuri - IT de gradul III şi în 8 (15,4%) cazuri - IT de gradul IV. Concomitent cu plastia DSV, la toţi pacienţii s-a efectuat şi repararea VT: la 6 (11,5%) pacienţi s-a efectuat plastia VT De Vega, la 26 (50,0%) pacienţi – comisuroplastia, la 6 (11,5%) pacient – suturare de cleft, la 2 (3,8%) pacient – plastia VT De Vega şi comisuroplastie, la 12 (23,0%) pacienţi – comisuroplastie şi suturare de cleft. Rezultate: La etapa postoperatorie s-a ameliorat semnificativ tabloul clinic: s-au redus dispneea (de la 91,7% cazuri la 8,3% cazuri), palpitaţiile (de la 91,7% cazuri la 33,3% cazuri) şi edemele periferice (de la 10,8% cazuri la 4,2% cazuri). Numărul de pacienţi cu insuficienţă cardiacă NYHA 1, care la etapa preoperatorie nu s-a determinat nici la un pacient cu DSV asociat cu IT, a crescut postoperator de la 0 la 54,2% pacienţi, NYHA 2 s-a redus de la 60,0% la 41,7% pacienţi, NYHA 3 - de la 36,0% la 4,2% pacienţi. Concluzii: În marea majoritate de cazuri s-a utilizat metoda prin sutură la comisura antero-septală. Această procedura chirurgicală este eficientă, necostisitoare, poate fi efectuată cu aorta declampată, practic lipsită de complicaţii şi diminuiază semnificativ regurgitarea tricuspidiană.Background: Isolated congenital tricuspid regurgitation (or Tricuspid Insufficiency, TI) occurs rarely and represents approx. 0.6% of all congenital heart malformations. More often it develops secondary as a complication of other congenital heart diseases. According to the literature, up to 30% of patients with ventricular septal defect (VSD) located within the perimembranous portion or in-let type may develop TI. The purpose of the study is to compare the various methods and techniques applied for correction of VSD accompanied by TI and to develop the optimal treatment algorithm for these patients. Methods and materials: Between 2010 and 2018, 52 patients whose ages averaged 85,9±25,5 months underwent tricuspid annuloplasty within correction of VSD in Center of Cardiac Surgery of Republic of Moldova. The patients weight were 22,3±2,8 kg and in limits of 4-68 kg. There were regurgitation of II grade of tricuspid valve in 34 (65,4%) of cases, regurgitation of III grade in 10 (19,2%) of cases and regurgitation of IV grade in 8 (15,4%) of cases. Within correction of VSD there was plastia of tricuspide valve performed: in 6 cases (11, 5%) of patients plastia of tricuspid valve De Vega, in 26 cases (50,0%) of patients comisuroplastia, in 6 case (11,5%) of patients suture of cleft, in 2 case (3,8%) of patients plastia of tricuspid valve De Vega and comisuroplastia, in 12 cases (23,0%) of patients comisuroplastia and suture of cleft. Results: After operation the clinic state of patients improved significantly: asthma reduced from 91,7% of cases till 8,3% of cases, cases of tachycardia reduced from 91,7% till 33,3% of cases and other cardiac failure symptoms from 10,8 % till 4,2% of cases. The number of patients with cardiac failure after NYHA classification class I was present after operation in 54,2% of cases comparative with its absence before operation, class 2 diminished from 60,0% to 41,7% of cases, class 3 from 36,0% to 4,2% of cases. Conclusion: In most commonly cases additional sutures were applied to approximate the septal and anterior leaflet close to the commisure. It is simple, reliable, inexpensive, and in our experience free of complications in correction of tricuspide valve insufficiency

Surgical treatment in acute aortic disection. Clinic experience

Secția Chirurgie Cardiacă a Viciilor Dobândite, Spitalul Clinic Republican ”Timofei Moșneaga”, Chișinău, Republica Moldova, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Disecţia acută de aortă este o urgenţă cardiochirurgicală majoră, fiind cea mai frecventă complicație letală la pacienții cu dilatarea anevrismatică a rădăcinii de aortă în asociere sau nu cu sindromul Marfan. Înlocuirea aortei ascendente disecate este o intervenție chirugicală de urgență ”life saving”, asociată cu o morbiditate și mortalitate ridicată. Din cauza polimorfismului clinic extrem de variat şi a complicaţiilor severe care survin rapid, diagnosticul şi conduita pacientului prezintă dificultăţi. Material și metode: În cadrul clinicii au fost studiați 51 de pacienți operați, care s-au împărțit în 2 categorii: grupul A – 43 pacienți (84%) cu Disecție acută și grupul B – 8 pacienți (16%) cu Disecție acută în asociere cu sindrom Marfan. S-au analizat diferențele dintre cele două grupuri cu privire la caracteristicile preoperatorii, tehnicile chirurgicale, rezultatele postoperatorii imediate și la distanță. Rezultate: Pacienții din grupul B au fost semnificativ mai tineri (B:34,2±11ani) vs (A:58,3±9ani). Hipertensiune arteriala (HTA) a fost întîlnită preponderent în grupul A. Incidența complicațiilor postopertorii, precum și mortalitatea intraoperatorie și cea de la 30 de zile au fost similare. În urma rezultatelor postoperatorii la distanță mortalitatea din grupul B este mai mică. Concluzii: Mortalitatea postoperatorie este similară în disecția acută de aortă cu sau fără sindrom Marfan. Supraviețuirea la distanță este mai mare a pacienților cu sindrom Marfan operați. Diagnosticul precoce al anevrismelor de aortă cu sau fără sindrom Marfan, corijarea permanentă a HTA, intervențiile chirurgicle planice pot reduce semnificativ apariția disecției de aortă.Introduction: Acute aortic dissection is a major emergency in cardiac surgery, being the most common lethal complication in patients with aneurysmal dilatation of the aortic root in combination or not with Marfan syndrome. Replacement of the dissected ascending aorta is a ”life-saving” surgical intervention, associated with high morbidity and mortality. Due to the extremely varied clinical polymorphism and the severe complications that occur rapidly, the patient's diagnosis and conduct presents difficulties. Material and methods: In the clinic, 51 operating patients were studied, divided into 2 categories: group A - 43 patients (84%) with acute dissection and group B - 8 patients (16%) with acute dissection in association with Marfan syndrome. The differences between the two groups were analyzed for preoperative characteristics, surgical techniques, immediate and long-term postoperative outcomes. Results: Patients in group B were significantly younger (B:34.2 ± 11) vs (A:58.3 ± 9). High blood pressure (HBP) was predominantly found in group A. The incidence of postoperative complications as well as intraoperative mortality and the 30-day mortality were similar. After post-operative outcomes, the mortality in group B is lower. Conclusions: Postoperative mortality in acute aortic dissection is similar with or without Marfan syndrome. Remote survival is greater for operated patients with Marfan syndrome. Early diagnosis of aortic aneurysms with or without Marfan syndrome, permanent coronary care of HBP, planar surgeries can significantly reduce the occurrence of aortic dissection

Trauma of the heart and the aorta. Case`s report

Secția Chirurgie Cardiacă a Viciilor Dobândite, IMSP Spitalul Clinic Republican ”Timofei Moșneaga”, Chișinău, Republica Moldova, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Traumatismele cordului și aortei reprezintă 2,7-3,2% din urgențele cardiochirurgicale. Complexitatea cazurilor sunt extrem de variate. Indicația operatorie poate fi necesară atît în traumatisme penetrante cît și nepenetrante. Din trauma cordului penetrant doar 35% din pacienți supraviețuiesc pînă la unitatea de gardă. Material și metode: În cadrul clinicii s-au studiat 7 cazuri operate cu traumatismul cordului și aortei. În 2 cazuri intervenția fiind secundară, efectuată pe cord deschis cu by-pass cardiopulmonar, pentru rezolvarea defectelor restante postpenetrante. Trauma aortei în toate cazurile a fost nepenetrantă, ce a condus la declanșarea anevrismului de aortă. Rezultate: Pacienții operați au o supraviețuire de100%. În cazurile intervențiilor pe cord deschis s-a efectuat și corecție valvulară. La pacienții cu anevrism de aortă s-a efectuat protezarea segmentului aortic, în dependență de localizarea anevrismului operația s-a efectuat cu by-pass cardiopulmonar sau cu șunt de ocolire. Concluzii: Intervenția primară de urgență majoră pentru trauma cordului penetrant este vital necesară, dar în dependență de gravitatea leziunii unele defecte necesită reintervenție secundară pe cord deschis.Introduction: Heart and aortic trauma represents for 2.7-3.2% of cardiac surgery. The complexity of the cases is extremely varied. The operative indication may be required both in penetrating and non-penetrating traumas. From penetrating heart trauma, only 35% of patients survive to the on-call unit. Materials and methods: In the clinic, was studied 7 cases of heart and aortic trauma. In 2 cases, the intervention was secondary, performed on open heart with cardiopulmonary bypass, to solve post penetrating defects. The aortic trauma in all cases was nonpenetrating, which led to the onset of aortic aneurysm. Results: Operated patients have a survival of 100%. In cases of open heart surgery, valvular correction was also performed. In patients with aortic aneurysm, aortic segment prosthesis was performed, depending on the location of the aneurysm, the operation was performed by cardiopulmonary bypass or bypass shunt. Conclusions: The primary emergency intervention for penetrating heart trauma is vital, but depending on the severity, some defects require secondary open-heart re-insertion