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IntroductionSurgery for primary non-resectable malignant tumors of the left atrium is controversial. Today heart autotransplantation as a method of surgical treatment for patients suffering primary massive malignant tumors of the left atrium is still not sufficiently studied.Material and methodsWe provide information on our single-center 5-year experience in performing surgical interventions for massive malignant tumors of the left atrium and including cases of 5 patients (3 males – 60%, 2 females – 40%). One case (1/5, 20%) involved debulking surgery with partial resection of the left atrial (LA) wall and its reconstruction using a xenopericardium patch. Orthotopic heart transplantation was performed in 1 patient (1/5, 20%) and heart autotransplantation (HA) in the 3 other cases (3/5, 60%).ResultsMean myocardial ischemia duration was 165.6 ±12.0 minutes (range: 137–198), cardiopulmonary bypass (CPB) duration was 248.6 ±36.6 minutes (range: 188–392), and intervention duration was 498.0 ±77.4 minutes (range: 330–780). Mean total blood loss was estimated to be 2432 ±616.5 ml (range: 1610–4880). Major in-hospital complications were registered in 4 patients (4/5, 80%). In-hospital mortality was registered in 3 patients (3/5, 60%). Survival time in 2 (2/5, 40%) patients discharged from the hospital was 29 and 9 months, respectively. Both died because of disease progression.ConclusionsSurgery in patients with massive resectable primary malignant tumor of the left atrium is associated with high incidence of major hospital complications and mortality. Heart autotransplantation with radical tumor resection is the treatment of choice for these cases. The surgical approach implies thorough primary hemostasis and selection of a proper surgical approach, allowing revision of all the regions of intervention during each step. The possibility of excessive tension and bleeding in the area of bicaval anastomosis should be considered when performing heart autotransplantation, and appropriate preventive measures should be applied.

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Введение. В год в Республике Беларусь имплантируется более 600 искусственных клапанов сердца (ИКС), а общее количество имплантированных клапанов достигло около 10 тысяч. Цель. Оценка in vitro и in vivo гидродинамических характеристик отечественных двустворчатых ИКС Планикс-Э . Материалы и методы. В данном исследовании проведено сравнение гемодинамических параметров 442 аортальных ИКС Планикс-Э в условиях in vitro и in vivo. Оценка in vitro проводилась в лаборатории испытаний изделий для кардиохирургии ОАО Завод Электронмаш . Результаты и обсуждение. Наименьшее отличие заводских показателей геометрической площади отверстия (ГПО) и эффективной площади отверстия (ЭПО) было на протезах 19-го размера и равнялось 0,11 см2 (5,76). С увеличением размера протеза разница ГПО и ЭПО увеличивалась и в среднем составила 0,910,68 см2. При сравнении ЭПО протезов в условиях in vivo / in vitro выявлена разница от 3 до 26. Наибольшее отличие было на протезах 19 мм и 21 мм, которое составляло 0,460,11 см2 и 0,490,11 см2 (p0,005). С увеличением размера протеза его ЭПО приближалась к стендовым показателям. Средние трансаортальные градиенты протезов 19 мм отличались на 7,21 мм рт. ст. (34,63) по отношению к показателям in vitro, и это отличие было максимальным (p0,005) по сравнению с другими типоразмерами. Отмечалось снижение разницы средних трансаортальных градиентов с увеличением размера протеза. В среднем данная разница равнялась 3,982,08 мм рт. ст. Заключение. Гемодинамические характеристики ИКС Планикс-Э в уловиях in vivo и in vitro отличались на протезах всех размеров. ЭПО и средние трансаортальные градиенты на протезах малого диаметра в послеоперационном периоде достоверно отличались от заводских показателей (p0,005). С увеличением размера протеза гемодинамические показатели приближались к показателям in vitro. Introduction. Each year in the Republic of Belarus, more than 600 mechanical heart valves are implanted, and the number of the implanted valves has reached about 10.000. Purpose. Сomparison of hemodynamic parameters of mechanical heart valves Planiks-E in vitro and in vivo. Materials and methods. In this study, comparison of hemodynamic parameters of 442 mechanical heart valves Planiks-E was conducted in vitro and in vivo. In vitro evaluation was carried out in the test laboratory of the products for heart surgery of the Plant Electronmash. Results and discussion. The smallest difference of the factory parameters of the geometric orifice area (GOA) and the effective orifice area (EOA) was on 19 mm prostheses 0.11 cm2 (5.76). With increase of the size of the prosthesis, the difference between GOA and EOA increased and was 0.910.68 cm2 on average. When comparing EOA prostheses in vivo/in vitro, the difference from 3 to 26 was found. The greatest difference was on 19 mm and 21 mm prostheses, which was 0.460.11 cm2 and 0.490.11 cm2 (p0.005). With increase of the size of the prosthesis, EOA approached the bench values. The average transaortic gradients of 19 mm prostheses differed by mm Hg (34.63) in relation to the indicators in vitro, and this difference was maximal (p0.005) in comparison with other type-sizes. There was noted the decrease of the difference of average transaortic gradients with the increase of the size of the prosthesis. On average, this difference was 3.982.08 mm Hg. Conclusion. Hemodynamic characteristics of Planiks-E in vivo and in vitro differed in prostheses of all sizes. EOA and average transaortic gradients on small-diameter prostheses in the postoperative period differed significantly from the factory values (p0.005). With increase of the size of prosthesis, hemodynamic parameters approached in vitro indicators.