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The study was designed to analyse results of alternative methods of myocardial revascularization in "no-option patients" to whom direct revascularization is not indicated. Over 600 cases were treated with the use of transmyocardial laser revascularization (TMLR), angiogenic factors (VEGF, alpha-ECGF), and cellular therapy. It was shown that TMLR is a safe and efficacious procedure increasing perfusion and normalizing myocardial metabolism. It eliminates angina and improves quality of life of the patients. Single bolus administration of angiogenic factors alone does not stabilize perfusion and patients' condition. The use of stem cells provokes the growth of new vessels and promotes restoration of viable myocardium via stimulation of angiogenesis. However, mesenchymal stem cells do not contribute to scar reparation and are inefficient in patients with a critical mass of cicatrically-altered myocardium.

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The paper presents the first results of therapeutic angiogenesis in clinical cardiosurgery: human VEGF(165) gene transplantation to coronary patients. The use of this therapeutic method is particularly effective in patients with inoperable cardiovascular injuries, i.e. patients with the most severe condition, in whom treatment remains little effective at the modern level of cardiosurgery development.

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The paper presents the results of a 5-year follow-up after coronary artery bypass grafting (CABG) combined with transmyocardial laser revascularization (TMLR). The study revealed high efficiency and safety of the combined surgery in patients with coronary heart disease (CHD) associated with diffuse lesions of coronary arteries. The procedure improved the myocardial perfusion and contractile function, thus significantly increasing the patients' life quality. Combined CABG + TMLR noticeably improved stenocardia functional class, increased physical exercise tolerance and led to a significant reduction in nitrate agent consumption in patients with CHD.

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The authors analyzed the efficiency of ECG-gated single-photon emission computed tomography (SPECT) with 99mTc-tetraphosmin in diagnostics of short-term myocardium stunning in CAD patients with transient ischemia. The technique was applied to 16 CAD patients. Combined evaluation of perfusion was based on the analysis of radiotracer uptake level in left ventricle (LV) myocardium. In order to evaluate myocardium function the authors measured LV systolic thickening index, using 20-segment pattern. 8 out of 16 patients (50%) displayed the phenomenon of stress-induced stunning. The volume of stunned myocardium in individual patients was 2 to 7 LV segments. In general, up to 37% (29/78) of reversible perfusion defects are subjected to short-term stunning under the condition of transient ischemia. After surgical treatment, 84% of segments with signs of stunning normalized their functioning both under stress and at rest.

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This paper analyzes the results of 94 coronary artery bypass grafts accomplished at the Department of Surgical Treatment of Concomitant Lesions of Coronary and Peripheral Arteries, A.N. Bakulev SCCVS, RAMS, in patients with coronary artery disease (CAD) provided control hospital bypass angiography over the period 1998 to 2002. Control bypass angiography revealed thrombosis of 11.7% of vein and of 1.5% of arterial grafts. The main causes of vein graft thromboses were: bypass grafting of small coronary arteries, that of the coronary arteries with so-called 'immature' stenoses, and mediastinitis. The data presented herein evidence that hospital arterial bypass graft provides for a considerably higher percentage of competence versus vein bypass graft. Hospital bypass angiography is essentially safe while its findings allow to make a detailed analysis of complications whereby upgrading the efficacy of operations.

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Results of transmyocardial laser revascularisation (TMLR) of the myocardium are analyzed. Two types of laser equipment were used domestic laser high-energy CO2 synchronized with patient's ECG, and XeCl laser Max-20. 32 patients underwent TMLR as a single method of surgical correction of the disease, 15 in combination with other methods of myocardium revascularisation. Obtained data testify that TMLR is a highly effective procedure in selective patients with IHD. Results confirm necessity of differential surgical policy for ischemic heart disease that permits to use adequate method of myocardium revascularisation for each patient.

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Results of 30 operations performed for combined lesions of coronary and peripheral arteries are analyzed. All the operations were performed as off-pump minimally invasive coronary surgery (MICS) on beating heart with "Octopus" system Medtromic. There were no lethal outcomes. Number of complications was minimal. MICS is high-effective procedure in selected patients with coronary heart disease. It is necessary to use differential policy of surgical treatment of coronary heart disease.

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13 hearts with the above congenital disturbance are studied. The disturbance of the space orientation of the anterior and posterior interventricular septa is found. The aortal and pulmonary valves are found to be oriented at an angle to each other, and the route of the left coronary artery is changed. These features allow to suggest that the anomalous issue of the left coronary artery from the pulmonary artery originates from the alterations of the interaction between the arterial valves and peritruncal ring. The choice of surgery depends on the heart anatomy in each individual case.

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12 hearts with Ebstein's anomaly were studied. This disease is a combined anomaly of heart formation with dysplasia of the folds of the tricuspid valve (TV), its tendinous chordas and papillary muscles, dysplasia of the trabecular part of the right ventricle and dysplastic interrelationships between TV and the right ventricle: attachment by short chordas of posterior and septal folds of TV with the right ventricle walls, anomalous distal attachment of the anterior fold of TV. "Atrialisation" of the right ventricle is the reflection of the folds dysplasia the extreme form of which is the loss of communication between TV and trabecular part and formation of the direct communication between TV and the infundibular part of the right ventricle.

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Formation of the atrioventricular valves under normal conditions is brought about after the completion of septation and envisages a sequential completion of atrioventricular fissure invagination, myocardium delamination and demuscularization of the folds. Anomalies of the atrioventricular valves are formed if the septation process or general principles of the valve formation are disturbed or if there is a combination of these factors. Specificity of the valve disturbances are determined by the causative factor.

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The origin of the aorta and pulmonary artery from the right ventricle is a complicated and little studied congenital cardiac malformation. The A. N. Bakulev Institute of Cardiovascular Surgery, USSR Academy of Medical Sciences, have developed anatomic and morphological criteria for the malformation. With the criteria, echocardiograms from 64 patients were retrospectively analysed and their anatomic and echocardiographic comparisons were made. The findings revealed the echocardiographic measures of the aorta and pulmonary artery from the right ventricle and determines the optimal echocardiographic projections for their estimate.

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The origin of the aorta and pulmonary artery from the right ventricle is a congenital heart disease whose anatomical and echocardiographic criteria are the object of wide current discussion. The classification of the disease has been developed at the Bakulev Institute of Cardiovascular Surgery, USSR AMS. It is based on identification of the anatomical differences in the types of origin of the aorta and pulmonary artery from the right ventricle (RV OAPA). The present research was devoted to the study of the possibilities of echocardiography in the differential diagnosis of the types of the anomaly in the RV OAPA complex and the possibilities of noninvasive differential diagnosis of RV OAPA and adjacent anomalies of the conotruncus. The results of the study allow the conclusion that location of intracardiac structures with purposeful use of ultrasonic projections provides the possibility of making the differential diagnosis of the types of the anomaly in the RV OAPA complex and that the obtained echocardiographic criteria may serve for establishing the differential diagnosis of RV OAPA and other congenital anomalies of the conotruncus.

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The anatomy and hemodynamics were compared in 59 patients with aorta and pulmonary artery origin from the right ventricle. The patients' age was from 3 months to 23.5 years. The pathophysiology of the patients' circulation was determined by many factors, the most important factors were the following: the anatomic type of the malformation, the presence or absence of pulmonary and aortic stenoses and other concurrent congenital heart malformations. The oxygen saturation of the arterial blood was associated with the direction of physiological blood flows in the right ventricle. The most "successful" anatomic and hemodynamic variants of the malformation were types A and B, in which there was no higher blood oxygen saturation in the pulmonary artery as compared to the level of blood oxygenation in the aorta despite the presence or absence of pulmonary stenosis and the site of great vessels. Type C with the inverse site of great arteries is the less "successful" anatomic and hemodynamic variant.

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The hearts were examined from 125 patients with isolated ventricular septal defects (VSD) who had died at the age of 0-14 years before or without operation. One hundred twenty five heart showed 178 defects: 103 with isolated, 22 with multiple VSD. Five major defect types were identified: (1) perimembranous; (2) sinus; (3) central trabecular; (4) boundary muscular trabecular; (5) infundibular. According to the relevance of fibrous skeleton and cardiac conduction system, the defects of various sites are divided into 2 large groups: 1) unadjacent to them (muscular) and 2) adjacent. In terms of septal geometry, there are also two large groups: 1) those located in the inflow portion of the septum and 2) those located in the outflow portion.

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One hundred and fourty-three normal hearts have been studied. The conoid septum, supraventricular crest, bulboventricular fold, area of the fibrous tissue between the aortal and mitral valves and the anterior interventricular septum make the walls (frontal view, in the direction of the hour hand) of the left ventricular cone. In the normal heart there is no real contact between the fibrous rings of the aortal and mitral valves. They are connected by means of a strip of the fibrous tissue, its size varies. The subaortal cone and deferent part of the left ventricular axes make an obtuse angle; the axes of the subpulmonary and subaortal cones have a cross direction. The geometrically definitive left ventricular cone is seen as obliquely-sectioned overturned isosceles cone, with its big base directed upward, right and back, and the small one forward and left.

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An original systematics of origin of the aorta and pulmonary artery from the right ventricle (OAPA RV) is suggested on the basis of examination of 63 heart specimens with the anomaly. Two main variants of OAPA RV are distinguished: (1) with and (2) without a formed infundibular septum (IS). Types A and DA belong to the first variant, types B, C, D, and DC to the second variant. Type A is characterized by drainage of the left ventricular (LV) outflow tract (OT) into the subaortic conus. Type DA differs from type A by the existence of an auxiliary opening between the ventricles due to a deficiency of tissue of the posterior (sinus part) of the septum. Type B is characterized by the absence (or marked hypoplasia) of the septum of the conus (SC). The LV OT in this case drains under both (aortic and pulmonary) coni. In type C the LV OT opens into the subpulmonary conus. In distinction from type C, type DC has an auxiliary defect in the sinus part of the interventricular septum (IVS). Type D is characterized by complete obturation of the exit and the absence of a defect in the sinus part of the IVS (type D1: OAPA RV with an intact IVS) or with a sinus defect in the IVS-DIVS (type D2: OAPA RV with noncommitted DIVS). According to the presence or absence of stenosis of the pulmonary artery (PA) or aorta, 4 subtypes are distinguished: (1) without stenosis; (2) with stenosis of PA; (3) with aortic stenosis; (4) with combined aortic and pulmonary stenosis.

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With the aim to study interrelations of the interventricular septum (IVS) and systematization of their definitions, 151 preparations of hearts of persons died from causes having no connections with cardio-vascular diseases have been studied. The IVS consists of inflow and outflow septa. The inflow septum includes the sinusal (posterior) and trabecular septa, the outflow one--the anterior and conoid septa. The distal part of the anterior and conoid septa form the infundibular septum. From the side of the right ventricle the conoid septum and bulboventricular fold form a supraventricular crest--muscular torus, separating its inflow and outflow parts. From the side of the left ventricle the supraventricular crest is seen as a muscular bar, forming the basal medial wall.

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Children with double outlet right ventricle, aged 3 months to 23.5 years, were examined to assess the possibility of angiocardiographic diagnosis of defect localization. It was found angiocardiography allows satisfactory localization of the defect in question. To be able localize the defect, it is critical to determine the interaction between the defect and the conus septum, and the origin of large arteries. To establish the diagnosis of ventricular septal defect, right and left ventriculography in standard and axial projections must be performed.

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The paper is devoted to analysis of the results of angiocardiographic investigation of 237 patients with a double deflection of great vessels (DDGV) from the right ventricle (RV) (the patients ranged in age from 3 months to 23.5 years) to study the potentialities of the method in the diagnosis of a defect position of the interventricular septum (DIVS). Angiographic investigation permitted a sufficiently accurate determination of a DIVS position in DDGV from the RV. Of paramount importance for determining a DIVS position is the establishment of the interrelationships of the latter with the infundibular septum and the openings of major arteries. For diagnosis of a DIVS position one should necessarily use left and right ventriculography both in standard and axial projections.

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