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Objective: Neuropsychological (cognitive) dysfunction has been described as an important complication, affecting up to 80% of patients early after cardiac surgery. Also it has been shown that cognitive abnormalities persist in a later postoperative follow up. The aim of our study was to determine incidence of cognitive complications early after isolated coronary artery bypass grafting using cardiopulmonary bypass, and to identify predictive factors, associated with perioperative cerebral dysfunction., Material and Methods: Eighty-six patients (63 men and 23 women; mean age 66.1+/-6.7 year) with identified isolated coronary artery disease were enrolled into prospective study using Case Report data collection document. Neuropsychological status was examined using Symbol Digit Modalities Test with additional Euro QOL test. All tests were performed at baseline (1 day before operation), at the 5(th) to 7(th) postoperative day and one month after operation., Results: Neuropsychological dysfunction (as compared with baseline) occurred in 59 patients (68.6%) at the 5(th)-7(th) postoperative day and persisted in 19 patients (22.1%) after one month. Patients who suffered postoperative cerebral dysfunction more often had history of prior cerebrovascular morbidity (p<0.05), poor left ventricular ejection fraction (

Unlabelled: The aim of our study was to evaluate the impact of stentless aortic bioprosthesis implantation on early and late postoperative results and hemodynamic changes., Material and Methods: Study group consisted of 66 patients, who received stentless aortic bioprosthesis in 1999-2003, and control group of 38 patients, randomly selected for data analysis out of 203 patients, who received mechanical aortic valve substitute during the same period at the Heart Center of Kaunas University of Medicine. Study protocol included clinical data, patients functional status and echocardiographic data pre and postoperatively up to 2 years., Results: Within a stentless bioprosthesis group clinically more severe forms of aortic valve disease were present (NYHA f. cl. 3.47 vs 3.0), with concomitant ischemic heart disease (51.5% vs 36.8%), and mitral valve insufficiency (51.5% vs 21.1%). Subsequently coronary artery bypass grafting was performed in 50% of patients within a stentless bioprosthesis group vs 28.9% in a mechanical valve group, and mitral valve repair in 30.49% vs 10.5%. Aortic cross clamp time in a stentless bioprosthesis group was 89.1+/-21.3 min, compared to 74.6+/-39.5 min in a "mechanical" group. Data analysis of valve/body surface area match was in favor of stentless valves: patients with the same body surface area received one size larger stentless valves. Mortality in a "stentless" group was 4.54 vs 7.3% in mechanical group. Mean transvalvular gradients after 2 years were statistically significantly lower in a "stentless" group: 9.4+/-3.1 mmHg vs 11.1+/-4.1 mmHg. Also there was significant decrease of left ventricular mass and mass index in both groups, however it was more pronounced in the "stentless" valve group., Conclusions: Despite more advanced patient age, stages of aortic valve disease, complexity of operations including more demanding stentless bioprosthesis implantation techniques, early and late postoperative results are in favor of stentless bioprosthesis. Low and acceptable postoperative mortality, lower transvalvular gradients, optimal matching of valve and body surface area, could be achieved, which warrants more pronounced positive postoperative left ventricular remodeling: reduction of left ventricle mass and left ventricle mass index with improved pts survival.

Unlabelled: The aim of the study was to compare late results of the minimally invasive operations of myocardial revascularization and conservative treatment in patients with acute ischemic syndrome., Material and Methods: Demographic, clinical and echocardiographic data was collected on patients with acute ischemic syndrome; data of 109 patients treated conservatively and data of 26 patients, who underwent minimal invasive operation of myocardial revascularization during acute phase of ischemic syndrome, were compared and ischemic consequences after one-year follow up period were determined in both groups., Results: The patients of both groups did not differ significantly according to the most clinical characteristics. One third of the patients in the surgery group had previous myocardial infarction, also they had higher rate of paroxysmal atrial fibrillation (26.9% vs 6.4%) and acute left ventricular failure (73.1% vs 44.0%) than the patients without operation. During one-year follow up period there were no cases of lethal events or myocardial infarction in the surgical group, however 37.5% of them had mild angina pectoris. At that time lethal outcome was observed in 6.1%, myocardial infarction in 3.5% and mild-severe angina pectoris in 68.8% of patients., Conclusion: The functional status of the patients significantly improved during one-year period after minimally invasive operation of myocardial revascularization compared to the patients treated conservatively.

Unlabelled: The aim of our study was to evaluate the influence of residual ischemic mitral insufficiency on patient's functional status and left ventricle remodeling after repair of ischemic mitral insufficiency., Material and Methods: The study group consisted of 95 out of 128 patients who underwent mitral valve repair for ischemic mitral insufficiency at the Department of Cardiac Surgery of the Heart Center of Kaunas University of Medicine in 1996-2002. The study protocol included general clinical data, patients NYHA functional class, pre, peri and postoperative echocardiographic data., Results: In patients with residual MI (MR>or=2 grade) late postoperative left ventricle morphometric parameters, left ventricle ejection fraction and mean pulmonary artery pressure did not change. Size of left ventricle was reduced (left ventricle end diastolic diameter index decreased from 28.9+/-0.4 to 27.7+/-0.4 mm/m(2), p<0.001; left ventricle end systolic diameter index - from 22.2+/-0.6 to 19.7+/-0.7 mm/m(2), p<0.001), left ventricle ejection fraction increased (33.3+/-1.0 and 40.1+/-1.2%, p<0.0001), mean pulmonary artery pressure, NYHA functional class significantly decreased with MR<2 grade late postoperatively., Conclusions: Residual MR is important factor for further worsening of patient's functional status and progressing of left ventricle remodeling after combined surgery.

Unlabelled: The aim of the study was to evaluate early complication rate and changes of left ventricular geometry and function after two types of left ventricular reconstruction surgery., Methods: The study included 54 patients with ischemic heart disease and left ventricular aneurysm, who underwent coronary artery bypass grafting and left ventricular reconstruction surgery: I group (31 patients) underwent modified Dor aneurysmectomy and II group (23 patients) underwent infarcted wall compression. The study protocol included operative data, early postoperative complications and evaluation of left ventricular function 10(th)-14(th) day after surgery., Results: Early complication rate had tendency to be higher in I group. Among patients with left ventricular ejection fraction <20%, in I group all 6 patients died, including 5 patients who underwent aneurysmectomy combined with mitral and tricuspid anuloplasty and 2 patients who underwent both apical aneurysmectomy and posterior wall compression, in II group - 1 of 3 patients died. Early changes of left ventricular geometry in I group included decrease in left ventricular diameter, volume, mass, as well as reduction of short axis of left atrium, in II group - decrease in left ventricular diameter, mass and both axis of left atrium. Left ventricular ejection fraction had tendency to increase in both groups: in 41.9% of patients in I group and in 56.5% in II group., Conclusions: Following different types of left ventricular reconstruction surgery early postoperative complications rate did not differ, except higher mortality rate in patients with left ventricular ejection fraction <20%, who underwent modified Dor aneurysmectomy combined with other surgical procedures. Early changes of left ventricular geometry and volume differed between patients who underwent different types of left ventricular reconstruction.

Objective: With the aim to check whether the atherogenic factors are involved in the mechanisms of valve fibrosis, we have studied the blood serum concentrations of apolipoproteins (apo) A-I and B concentration in patients suffering from rheumatic heart valve fibrosis., Method: The quantities of apoA-I and apoB in the blood serum were tested by the ELISA method. Concentration of apoA-I and B in the blood serum was determined in rheumatic females with replacement of the damaged valves: after aortic valve operation (n=11; mean age 43.3+/-3.6 years) and after mitral valve operation (n=29; 41.3+/-4.1). The results obtained for rheumatic patients were compared with the data on age-matched healthy females (n=43; 39.5+/-5.2 years)., Results: Significantly lower apoA-I level in the blood serum of all patients suffering from rheumatic heart valve disease was determined as compared with controls: in the pooled group of patients (1.02+/-0.22 vs 1.23+/-0.23 g/l, P<0.001), in women after aortic valve replacement (0.98+/-0.21 vs. 1.23+/-0.23 g/l, P<0.005), and in women after mitral valve surgery (1.03+/-0.23 g/l vs 1.23+/-0.23 g/l, P<0.005). The apoB level in patients suffering from rheumatic heart valve disease did not differ from that of controls. The apoB/apoA-I ratio for patients with valve fibrotic damage was significantly higher as compared to controls in all groups (P<0.02). The increase of apoB/apoA-I ratio in patients with rheumatic valve fibrosis was caused by lower apoA-I levels in blood serum., Conclusion: The obtained results indicate that decreased apoA-I levels in blood serum can be indicative of valve fibrosis in rheumatic heart valve disease patients.

The aim of the study was to determine the effect of pyruvate, a substrate of energetic metabolism, on the dependence of electromechanical activity on stimulation frequency in human myocardium. The experiments were performed on human ventricle myocardium from patients undergoing cardiac corrective open heart surgery at Clinic of Cardiac Surgery in Kaunas University of Medicine by using standard method of registration of myocardium electromechanical activity. The stimulation frequency of myocardial strips were 0.2, 0.5, 1.0, 1.5, 2.0, 2.5 and 3 Hz, duration of pulses -2-5 ms. In control, i.e. at perfusion of mycoardial strips by Tyrode solution and stimulation frequency 1 Hz, an average of contraction force (P) was 0.94+/-0.18 mN (n=12), half time of relaxation (t(a)) - 178.88+/-9.31 ms (n=12), and action potential duration measured at 50% repolarization level (VP(50)) - 294.75+/-27.95 ms (n=9). Pyruvate (10 mM) increased P to 159.9+/-13.4% (p<0.00), t(a)- 106.9+/-2.2% (n=12) (p<0.001), and VP(50)- 111.1+/-7.4% (n=5) (p<0.05), as compared to control. In the absence of pyruvate values of P, t(a) and VP(50) of myocardial strips were higher at 0.2 Hz and 0.5 Hz and lower at 3 Hz compared with those at 1 Hz of stimulation frequency. Although the dependence of these parameters on stimulation frequency in the presence of pyruvate (10 mM) was not altered but their values were persistently increased at all stimulation frequencies. The present data indicate that pyruvate is an effective inotropic agent, which can improve contractility function in wide-ranging diapason of stimulation frequency in failing human heart.

An impact of surgery for infective endocarditis on survival and heart failure has been analyzed. A total of 131 patients with IE have been observed during 1999-2001. Eighty seven of them were male and 44 female, mean age - 50+/-16 years. Sixty three (48.1%) patients underwent surgery, remaining 68 (51.9%) were treated conservatively. The surgical patients had signs of remarkably worse heart failure (p=0.0001), higher grade aortic (p=0.0001) and mitral (p=0.001) valve regurgitation. Surgery resulted in significant improvement of heart failure (p=0.01). Hospital mortality was 25.2% and did not differ between the groups. Elimination of the influence of complications revealed reduced hospital mortality of all patients by 9.9% and mortality of NYHA III-IV patients by 23.9% (p=0.02) as a result of surgery.

Technological development, implementation of new techniques and scientific knowledge into clinical practice, has a strong impact on development of surgical and anesthesiological professions. However, it creates new and unknown ethical issues within surgeons-anesthesiologist and their patient's relationship. Development of physiological-individualized anesthesia techniques focused on patient's outcome unquestionably is related to more general organizational ethical issues. Presented article analyzes factors influencing unavoidable, concomitant development of surgical and anesthesiological professions. It also addresses several ethical issues within the context of society development. There is a body of evidence ascribing identities of profession and different attitudes as well as interpretations of inter specialty relations. There is a need for constant discussion between the specialty representatives groups elaborating professional recommendations for further co-operation accepted by both sides.

Objective: The aim of this study was to review early postoperative results of the combined coronary artery bypass grafting and carotid endarterectomy (CABG/CEA) performed at the Clinic of Cardiac Surgery Heart Center of Kaunas University of Medicine., Material and Methods: A series of consecutive 19 patients (64.5+/-8.2 years old, 17 (89.5%) male patients) with coexisting severe ischemic cardiac and carotid artery disease were operated on during 8-year period ending December 2001. Seven (36.8%) patients with carotid artery stenosis were asymptomatic. Previous neurological events had occurred in 12 (63.2%) patients: five (26.4%) patients presented with a previous stroke, seven (36.8%) - with a transient ischemic attack. Demographics and perioperative variables of these patients were compared with variables of 42 patients, that underwent isolated CABG during this period (control group)., Results: After introducing of the routine preoperative screening carotid ultra-sonography in the year 2000, the rate of asymptomatic carotid artery stenosis among all diagnosed hemodynamically significant carotid stenoses has raised up to 43.8%. The in-hospital results were similar between the two groups with regard to 30-day perioperative mortality, stroke and major postoperative complications., Conclusions: Based on our results, combined interventions of CEA and CABG can be performed with an acceptable morbidity and mortality when severe carotid stenosis is associated with advanced, symptomatic ischemic heart disease. Patients with total occlusion of the carotid artery compose a high-risk subgroup for perioperative stroke. The introduction of routine preoperative carotid duplex scanning resulted in higher rate of asymptomatic carotid artery disease among the patients scheduled for combined CABG/CEA procedure.

Unlabelled: Earlier we have shown significantly more frequent B blood group and a significantly more rare O blood group of ABO blood group system in men aged under 45 years suffering from coronary atherosclerosis compared with these frequencies in the population of Lithuania. The aim of the study was to investigate the frequency of blood groups of ABO system in women with coronary atherosclerosis., Materials: The frequency of the ABO blood groups was examined in 441 women, suffering from coronary atherosclerosis, divided into two groups: I group - 109 women till 60 years old (mean age 55.1+/-4.8) and II group - 332 women aged over 60 years (mean age 68.1+/-5.0). For all patients coronary atherosclerosis was diagnosed by coronary angiography and confirmed during coronary bypass surgery. The frequency of the ABO blood group in the studied pts was compared with the frequency of the blood group in the control group of healthy blood donors (n=595). To evaluate the significance of data, we compared the frequency of ABO blood groups with the data in women long-livers (n=75, mean age 94.1+/-3.8). Earlier our studies showed that long-livers are an important antiatherosclerotic control group for evaluation of the genetic markers of atherosclerosis., Results: The O blood group was found significantly more rarely in the women group I as compared to that of healthy donors group (28.4% vs 38.2%, p<0.04). The B blood group was significantly more often in group II (22.9% vs 15.0%, p<0.04) compared with the frequency of the B blood group in the healthy donors' group. In the long-livers' group the frequency of the B group was significantly more rare than in healthy donors (6.7% vs 15%, p<0.01) as well as in the groups of tested pts (20.2% and 22.9% respectively, p<0.01). We did not find any significant changes in the frequency of AB blood group in women with coronary atherosclerosis., Conclusions: The B blood group can be related with coronary atherosclerosis in women. The O blood group can possibly serve as a protective antiatherogenic factor in women. The A blood group is not a risk factor for atherosclerosis in women in Lithuanian population. Long-livers are an important antiatherogenic control group for evaluation of atherogenetic markers of coronary atherosclerosis.

Objective: This retrospective study was undertaken to evaluate the accuracy of risk-adjusted EuroSCORE models in predicting mortality in individual patients who are undergoing coronary artery bypass grafting., Material and Methods: The study population is a consecutive series of 1698 isolated primary and repeat coronary artery bypass grafting patients, inclusive patients in cardiogenic shock or resuscitation, operated in Kaunas Heart Center from January 1997 to December 2001. The pre-operative risk of death was calculated with EuroSCORE models and then compared with the actual outcome. The accuracy score was used to evaluate the reliability of each score to predict the individual outcome. The studied event was in-hospital death, defined as mortality during hospital stay, which was unlimited in time and included a stay in a secondary hospital without discharge home., Results: Eighty deaths (4.7%) were observed. The age of this patients was 66.0+/-9.5 years, 73.7% were male and 3.7% were repeat procedures. In most patients who died the mean predictive scores were high. The EuroSCORE average was 11.0+/-4.3, with a range from 3 to 21., Conclusions: The EuroSCORE presurgical predictive models were highly accurate to predict overall mortality, but were inaccurate to predict mortality in individual patients.

Unlabelled: The aim of our study was to evaluate the initial results of left ventricular CABG and left ventricular remodelling operations. Study group consisted of 47 patients (pts) who underwent left ventricular geometry and volume restoration operations at the Kaunas University of Medicine Hospital during 1996 to 2002. Protocol included general clinical data, NYHA functional class, pre- and postoperative echocardiographic data, left ventricular aneurysm repair procedures. Pts mean age was 63.4+/-1.2 years. Men/women ratio 38/9. At admission NYHA functional class was 3.5+/-0.1. Mean left ventricular ejection fraction preoperatively was 24.2+/-0.9%, LV end diastolic diameter - 60.3+/-1.2 mm. Correction of left ventricular aneurysm consisted of: 1) direct aneurysmectomy - 11 pts, 2) endoventricular patch plasty - 7 pts, 3) circular suture - 19 pts, 4) aneurysmal reinforcement - 10 pts., Results: Early postoperative NYHA functional class decreased from 3.5+/-0.1 to 2.8+/-0.1 (p<0.0001) and late postoperative to 2.7+/-0.2 (p<0.0001). Within 2 weeks LV morphometric parameters, left ventricular ejection fraction, mean pulmonary artery pressure didn't change significantly. There was a significant reduction of mitral regurgitation in all survivals from grade 2.5+/-0.1 to 1.4+/-0.2 (p<0.0001). Hospital mortality - 25.5%, late mortality - 22.2%. Late postoperative LV end diastolic and systolic diameters had a tendency to increase. All of the patients showed late postoperative increase in deceleration time from 0.13+/-0.01 to 0.18+/-0.02 s (p<0.05), decrease in degree of MR from 2.6+/-0.1 to 1.8+/-0.3 (p<0.05). LV systolic function has a tendency to increase from 25.6+/-1.4 to 29.1+/-1.4. In conclusion, effective LV surgical remodelling combined with CABG improves pts functional status: NYHA functional class, LV diastolic function. But the results of these combined cardiac operations are not so excellent. The hospital mortality remains high, correction of LV morphometric parameters is not preferable.

Objective: The aim of this prospective study was to review incidence of neurological and cognitive complications after coronary artery bypass graft surgery and find out predictive factors, associated with perioperative cerebral dysfunction., Material and Methods: A prospective pilot study of 35 (27 men and 8 women, mean age 64.5+/-4.3 year) patients with identified coronary artery disease was conducted using Case Report data collection document. All patients underwent isolated elective CABG procedure at Cardiac center of Kaunas University of Medicine Hospital., Results: There were two cases (5.7%) of postoperative transient ischemic attack, two cases (5.7%) of restless agitation with delirium, characterised as an postoperative encephalopathy and eight patients (22.8%) with cognitive abnormalities., Conclusions: The Canadian Stroke Scale and The Confusion Assessment Scale are sensitive and objective methods for diagnostics of postoperative neurological dysfunction. To characterize the incidence and severity of neuropsychological dysfunction, a concise battery of neuropsychologic tests that provides reliable evidence of subtle brain trauma should be used.

Patients with coronary disease associated with abdominal aortic aneurysm or aortoiliac occlusive disease often raise problems of operative strategy. In particular, the order in which these lesions should be treated is a frequent source of controversy. Our approach for the past two years has been a combined myocardial revascularization with abdominal aortic reconstruction in patients with both lesions. From 1999 through 2001 seven patients underwent combined abdominal aortic reconstruction with coronary artery bypass grafting. We report here the fatal case of combined coronary artery bypass grafting and abdominal aortic aneurysm repair. Partial heparinization and operation without extracorporeal circulation caused acute thrombosis of abdominal aortic aneurysm and femoral arteries. Our first experience advocates using total heparinisation and cardiopulmonary bypass for combined cardiac-aortic procedures.

Objective: Patients with coronary artery disease associated with peripheral vascular disease often raise problems of operative strategy. Particularly the sequence of procedures in which lesions must be treated is a frequent source of controversy. The aim of this study was to research surgical strategy, early and late clinical outcomes for patients undergoing one-stage coronary and abdominal aortic or magistral artery surgical interventions., Material and Methods: From 1999 through 2002 twenty eight patients underwent combined major vascular reconstruction with coronary artery bypass grafting., Results: In group with abdominal aortic aneurysm 2 patients died. One patient died from intraoperative acute abdominal aortic aneurysm and bifemoral artery thrombosis with continuous bleeding from the vascular prosthesis in association with disseminated intravascular coagulation. Another patient died from bleeding from the sudden multiple gastroduodenal ulcers on post-operative day eight. In groups with peripheral vascular occlusive disease and carotid artery disease there were no deaths., Conclusions: The data show that combined coronary artery bypass grafting and vascular operations are feasible on patients with concomitant carotid artery or peripheral vascular occlusive disease. Management of CAD associated with abdominal aortic aneurysm remains controversial.

Unlabelled: The aim of our study was to evaluate the patients' (pts) survival, changes of functional status after repair of ischemic mitral insufficiency (IMI) and to determine their prognostic determinants. Study group consisted of 128 pts who underwent mitral valve (MV) repair for IMI at Kaunas University of Medicine hospital during 1996 to 2002. Study protocol included general clinical data, coronary artery involvement, patients NYHA functional class, pre, post and operative echocardiographic data, mitral valve repair procedures., Results: There was a significant reduction of MR in all survivals from grade 2.8+/-0.1 to 1.5+/-0.1 (p<0.0001). All of the patients showed late postoperative increase in LVEF from 32.2+/-1.0 to 37.1+/-1.1% (p<0.0001). Late postoperative NYHA functional class changed significantly from 3.3+/-0.1 to 2.3+/-0.1 (p<0,0001). Two-year years survival without heart failure was 51.6+/-7.9%. Prognostic markers of late postoperative heart failure (II-IV NYHA functional class): LVEF/=II grade late postoperatively. Two-year years survival without residual MR was 51.1+/-7.8%. Predictors of late residual MR are early residual MR>I grade (p<0.0001), LVEF<30% early postoperatively (p<0.0001) and LVEDDI late postoperatively >/=28 mm/m(2) (p<0,01). Hospital mortality - 17.2%, late mortality - 7.9%. Two and four-year years survival after combined heart surgery - 66.7%., Conclusions: Repair of IMI - effective method in treating ischemic heart disease complicated with MV regurgitation: late postoperatively patients functional status improves, LVEF increase. Prognostic markers of late postoperative heart failure (II-IV NYHA functional class) are: LVEF/=II grade late postoperatively.

Minimally invasive operations of myocardial revascularization (MIMR) are done using usual approaches, but without extracorporeal circulation and cardioplegia. Doing these operations according to indications, there is no difference in early results of these operations and the operations with extracorporeal circulation and extracorporeal circulation (1, 2). OBJECTIVE. To evaluate the late results of minimal invasive operations of myocardial revascularization 1 year after intervention, according to detection of patient's functional class, findings of echocardiography and stress test. Also to compare the results of operations in patient's groups of age up to 65 years old and over 65 years old. MATERIAL AND METHODS. From 88 patients, that underwent minimal invasive operations of myocardial revascularization, 34 patients were checked according to investigation protocol, evaluating functional class, myocardial contractility and stress test tolerance. The late results of two different groups of age were compared (each group includes 17 cases). RESULTS. All patients have survived 1 year after operation. Findings of stress test showed, that 60% of patients have reached 100 W and more strain tolerance. Pectoral angina was detected in 12% of cases. There was no difference, that was improved statistically in findings of myocardial contractility before and after operation. CONCLUSIONS. Evaluating the late results of minimally invasive operations of myocardial revascularization (1 year after operation), we can consider, that these operations, that were done according to indications, are improved, safe and suitable also to elderly patients.

Timing of surgery in infective endocarditis remains a challenge in the face of potential drug toxicity on one hand and recurrence of endocarditis on the other. The aim of the study was analysis of risk factors for hospital mortality and recurrent endocarditis. A total of 131 patients with infective endocarditis have been observed during 1999-2001. Eighty seven of them were male and 44 female with mean age of 50+/-16 years. Sixty three (48.1%) patients underwent surgery, remaining 68 (51.9%) were treated conservatively. Hospital mortality was 25.2%. Postoperative perivalvular leak was associated with culture negative endocarditis (p=0.09) as well as with positive valve culture (p=0.04). Recurrence was related to positive valve culture (p=0.08) and embolism (p=0.02). Increased risk of death was associated with neurologic, embolic, renal complications, myocardial abscess, NYHA IV f.cl. and extracardial surgery. According to the data obtained, optimal surgery time in the group appeared to be between 17 and 45 days after the diagnosis of infective endocarditis has been made (p=0.049).

Introduction: Surgical interventions because of mitral valve disease have been ascribed since 1951. Many changes within mitral valve replacement have passed including closed and open mitral commissurotomy, mitral valve repair operations implantation of mechanical, biological heart valve and finally use of mitral valve homograft. Despite changes in chirurgical tactics and medico-technical environment, mitral valve homograft implantation remains one of the most complex surgical interventions. Surgical and technical details of mitral valve homograft implantation are discussed., Objective: to estimate technical difficulties and anatomical positioning of mitral valve homograft considering a spectrum of indications of mitral valve replacement., Case Report: 62-year-old woman 26 years ago underwent mitral valve replacement with Starr-Edwards mitral valve prosthesis, because of rheumatic heart disease by homograft. Due to malfunction of the mitral valve prosthesis, and progressive left ventricular failure patient was reoperated on 26(th) of February 2002. Fresh antibiotic preserved mitral valve homograft was implanted. Surgical techniques were guided using left ventricle size measurement indicated by echocardiography., Results: The technique described by Acar/Carpentier was used except of mitral valve annuloplasty ring implantation. Peri- and early postoperative period was free of homograft related complications. The left ventricle function was improving and the heart size decreased dramatically during first postoperative week., Conclusion: The most important peculiarities for mitral valve homograft implantation are echocardiography data and intraoperative left ventricle measurements. Homograft implantation techniques are rather demanding therefore indications for mitral valve replacement have to be selected carefully and should be based on the presence of severe mitral valve dysfunction in order to achieve best hemodynamic results and prevent patient from anticoagulation therapy.