Heart surgeon Vladimir Ilyin: the excitement of the struggle with the disease need every physician

Why does it seem that over the years, anomalies and heart defects becomes more why to evaluate the results of heart surgery in 20 years, can cardiology to exist on subsidies and why in the fight against the disease important race, says children’s heart surgeon Vladimir Ilyin.

Vladimir Ilyin. Photo: Yefim, Richman

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Professor Vladimir Ilyin more than forty years saves children with congenital heart defects. Twenty of them he headed the Department of newborns and children first year of life the National centre of cardiovascular surgery named. Bakulev.

Ten years ago the doctor refused to work in Kuwait and became head of the new and only in Moscow the division of pediatric cardiac surgery at the city clinic in the Filatov hospital. Professor often repeats two words – motivation and a team. And although the work with heart is always a big risk, interest every doctor can make the treatment successful.

In the early 2000s, Vladimir Ilyin has created an online forum and began to counsel the parents of children with congenital heart disease – support for families who are in such trouble, he calls another of his destiny.

Why today find more abnormalities of the heart than before

– Vladimir Nikolaevich, today we increasingly talk about the fact that children with congenital heart disease becomes more – is it really so?

– Reliable information about the fact that defects become more, no. But the more common modern methods of diagnostics that can detect more defects and vices. For example echocardiography. In experienced hands, it allows us to detect many, even a small cardiac defects. It was previously inaccessible, but the effect on statistics now.

Increasingly, prenatal diagnostics using two-dimensional echocardiography. She is not a threat to the health of the child. The main thing – to have qualified pediatric cardiologist. In hospitals more and more have specialists in ultrasound diagnosis of heart defects in newborns. Introducing and screening of newborn screening for the early detection of severe heart defects.

– And what are the vices and all you have to fear?

– Best known for more than 330 types of congenital heart defects. And we must understand that this is not just an anomaly/defect in formation available to the child at birth, and definitely an anomaly, which is accompanied by significant dysfunction of the heart and circulatory system. Modern methods of cardiological examination allow suddenly discover absolutely amazing things.

So, three years ago, the French cardiology published the census 92-year-old woman was diagnosed with severe anomaly of the heart: corrected transposition of the great arteries. Many kids with this disease feel unwell already in early childhood. And she gave birth to 10 children!

Today, more and more is revealed anomalies of the structure of the heart that manifest clinically only in the “adult” age. But sometimes they at any age can begin to affect the health and length of human life.

– That is possible too: the man had lived, and then found out that he lived with a problem?

– Yes, probably. And people, and others begin to notice that he was increasingly unwell. About three years ago we were approached by 14-year-old girl with a hole in the valve was 3 mm. It is a severe aortic stenosis! It is hard to imagine how she lived all these years!

In recent years, cardiologists and cardiac surgeons actively studied such a defect, when both coronary arteries extend from the aorta, but usually not, and one aortic sinus. When one of the arteries may take a long course inside the aortic wall or in the space between the walls of the aorta and pulmonary artery.

And imagine: a guy with such a defect goes to the army – he is perfectly healthy, because no ill effects alone do not, and ECG changes either. Heat runs, is laid out as required service. It increases blood pressure and pulmonary artery pressure. One of the abnormally running of the coronary arteries may be subjected to compression, resulting in disturbed coronary circulation, and this guy suddenly dies.

The same thing can happen in school, say, in gym class. What does the teacher blame? It is undiagnosed congenital anomalies, which may be called the heart disease and that manifest themselves only under certain conditions.

So now slowly starting to be implemented screening of students to identify such “hidden” anomalies. And this initiative should continue to develop further. Just need to research performed by qualified doctors: Sam a diagnostic system that will not detect.

– What defect may not be diagnosed?

– 1/8-1/10 of all people are born with two wings in the aortic valve, not three. It would seem, well, think. Fold there are often thin, well-opened and closed. A person grows, learns, works. And suddenly, in 20-30 years, he starts feeling sick: there is heaviness and pain in the chest – growing aneurysm of the ascending aorta.

And it turns out that this is a serious problem – double valve changes the blood flow in the ascending aorta, and the presence of defects in elastic fibers in the aortic wall of the aorta eventually start to deleteroute, that is, to expand that dangerous rupture of its wall and can disrupt the function of the aortic valve.

How heart disease can change a life

But your patients are the ones who need help here and now, because you can not wait?

– Our patients – children. And many of them have serious heart abnormalities can significantly affect their health, ability to cope with breastfeeding, to grow and develop. This may seem strange, but most often occur in children defects “simple” morphological defect – atrial septal defect, ventricular septal defect, open arterial (known to inhibit) duct and others. Patients with anatomically simple, and although threatening the health and lives of children with defects. And in our practice the majority.

“Simple” congenital heart defects that are fixed in time, often allow former patients to lead a practically normal life, and sometimes sports. Young women dream about motherhood, and most of it is possible, even after correction for complicated defects.

Recently, I visited a young woman with kids and I didn’t recognise her. She was only 4 months when she was in serious condition when we operated about rare and serious defect: the left coronary artery she was not from the beginning of the aorta and pulmonary artery. The left ventricle was barely reduced, and on the mitral valve had severe regurgitation. We fixed her circulation via the left coronary artery, and now – please: she is the mother of a beautiful baby.

Most our attention is drawn to the condition of the patients, with a statistically less frequent, but functionally much more severe heart disease, which can manifest itself clinically in the neonatal period or infancy and actually threaten the lives of children in the first days and months of life. Such defects include transposition of the great arteries, complex, hypoplastic left heart, coarctation of the aorta, atresia of the pulmonary artery, common arterial trunk and others.

15-20% of our patients can have complex congenital defects, i.e. defects with very serious multiple and difficult to remove defects of the structure of the heart.

In addition to heart disease patients there are often other congenital defects of the digestive tract, the respiratory system and excretion. Just today, we operated on a boy who at birth was found to have atresia of the esophagus. And before doing heart surgery, thoracic unit of our hospital he restored the patency of the body. In General, this combination of birth defects can greatly affect patient outcomes.

– Child with so heavy a heart disease can be cured?

– We are modifiable, many such congenital heart defects. But in later life certain heart problems such a person may arise, and he will have still life to be observed by a specialist.

Our complex and often multi-stage procedures can greatly extend his life: someone, say, eighteen, and someone to sixty. But the way of life most of these people will be special. It must be borne in mind, and we must prepare for this.

Now parents are more willing to understand and correctly treat their children and what their future is. But even not one of them comes from an understanding of how the heart defect, the child can change their life plans, even if the child is “cured”. The situation is not always dramatic, but always requires adequate assessment and life planning.

I quickly realized how important it was to support parents

– So you decided to create an online forum for parents of such children?

– I quickly realized that one of our important purposes, perhaps, is not only to create a perspective for the life of the child, but also to support the parents because congenital heart disease, especially severe, it is a big problem, a psychological shock for the whole family. Especially for a young couple, where the first child is so seriously ill. Can crumble all life plans, the world narrows to a small cot with a seriously ill child. We still remember the time when relatives used to bring us the child for treatment, secretly hoping that after the surgery he will die and will not suffer and complicate their lives.

In 1994 at a clinic in new York saw the free access to a small pamphlet: a guide for parents “If your child has congenital heart disease”, published professional public organization American Heart Association. I asked permission to translate, publish it and saw the parents of our patients a great interest in him.

Many of them, trying to understand the essence of things, came with questions about heart disease, the treatment of children and their future. If you open the sites to any foreign health clinics, you will always see large sections for parents, which explains what heart disease, how to recognize it, at what age is it necessary and can it be fixed, and why sometimes you need to wait with surgery.

I remember one called the baby’s father: “My son is two weeks, and he has a patent foramen ovale. When you will be able to take him for treatment?” But patent foramen ovale have a newborn, why should it be treated? It should be observed, as well as patent ductus arteriosus.

If your child is already one-two-three years, that is another matter. Often at this age it is already necessary to treat. But it is well known that about 40% of “simple” heart defects (patent ductus arteriosus, patent foramen ovale and small defects mejjeludockova partitions) spontaneously disappear within 1-2 years.

And when I realized that via Internet forum it is very convenient to convey this information to parents, through the son created the website and was quietly with his parents to chat.

In that moment you were the head of the Department of emergency surgery of newborns and children 1st year of life in Bakulev center. How do you manage to combine the forum with the main work?

Well… in the Evenings and on weekends. But it does not matter, the main thing – the result.

And many of those parents with whom we spoke at the forum, then came to us for treatment of children.

The results should be studied 15 years after surgery

– And whither cardiac surgery? What treatments can be considered “breakthrough”?

– Surgeons for the last 30-40 years have learned to correct such defects, which previously could not even dream of. Then cardiac surgical and anesthetic methods were imperfect, the mortality rate was high, and after the operation we talked and wrote: “the Child survived – a great result!” But in our time, to say so is wrong. Now surgical mortality is low: 0-3%. But long-term results are often unimportant.

Many years of experience in this area suggests that effective surgical technique – one that leads to good remote results of treatment.

Such results, in which a person does not require re-hospitalizations and cardiac surgeries, is not experiencing severe physical limitations due to the painful condition, it can at least satisfactorily to adapt to modern life. So us cardiologists, and surgeons – all more necessary to move towards using these criteria, the effectiveness of treatment.

In the last 20-30 years there were many surgical and therapeutic methods of treatment of patients of different ages with congenital heart disease: the search goes on constantly. However, there are insufficient grounds for some of them to be considered adequate and effective. And long-term results should be studied after 15-30 years after surgery, and not in 2-3 years, as is often the case.

Someone takes the liberty to call the breakthrough by the introduction of robotic surgeons, but from the standpoint of medical problems, this is complete nonsense – attempts to obtain money or to become famous. The money spent on the purchase and development of one such robot-a surgeon, you can build a hospital block. And in our area it is not necessary, although someone says that robots are more precise in the conduct of incisions and suturing. But the existing surgical problems.

The important thing in surgery is to make the right strategic and tactical decision. What and how to cut and sew is in third place. Meanwhile, many other technical innovations in cardiology and cardiac surgery are very useful and necessary.

Something breakthrough can appear only in genetics, and now attempts are being made to correct the “wrong” genes, although not only they influence the occurrence of congenital heart disease, but all sorts of random reasons. For example, viral infections in the mother, the conception of a child in a state of intoxication, Smoking or the work of one of the parents in the enterprises with radiation.

Genetic breakdown is the main cause of many defects, including congenital heart defects. Now in order clinical studies attempts are made to intervene surgically in fetal heart and vessels of the fetus, but not in order to cure the unborn child, but only to save his life or make it more curable.

– You said that it is difficult to study long-term results of the operation. Why?

– In our country it is very difficult to do, because many patients, if you feel good, stop going to the doctor: as you know, this is little joy. And if they live in some small town or village and there is a problem, then go to the local doctor in their community center, he writes them pills, and the person may require the examination and advice of a good specialist. Many families in our country move from place to place and do not respond to our letters. So information about the long-term results may be lost.

In our case, post-operative treatment, also called rehab, is one of the most important stages of treatment of the child. She must be very competent, accurate, extremely accurate and, where necessary, extended. Because almost inevitably after operations for complex congenital heart disease it is accompanied by difficulties.

It is very important to practiced by cardiologists with expertise in the clinic of congenital heart defects, the pathophysiology changes as a result of operations and age, and most importantly – motivated to achieve positive result. Otherwise, formal, inadequate therapy in the rehabilitation period can ruin any perfectly done surgery. Unfortunately, the right professionals is still insufficient.

The excitement of the struggle with the disease need any medic

– You often talk about motivation in work. Is it really so important?

That’s what we were taught academician Vladimir Ivanovich Burakovsky and our entire professional lives – every medic needs to make the maximum contribution to the treatment of a child in the success of the operation, to be useful to the case. But the majority of doctors today are not motivated to succeed, and just work from 8 to 17 hours. “Drink the pills, a week will see you another doctor because I’m on vacation.”

Work heart carries certain risk, and this risk is behind every cardiac surgeon. But the operation is the collective work of the team. Brilliantly performed complex surgical procedures can be “spoiled” by any other member of the team involved in the treatment of a patient: the anesthesiologist, a perfusionist, scrub nurse, intensive physician and ward nurse and so on.

In an atmosphere of shared responsibility, clear communication, mutual respect and trust can develop a good team. Understanding that all your work, your successes and mistakes for all to see that all of this will be adequately evaluated, can produce a motivation to honest high quality professional work.

And don’t even have to be highly professional in order to experience satisfaction and even joy that I managed to understand the complex diagnosis, to dismiss a host of related problems and diseases, to operate successfully, to hold the anesthesia, cardiopulmonary bypass and intensive care and… to see a recovering child in the mother’s arms. These feelings and even a kind of excitement, the disease is very important for any health professional, but, unfortunately, not available to all physicians.

– What operation was most difficult for you?

In 40 years of my work you can recall and not just one (smiles). Sometime even surgery to close the defect mejjeludockova septum in an infant was uncommon, and if successful ended – was a great event for all. Now is a routine.

I was lucky and I, for example, for the first time the country has successfully operated on a child with transposition of great arteries using the arterial switch method. It is not very easy to decide on surgical intervention, where almost all the first time. Such transactions before I was conducted, but were not successful. But in the West they did for about 10 years.

It was 1992, I was head of the Department of newborns and children 1st year of life. We brainstorm, studied all that was available in the scientific literature, convinced the leadership of the Institute in the feasibility of implementing such a method and successfully operated a 4 month old baby. Then during the year, has successfully performed another five such operations, and solely on the basis of the learning outlined in scientific papers. It really surprised my colleagues abroad.

The next year at one of the international conferences I went to a wonderful children’s heart surgeon Claude Planchet, who worked in a Paris hospital Plessis Robinson and had already made more than 700 such transactions. I told his story and asked for a short internship. He was happy, was allowed to come, and I for three weeks worked with him. He and his colleagues allowed us to learn from them. We made friends with him for many years.

I was in the Department of pediatric cardiac surgery and at first I was upset

– Vladimir Nikolaevich, why did you choose this specialty?

– Probably, because it quickly developed, its efficiency was very striking phenomenon and even a holiday, because it “revolved” a very decent and attractive people. Finally, she gave great joy to save lives.

Anyway, I wanted to go to school for a degree in electronics, like my cousin. He was older than me by five years, he studied at the Moscow aviation Institute, went Hiking, took pictures, know how a lot to do with your hands. I took his example in almost everything. And the electronics was so concerned that, while studying in the 10th grade remade home of the old TV KVN on a large television tube. It somehow worked, and all the tenants and neighbors came to amaze the television on the big screen.

But in early childhood I grew up not very healthy child, always went to kindergartens and sanatoriums. My parents lived in a room in a communal apartment in the house on Bolshaya Polyanka, and the parents are my visits to children’s sanitarium was of great help, but because of this I was often ill. Perhaps, in some degree, my decision was influenced by this.

But the decisive event was the fact that during the year prior to school release in my hands was the book surgeon Nikolai Amosov “Thoughts and heart”, released in 1965, one of the pioneers of Russian cardiac surgery. Impressed me with his profound reflections on the hard work, the joys of successful operations, the sorrows of failure, description of clinical observations from his rich practice.

Behind the door was waiting for me in the military. Part of the reason for admission to the medical school I trained hard and got the same passing score on the medical faculty of the Second honey.

There was a funny episode – mother told father, “Go learn in College, what Vova can help.” And my dad’s an architect. In the first months of the war he volunteered to the front, near Moscow, frostbitten feet and was released from military service. Served as a lecturer in the school of engineering troops. So, he came to the main building of the Institute at pirogovka and the watchman asked, what are the chances of the son. He said, “All guys”. And dad with a sense of accomplishment went home to reassure mom (smiles).

And in the first year, apparently still under the impression from the book of Amos, I wanted to get to know what a surgical clinic, and went to work as an orderly in the operating unit of the Institute. Sklifosofskiy. Worked there for six months, observed the operations, people, relationships. Then concentrated on his studies and began to look to other branches of medicine.

After the third year all were practice nurses and nurse. I with friends was in the Institute of cardiovascular surgery, which was next to the 1st City hospital – base 2-year Medical school. Interested in the Department of acquired heart disease and another six months to work there at night.

– You already chose cardiac surgery?

– Some time was thinking about neurosurgery, but at this point in the Bakulev Institute has formed the scientific student circle. I then finished the 5th course. We with three friends for some reason a little late to the first meeting, where they discussed topics of research, and we got only the latter is to investigate the effects of massive blood transfusions in the experiment. In those days, this problem was very relevant to the clinic, and in the end we did not regret the incident.

Very enthusiastically worked for a year, and the data obtained allowed our small group to prepare a good report on the scientific session of the Institute of cardiovascular surgery them. A. N. Bakulev. That is still students, we did his first scientific work, and published abstracts. Then I have matured the decision to enter the residency in this institution.

And immediately appeared in the children’s Department?

– Enrolling in the clinical residency, I went to the Department of pediatric cardiac surgery. At first I was upset, but the Director promised that there will be a rotation of interns in all offices. I calmed down, but soon saw that many do not understand, do not know. Eagerly listened to the conference presentations, asked questions, began to read. Got carried away. Weekend days are spent in the Lenin library: more literature to get anywhere in the world, and the Internet, as you can guess, did not yet exist.

I was invited to a small nearby office for young children up to three years. Head was on a long business trip, and his Deputy is a wonderful female surgeon Larisa Buzinova – asked me to help. I was the only young doctor in the er gave me to ward with 5 patients, often joyfully helped in the operating room. Two years flew by almost unnoticed.

It’s time to go to graduate school. In the graduate school of the academician Vladimir Ivanovich Burakovsky suggested me the topic: “a Combined method of deep hypothermia for the correction of heart defects in children of early age”. The use of artificial circulation is to perform operations on “open-heart” in young children were accompanied at the time of great complexity. And we, like all over the world, explored ways to combine extracorporeal circulation with deep hypothermia was believed that this may improve the results.

Used method allowed to intervene in the heart when the circulation is stopped. Patient’s body is cooled to 18-20 degrees, the surgeon performed the manipulation, and then the patient is warmed with the aid of cardiopulmonary bypass.

The work on this topic has made me acquainted with the theory and practice of multiple related disciplines: anesthesiology, extracorporeal circulation, intensive care, clinic, biochemistry, psychology and pathomorphology. In the sections of the dissertation it was all reflected. And with the results of their research, I was lucky enough to participate in those years in all joint symposia of scientists of the USSR and the USA on the subject “Congenital heart defects”.

– In the 90s many doctors left the profession. How could you resist?

And many never left. I was lucky: in the 90s we continued to develop international cooperation, particularly with European colleagues. We went to trial and a scientific trip to the socialist countries.

European surgeons and cardiologists have come at a scientific conference in Moscow. Some of them managed to get close and even friends. Created a wonderful atmosphere of cooperation: European surgeons have helped us to operate in Moscow, we have increasingly traveled abroad, studying the organization of work and therapeutic techniques.

Through these relationships I am already in 1991 he received an invitation to participate in the creation of the European club for pediatric cardiac surgeons. There were going to already established professionals who could not only Express themselves, but also to listen to colleagues and to discuss different issues of pediatric cardiac surgery.

It was the beginning of a large work on the creation of a European database of paediatric cardiac surgery is a very important operational tools for improving the quality of work. At first we were 12, then 30 people. And in recent years the club has transformed into a full-blown European Association of pediatric surgeons. She is now developing very effectively.

Cardiac surgery is very expensive, the subsidies are not enough to anyone

– What happened to the system of cardiac care to children? What is happening in the regions?

In the last 10-15 years in the country were created several Centers of high technology, with the divisions of pediatric cardiac surgery in Penza, Astrakhan, Krasnoyarsk, Kaliningrad, Khabarovsk and other cities. Along with the old centers in Moscow, Novosibirsk, St.-Petersburg, Perm, Rostov-on-don, Krasnodar and a large number of small units of pediatric cardiac surgery (only about 40) they are on the number of running operations children come much closer to our health care to the state when the needs of the people in this kind of medical assistance is fully satisfied.

The quality of aid information is collected difficult, maybe even impossible. Domestic database of pediatric cardiac surgery there, and the participation in international contemporary bases for some reason, all scary. We (at the Filatov hospital) – the country’s only team, actively participating in European and world databases for pediatric cardiac surgery. This allows us to compare own results with data of a huge number of foreign children’s hospitals. And we are not afraid, especially because these data is presented anonymously to others.

The Ministry of health is now widely implements the criteria for quality of care. Among them you will see – “how many minutes after admission to the hospital you went to the doctor, the nurse?”, “When you did a blood test after admission?” and so on. But this is the criteria of organization of medical care, but not quality of care. And the quality of care in our region is, for example, the number of hospital re-admissions and operations at the child, tenderness of his General condition (there is a term – mоrbidity), physical and intellectual development of a former patient.

Organizing principle today is team work in the clinic of pediatric cardiac surgery. In our Department the treatment of the child at all stages involved a team consisting of doctors of different specialties – surgeons, cardiologists, anesthesiologists, endovascular surgeons, intensive care physicians, ultrasound physicians and large staff of nurses.

All have one common goal – to cure a sick child. Together we discuss and rejoice in the successes. We have a small office, all are there, each in a glass house.

– Charities often raise funds for cardiac surgery, because patients can’t wait for the quota, on the occluders. With what it can be connected, in your opinion? Not enough money from the state or rare and expensive?

Cardiac surgery in General and children in particular are very expensive. The most difficult diagnostic and therapeutic equipment and technologies, a huge number of necessary expensive medicines, blood products, disposable supplies, implants, a large number of participating qualified personnel often – long duration multi-step treatment. All this, together with a modern organization of work requires a lot of money. Insurance, state, and University grants do not have enough to anyone.

And some of our charity funds to help hospitals treat children with congenital heart defects. For example, if the child has a complex heart surgery there is a complete transverse blockade and heart rate slows to 40-50 per minute, with the help of the charitable Foundation clinic very quickly can get expensive artificial pacemaker implantation for the child: in 1-2 weeks.

Work is one of my biggest successes

You were offered to move to work abroad?

In 90-e years were with a professional visit to America on Sunday, along with colleagues decided to go to Church. After the service we were introduced to the entire community, said: “we Have today people from Russia – Dr. Vladimir Ilyin. Let’s welcome him.” They all stood up, smiled and started shaking hands. And that day, my colleagues suggested: “Maybe moving in with us?” But no doubt the failure I had. Yes, 1992-94 years were terrible. But my family and my friends in Moscow, it was necessary to develop the service and Department at the Bakulev centre. This was largely a political decision, and just loved Russia: still my homeland.

Fifteen years later I was offered a position at a hospital in Kuwait, but I again refused. And was happy to trust the Moscow authorities to open the city’s first pediatric cardiac surgery here in the Filatov hospital, to help Russian children. I do this work with pleasure and very sincere, though I have to say, wages in foreign countries was crazy.

– And for you work is that: the joy of salvation, the meaning of life?

– For me work is a way of life, one of my biggest successes because it allows me to feel successful and effective, is what makes life interesting content, gives me a bright prospect of further development of the case, to whom I gave a lot of years and effort.

– In your biography it seems that your whole life is just work…

– Well, why not. I have a good family: wife, two children, two grandchildren, house, car. For a long time I was fond of skiing, Hiking, photography, traveled a lot – in this respect, Russia is a beautiful country. Was in the North in Arkhangelsk and on Solovki, Siberia, on the Ob, on the Kuril Islands, traveled all the suburbs and the Central Russia. Developing professional contacts, visited almost all European countries. Have wonderful friends in our country and of fellow professionals all over the world.

– You have in the closet and saw icons. Are you a believer?

No, I was not baptized and unbelieving: I grew up in the Soviet time and in a Soviet family. But with respect to the religious feelings of others and am very glad that next to our building on the hospital grounds is an old Orthodox Church. It is a good support for parents of patients. It is easy to see and hear from the Windows of our office. I visit temples as monuments of architecture, and presented the icons are kept as works of art.

What do you think is the meaning of your life?

– The meaning of life, obviously, is to acquire and grow a good offspring: family and business, to your work and the results were useful for people and all mankind so years of his life were filled with many joyful events for you and your loved ones.

– You often come to former patients? Do you remember them?

– Yes, I’m very happy to see my grown up former patients. But come, as a rule, only those who want. For example, after a long break, wrote a letter and came a young man we operated on at the age of 4 months with a complex heart defect transposition of the great arteries. He is now 21 years old. He was in Moscow because became a member of the famous contest “the Voice”, and came to share that joy. But he did not protest when we asked him to undergo a cardiologic examination, although his health was quite good. Evaluation of remote results of the operation are very important for a former patient and his treating professionals.

The survey was great and we didn’t have any objection to his participation in this challenging competition. He did great, very pleased with all of us, although not as a winner. But, as everyone can see, no longer did not matter.

Talked Hope Prokhorov

Photo: Yefim, Richman

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