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Authors: Mazhidov U.A., Gorbachevskiy S.V., Grenaderov М.А.

Company:
Department for Surgical Treatment of Heart Disease with Concomitant Progressive Pulmonary Artery Hypertension, Bakoulev Scientific Center for Cardiovascular Surgery, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

Heading: Original Research

UDC: 616.126.4-007.089.168:616.12-007-053.1

Link: Clinical Physiology of Blood Circulaiton. 2019; 3 (2): 103-110

Quote as: Mazhidov U.A., Gorbachevskiy S.V, Grenaderov М.А. Surgical treatment of the atrioventricular septal defect complicated by Eisenmenger syndrome: results, indications and contraindications. Cardiovascular Surgery News. 2019; 3 (2): 103–10 (in Russ.). DOI: 10.24022/2588-0284-2019-3-2-103-110

Received / Accepted:  04.06.2019/28.06.2019

Full text:  


Abstract

The aim of this study is to determine treatment tactics for the patients with atrioventricular septal defect (AVSD) complicated by Eisenmenger syndrome (ES), basing on results of invasive monitoring of pulmonary artery pressure (PAP).

Material and methods. From 2004 to 2015, 46 patients with AVSD complicated by ES were examined and treated. Mean age was 53.3±45.1 months (6–180). Determination of operability and surgical tactics in patients with AVSD complicated by ES was based on results of invasive monitoring of PAP. PAP exceeding 80% of systemic pressure was the indication for invasive monitoring of PAP, which was performed in all patients divided into three groups, according to results of the test: one-step approach (n=22), two-step approach (n=14) and inoperable patients (n=10).

Results. The first group have demonstrated decrease of the mean systolic PAP after one-stage radical surgical treatment from 92.6±8.6 to 59.4±16.4 mm Hg while mortality due to PAH crisis (PHC) took place in 3 (13.6%) patients in the early postoperative period. Simultaneously, there was only 1 (7.1%) death due to PAH crisis after the first step of surgical correction in the second group while other 13 patients have demonstrated significant decrease of the mean systolic PAP from 90.3±18.4 initially before surgery up to 37.1±12.1 after the second step of surgical correction (p<0.001). The third group was recognized as inoperable.

Conclusions. Our results allow us to make a conclusion, that the two-stage surgical approach is the most preferable tactics of surgical treatment in AVSD complicated by ES. The final decision on favorable tactics in each specific case should be based on the results of invasive monitoring of pulmonary artery pressure. It is expediently to divide radical surgical treatment in AVSD complicated by ES into two steps with pulmonary artery banding as primary procedure.

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About Authors

  • Mazhidov Ulugbek Abdisattarovich, Cardiovascular Surgeon, orcid.org/0000-0003-2883-8019;
  • Gorbachevskiy Sergey Valer'evich, Doctor Med. Sc., Professor, Chief of Department, orcid.org/0000-0002-4193-3320;
  • Grenaderov Mikhail Aleksandrovich, Cardiovascular Surgeon, orcid.org/0000-0002-0720-9187

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