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Gained vices of the heart and coronary artery disease Prevalence and etiology. Most of acquired heart failures have rheumatic etiology. It’s marked that changes of mitral valve are occurred in 90% , aortal – 50%, tricuspid -20% Rheumatic heart disease is common between young people(until 40). It develops by type of endomyocarditis. Endocarditis leads to loss of valve substance with developing of defects, perforations. More seldom they can be occurred at coronary artery disease, diseases of connective tissue (Marfan’s syndrome), atherosclerosis, closed trauma of heart, bacterial endocarditis or congenital abnormalities. Mitral insufficiency Isolated mitral insufficiency is less common (about 2%), usually it’s connected with another failures. There are 2 types: relative and organic mitral insufficiency. First operation of prosthetic appliance of mitral valve was done by American surgeon Lillehay in 1958 In 1962 V.I.Shumakov offered original spherical prosthetics , but later the operation complicated by thrombosis. Nowadays there are used 1-and 2 – petalous, hemispherical and other types of artificial valves, and also bioprosthetics – swine heterovalves. Mitral stenosis 30% of all mitral valve failures. According to V.H.Vasilenko it exsists at 500-800 patients on 100000 of population. 30-60% of patients in anamnesis had no obvious attacks and rheumatic disease is without symptoms. This failure is formed in young age at women. There are mild (d – till 0,5 sm), middle ( 0,5-1 sm) and severe ( more than 1 sm). Normally the area of atrioventicle foramen is 4.5 -11 sm 2 primary the operation of stenosis liquidation was done by English surgeon Suttar in 1925 by finger mitral comissurotomy. During the impossibility of finger dilatation there is used Dubost dilatator. Aortic valve insufficiency Isolated type at 20-30 % of cases, at male 10 times more often than at female. Among people died from heart failures it is occurred at 14% Aortic insufficiency stimulate retrograde floe 5-50% of systolic blood from aorta to left ventricle, which causes compensatory dilatation of left ventricle and its hyper trophy Aortal stenosis Occurred at 20-23% of people died from heart failures. It’s more common for people in young and middle age and occurred at male more often. (2,4:1). Narrowing of aortic valve put obstacles in the way to left ventricle , which causes prolonging of systolic phase of left ventricle, increasing of pressure in it. Gradient of pressure in the system “aorta-left ventricle” is 50-150 мм hg., it causes fast developing of hypertrophy of left ventricle, usually without widening of its cavity. Аортал стеноз Coronary artery disease According to WHO , CAD exists 53 % of all death cases from cardiovascular diseases between 45-64 years. In the USA annually is occurred 600 000 deaths from this disease, and economic loss is accounted many billion dollars in a year. In developed countries about 20% of healthy working men at the age of 60 are at risk of CAD. In Russia it takes a leading place between cardiovascular disease, accounting 28%. In 2005 in Russian Federation there are died 550000 of people because of myocardial infarction. In Uzbekistan In 1960 was performed finger and later instrumental comissurotomy At this year was performed first pericardiotomy at pericarditis, in 1969 implantation of cardiostimulator during atrioventicle blockage. In our country first operation of aortocoronary shunting was performed at the Republic Centre of Surgery in 1988, founded by acad. V.V. Vakhidov with Russian colleagues prof. B.V. Shabalkin and YU.V.Belov. In Uzbekistan From our surgeons first in republic it was performed by B.L.Gambarin in 1988-89, then E.A.Karimov in 1989 – 1993. Between 1992and 1995 it was performed by A.V. Vakhidov. A great role in Uzbekistan played Yu.P.Andres, D.F. Yugay and N.U.Sharapov. N.U.Sharapov also made a great work at introducing of resection and plastic of postinfarctional aneurisms of left venticle – one of the heaviest comlications of myocardial infarction. F.Sh. Bakhritdinov began to perform coronary operations between 1996-2005 years and had dome about 100 operations of myocardial revascularisation. Before this time there was used autovenous transplantants, but F.Sh. Bakhritdinov used autoarterial conduits – brachial artery. There were made combined operations on coronary arteries and branches of aortic arch, resection and plastic of left ventricle aneurisms. Mitral stenosis Comissurotomy with finger Stage of the close mitral comissurotomy Stenosis of the mitral valve Instrumental mitral comissurotomy Artificial valves of the heart Mitral vise of the heart Mitral stenosis. Stage of the section of the mitral valve Macropreparate of the mitral valve. Combined mitral vice with the prevalence of the insufficiency Stage of the prosthesis of the cardiac valve Artificial valve of the heart X-ray of the chest Stage of the prosthesis of the cardiac valve ANATOMY OF THE CORONAR ARTERIES OF THE HEART Stenting Stenting X-ray endovascular interventions are performing at the Xray operation room, equipped with the digital angiocardiographic installation For performance of the interventions at the coronar arteries are frequently used the access from the femoral artery Less frequently is used the access from the vessels of the upper extremities (axillar and radial) Allen’s test Точка пункции Точка пункции STAGES OF THE BALLOON ANGIOPLASTIC A) Passing of the intraducer through the defeated part of the CA B) extending of the balloon with the compression of the atherosclerotic athery c) Installation of the balloon at the level of defeat; D) reconstruction of the passability of the CA; Stages of the stenting А INSTALLATION OF THE SYSTEM STENT-BALLOON IN THE ZONE OF DEFEAT В EXTENDING OF THE SYSTEM BALLOON-STENT AT THE LEVEL OF DEFEAT С AFTER THE IMPLANTATION OF THE STENT (FRAMEWORK FUNCTION THE SPOT IS RECONSTRUCTED) Operations on the heart at the CAD Aortocoronar shunting Mammarocoronar shunting Operations on the heart at the CAD Aortocoronar shunting Mammarocoronar shunting