Резюме Цель исследования. Анализ результатов шунтографии после операции аортокоронарного шунтирования (АКШ) в зависимости от условий операции (на работающем сердце, в условиях искусственного кровообращения-ИК с остановкой сердечной дея тельности и параллельного ИК) и выявление факторов, влияющих на проходимость шунтов в ближайшем послеоперационном периоде и при динамическом наблюдении. Материалы и методы. В ретроспективном исследовании, включавшем 142 пациента (114 мужчин и 28 женщин, средний возраст 68,7±12,3 года), оценивалось влияние на функцию кондуитов скорости кровотока по шкалам TIMI, SYNTAX, диаметра и степени поражения сосудов после операции на работающем сердце, в условиях оста новленного сердца и параллельного ИК. Продолжительность наблюдения в среднем составляла 12,7±6,5 мес (от 1 до 30 мес). Результаты. По данным шунтографии, из 142 пациентов у 74 (52,1 %) дисфункции шунтов не обнаружено, у остальных 68 (47,9 %) имелась дисфункция кондуитов различного типа, что составило 3 % от общего количества оперированных паци ентов. Из 68 (47,9 %) пациентов, у которых при шунтографии обнаружена дисфункция кондуитов, 31 (46 %) был оперирован в условиях на работающем сердце (Off pump), 19 (28 %)-в условиях остановленного сердца (On pump) и 18 (26 %)-с исполь зованием параллельного ИК. По нашим данным, такие параметры, как оценка по шкале SYNTAX, диаметр шунтируемого сосуда и процент сужения, достоверно не влияют на функционирование шунтов при сроке наблюдения 12,7±6,5 мес; оценка коронарного кровотока по шкале TIMI достоверно влияет на функционирование шунтов. Выводы. В ближайшем послеопера ционном периоде и при динамическом наблюдении на функцию шунтов достоверно влияет скорость коронарного кровотока согласно оценке по шкале TIMI. Результаты операции на работающем сердце и с использованием параллельного ИК не отли чаются от результатов операции в условиях ИК с остановкой сердечной деятельности в ближайшем послеоперационном пери оде, но имеют тенденцию к увеличению дисфункции шунтов в сроки до 30 мес по сравнению с операциями, выполненными в условиях остановленного сердца. В средние сроки наблюдения до 12 мес на дисфункцию шунтов не влияют оценка по шкале SYNTAX, диаметр коронарных артерий, процент сужения и условия операции.

Purpose -The aim of our study is to assess the transthoracic Doppler parameters of left internal thoracic artery`s stem (LITA) flow after coronary artery bypass surgery with free right internal thoracic artery using Y graft technique and compare them with such parameters of LITA-LAD (left anterior descending) graft flow after regular coronary artery bypass surgery (CABG). Material and Methods -51 consecutive patients with coronary artery disease underwent CABG. Comparison between groups was performed using the following parameters: age, body mass index, angina class, presence of hypertension and diabetes, left ventricular ejection fraction and hemoglobin level, hemodynamic parameters during the Doppler investigation. Results -Higher systolic acceleration time value in Y graft group is due to bigger runoff of Y graft compared with the classic group. The diastolic acceleration time is shorter in Y graft group as the distal coronary runoff is bigger and LITA`s peak flow accelerate faster. The systolic and diastolic acceleration times are very sensitive parameters which depend on the distal coronary runoff changes. Conclusions -We conclude that blood flow volume in tha LITA graft depend of coronary artery distal run-off and rising when we using to revascularize more than one coronary artery.

Relevance: Surgical treatment for congenital heart disease (CHD) with borderline left ventricle (LV) dimensions is one of the most challenging issues in current pediatric cardiac surgery. Despite the prevailing general trend to the expansion of indications for biventricular repair of an unbalanced atrioventricular septal defect (AVSD) with a dominant right ventricle (RV), the diagnostic criteria for imbalance, feasibility of radical repair and its functional results are intensively discussed in the literature.Aim: To present quantitative criteria for the assessment of the LV size which could serve as an indication for biventricular repair of the right dominant unbalanced AVSD.Materials and methods: We present a  series of 4  patients with AVSD and dominant RV, who underwent radical repair of the defect. The mean age of the patients was 2.4 years, and 3 of 4 had concomitant CHD: tetralogy of Fallot, double outlet right ventricle with pulmonary artery stenosis, and moderate hypoplasia of the aortic arch with subaortic stenosis. Three of 4 patients had previously undergone palliative interventions: two of them – pulmonary bending, one, the first stage of univentricular repair (atrioseptostomy, cavopulmonary anastomosis). Two children had been diagnosed with Down syndrome. The mean left ventricular end diastolic diameter (LVEDD) at baseline was 17.9 mm, corresponding to Z score of -5.4.Results: All four patients underwent biventricular repair of the defect with a  two-patch technique. In one case, it was supplemented with placement of the pulmonary trunk homograft prosthesis, in the other with pulmonary valve commissurotomy and cavopulmonary anastomosis due to moderate tricuspid valve stenosis and in the third case the mitral valve was replaced. In 3 patients pacemaker implantation was performed. The criterion for feasibility of complete septation was the ratio of the longitudinal dimensions of the left and right ventricles (LAR > 0.7), confirmed by computed tomography performed before the surgery. The mean LVEDD after surgery was 28.3 mm, corresponding to Z score of -0.8. At the time of the hospital discharge, the left and right atrioventricular valves insufficiency did not exceed 2 and 1 degrees, respectively.Conclusion: Computed tomography allows for accurate measurement and comparison of the longitudinal dimensions of the heart ventricles with LAR index as a tool for assessment of the LV size before the biventricular repair. An additional prospective study is required to objectify the data obtained and identify predictors of an unfavorable outcome of radical repair in patients with right dominant unbalanced AVSD.

Purpose — The aim of our study is to assess the transthoracic Doppler parameters of left internal thoracic artery`s stem (LITA) flow after coronary artery bypass surgery with free right internal thoracic artery using Y graft technique and compare them with such parameters of LITA‐LAD (left anterior descending) graft flow after regular coronary artery bypass surgery (CABG). Material and Methods — 51 consecutive patients with coronary artery disease underwent CABG. Comparison between groups was performed using the following parameters: age, body mass index, angina class, presence of hypertension and diabetes, left ventricular ejection fraction and haemoglobin level, hemodynamic parameters during the Doppler investigation. Results — Higher systolic acceleration time value in Y graft group is due to bigger runoff of Y graft compared with the classic group. The diastolic acceleration time is shorter in Y graft group as the distal coronary runoff is bigger and LITA`s peak flow accelerates faster. The systolic and diastolic acceleration times are very sensitive parameters which depend on the distal coronary runoff changes. Conclusions — We conclude that blood flow volume in tha LITA graft depend of coronary artery distal run‐off and rising when we using to revascularize more than one coronary artery.