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The number of patients with severe liver failure awaiting transplantation is increasing steadily. The shortage of donor organs, in turn, leads to long waiting time for liver transplants and increases the likelihood of decompensation and progression of the disease, significantly increasing the proportion of urgent patients on the waiting list for liver transplantation. This article presents a clinical case report of a successful multistage surgical and therapeutic treatment of complications in a patient before and after liver transplantation. In the early postoperative period, the recipient of the liver from a deceased donor underwent the debridement of the aortic root and the aortic valve replacement for the treatment of acute infective endocarditis, with the immunosuppressive therapy being discontinued for 3 weeks without a deterioration of the graft function.

To assess linear and geometric parameters of the aortic valve and to determine the changes which are associated with impaired leaflets coaptation and aortic root enlargement.Surgical anatomy of the aortic root and its spatial relationships with surrounding heart structures were studied with plastination by using of combined silicon technologies. 123 specimens of the aortic root with preserved original geometry were created with silicone plastination technique and perfusion embalming. Analysis included 15 heart specimens with the signs of aortic root dilatation and 108 specimens without evidence of dilatation. Multiple logistic regression was used for statistical analysis.Anatomical and clinical analysis showed that deviation angle of the intercusp triangle is the factor contributing impaired aortic root geometry and aortic regurgitation (OR 1.3, 95% CI 1.114-1.350, p0.0001).1) Increased deviation angle of intercusp triangles is associated with impaired coaptation of aortic valve leaflets. 2) Restoration of intercusp triangle deviation angle within 1.7±1.2° degrees is geometrically necessary to achieve normal function of the aortic valve.Коаптация заслонок аортального клапана (АК) зависит от соотношения пространственных и геометрических характеристик структур корня аорты. Размеры структур имеют различия не только между индивидами, но и между структурами одного корня аорты. Происходящие изменения геометрических параметров корня аорты при различных заболеваниях являются гемодинамической компенсаторной реакцией. Изучение оптимальных геометрических характеристик корня аорты, соблюдение которых обеспечивает замыкательную функцию АК даже при его исходной дилатации, необходимо для выполнения реконструктивных операций, разработки новых протезов корня аорты для долговечного функционирования реконструированного клапана, а также для создания кондуитов, долгосрочно функционирующих в выходном отделе как левого, так и правого желудочка. В настоящей работе проанализировано влияние геометрических характеристик на развитие морфометрических изменений корня аорты, которые приводят к недостаточности АК. Проведено анатомо-клиническое исследование структур корня аорты. В результате статистического анализа выявлено, что изменение угла отклонения межзаслончатого треугольника АК является фактором, влияющим на прогноз развития дилатации корня аорты и недостаточности АК (отношение шансов 1,3, 95% доверительный интервал 1,114-1,350, р0,0001). Цель работы - провести комплексное морфометрическое исследование линейных и геометрических параметров АК и определить, изменение каких параметров сочетается с неполным смыканием полулунных заслонок АК и дилатацией корня аорты. Материал и методы. Для изучения хирургической анатомии корня аорты и исследования его пространственных взаимоотношений с окружающими структурами сердца использовались объемные пластинаты сердца, изготовленные с помощью силиконовой техники при комнатной температуре. Для создания 123 препаратов корня аорты с сохранением первоначальной геометрии были использованы комбинированные методики силиконовой пластинации и перфузионного бальзамирования. Исследование проведено на 15 препаратах сердца с признаками дилатации корня аорты и 108 препаратах без признаков дилатации. Статистическую обработку полученных данных осуществляли с помощью метода множественного логистического регрессионного анализа. Результаты. Проведено анатомо-клиническое исследование структур корня аорты. В результате статистического анализа полученных данных выявлено, что фактором, влияющим на прогноз развития изменений геометрии корня аорты и недостаточности АК, является изменение угла отклонения межзаслончатого треугольника АК (отношение шансов 1,3, 95% доверительный интервал 1,114-1,350, р0,0001). Вывод. Увеличение угла отклонения межзаслончатых треугольников АК приводит к нарушению его замыкательной функции. Геометрической основой достижения нормальной функции АК при реконструкции корня аорты является восстановление углов расположения межзаслончатых треугольников АК в пределах 1,7±1,2°.

Main approaches to intravital diagnosis of alcaptonuria are described. Attention is focused on damages determining invalidisation of patients. A clinical case is presented which demonstrates success of surgical treatment of aortic stenosis of alkaptonuric genesis.

A comparative analysis of biomechanics of implanted xenografts has shown that the functioning of the newly formed aorta root might be dependent on constructive features of the bioprosthesis, choice of the optimal type size and on the implantation technique. The best hemodynamic and biomechanical characteristics were obtained when using the technique of a complete prosthesis of the aorta root with the Medtronic Freestyle xenograft and subcoronary implantation of bioprosthesis AB-Mono- and AB-Composit-Kemerovo.

The authors have analyzed 139 patients with specific features of the clinical course of infectious pathology, massive and unusual destruction of the intracardiac structures, non-standard kinds of valvuloplasty. They required individualized strategy of diagnosing and operative treatment.

Using a mathematical model of artificial neuronal network the authors have determined the main significant factors for prognosis of the development of acute myocardial insufficiency during aorto-coronary shunting.

Effect of nimotope on cerebral metabolism and incidence of mental disorders in patients operated on under forced ventilation of the lungs (FVL) was studied in 32 patients subjected to replacement of mitral and aortic valves for infective endocarditis. Nimotope was used for preventing hypoxic disorders of the CNS. The drug was injected starting from the stage of operation before FVL. Cerebral hypoxia was diagnosed using lactate-oxygen index (LOI) and other cerebral metabolic coefficients. LOI increased in all patients immediately after FVL, being much higher in the patients without cerebral protection. Moreover, numerous neurotic and mental disorders were observed in this group of patients during the early postoperative period. By contrast, no mental disorders, disorders of memory or attention were detected in the patients treated with nimotope. These data indicate that nimotope decreases the unfavorable effect of FVL on the CNS function in patients with infective endocarditis. The difference of lactate content in arterial blood and in the internal jugular vein bulb and LOI can be used for the diagnosis of brain ischemia in heart surgery with FVL.

Serological markers of Epstein-Barr virus (EBV) infection has been investigated in 28 patients with infectious endocarditis. In 75% of patients IgM antibodies to "early" antigen of the virus which are the marker of active viral infection occurred vs 6.2% among healthy blood donors. Specific for infectious endocarditis reaction profile (anti-EBV combination in one person) indicates reactivation of latent viral infection. The conclusion is made on the necessity of further investigation of both the role of EBV in pathogenesis of pyoseptic diseases and immunologic mechanisms for reactivation of latent viral infections.

Antibodies to cytomegalovirus class IgG and IgM and level of tumor necrosis factor (TNF) in the serum were measured in 81 patients with severe surgical infections. In patients with acute lung abscess TNF level was twice higher and activation of cytomegalovirus infection (specific IgM) was three times more frequent than in patients with infectious endocarditis. The conclusion is made that severe surgical infections inducing progressive immunodeficiency create conditions for activation of latent viral infections, cytomegalovirus, in particular). Recommendations on prevention of hemotransmissible cytomegalovirus infection are presented.

Under analysis was an experience with closed mitral commissurotomies (CMCT) in 865 patients. Among them 285 patients had mitral stenosis complicated by calcinosis, thrombosis of the left auricle, mitral insufficiency of the I-II degree or by a previously done commissurotomy. CMCT was shown to be possible and sometimes even necessary in spite of the presence of aggravating factors.

The immunologic status of 28 patients with angiogenic sepsis was studied. Characteristic impairments and the prognostic value of certain indices (T- and B-lymphocytes, isohemagglutinin, circulating immune complexes, general clinical analyses of blood with the counting of the leukocyte intoxication index) were established. Recommendations for the assessment of the immune protection of the patients and a program of the immune-correcting therapy are given.