High-frequency oscillatory lung ventilation in neonatal infants with surgical diseases

The paper presents data on the varieties and modes of the present artificial ventilation and high-frequency artificial ventilation (AV). It describes the basic impact of various ventilation modes on gas exchange, hemodynamics, and mechanical lung properties. The data on the use of high-frequency AV in neonatal infants with various surgical diseases are given. Its place and indications in malformations, such as diaphragmatic hernia and esophageal atresia, are defined. High-frequency oscillatory AV may be recommended for use as an alternative method in the treatment of respiratory failure in neonates with difuse lung lesion and in those with congenital surgical diseases when it is impossible to ensure adequate gas exchange.     

Aneurysm of internal carotid artery. Clinical symptoms, surgical treatment, results

Aneurysms of the extracranial portion of the internal carotid artery is rare pathology - only 2.2% of all surgical procedures on this portion of the internal carotid artery are caused by this disease. Ten-year experience in surgical treatment of these aneurysms is presented in article. Symptoms and etiology of this disease are considered. It is demonstrated that fibromuscular dysplasia is one of the main causes of these aneurysms. Strategy and policy of surgical treatment, clinical cases are analyzed. Resection of the aneurysm with angioplasty or grafting is optimal. End-to-end anastomosis is possible in patients with kinking. Results of surgical treatment are positive, there is no hospital lethality.     

Comparative characteristic of surgical approaches for aneurysms of thoracoabdominal aorta

The surgical approaches for aneurysms of thoracoabdominal aorta are analyzed. Both thoracoretroperitoneal and thoracolaparotomic approaches are appropriate; they are up to quality of visualization and manipulation on low-thoracic part, visceral branches and bifurcation of aorta that is verified by experimental studies (wound depth 11-15 cm, angle of surgical action 100-110 degrees, angle of surgical action axis 80-90 degrees). The level of thoracotomy and type of approach depends on variant of lesion and planned reconstruction. Modified thoracophrenopararectal approach (wound depth 11.4+/-0.2 cm, angle of surgical action 97.0+/-3.7 degrees, angle of surgical action axis 88.0+/-2.0 degrees) is optimal for manipulations on aortic isthmus.     

Valve sparing operation in a patient with aneurysm of ascending aorta with aortic regurgitation and concomitant ischemic heart disease

Bentall procedure is considered to be operation of choice for ascending thoracic aneurysms with aortic regurgitation. The however procedure has some inherent drawbacks (e.g. need of lifetime anticoagulation because of risk of late thromboembolic complications). These drawbacks can be eliminated by the use of valve saving surgery. We present a case of nontraditional valve saving operation combined with myocardial revascularization in a patient with ascending thoracic aneurysm, aortic regurgitation and ischemic heart disease. Technique of sinus of Valsalva plication for narrowing of sino-tubular ridge during prosthetic replacement of the ascending aorta turned out to be effective in this situation. The procedure described requires correct assessment of the state of aortic valve and selection of prosthesis of suitable diameter.