[Clinical characteristics of angina pectoris in relation to disease of the coronary arteries]. / Klinicheskaia kharakteristika stenokardii v zavisimosti ot porazheniia koronarnykh arterií

Clinical and coronary angiographic comparison conducted in 164 patients with typical angina pectoris demonstrated that the nature of the pains may serve as a criterion of the degree of stenosis and the number of diseased arteries. The development of typical anginal seizures indicates the presence of clear changes in the coronary arteries. A daily intake of over 10 pills of nitroglycerine is a sign of a narrowing of the diameter of the coronary arteries exceeding 75%. A growing number of daily taken pills of nitroglycerine indicates an increase in number of diseased coronaries. Pains occurring during or after meals, when lying down, awakening the patient at night are typical for coronary narrowings exceeding 75% of their diameter. Usually such pains are observed in patients with 2 and more cornary arteries affected by the disease. Rightward irradiation and especially strictly localized pains are often associated with the lesion of the right coronary artery.

[Diagnosis of angiospastic angina pectoris by coronarography]. / Diagnostika angiospasticheskoi stenokardii s pomoshch'iu koronarografii.

Tests with intravenous ergometrin maleate and selective coronarography were performed in 82 coronary patients. In 16 of those, coronary spasm was suspected from ECG findings at preliminary testing and confirmed at repeated pharmacologic tests during coronarography. Episodes of vasospastic angina pectoris accompanied by multiple spasms in branches of the main coronary arterial trunk, and spastic response developing at different levels of one coronary artery were demonstrated. It is suggested that angiographic diagnosis is indispensable, particularly at a cardiosurgical in-patient unit, as a procedure both specifying the diagnosis and localizing the spasm, so that the site of distal anastomosis can be chosen for future aortal-coronary shunting.

[Importance of the atrial vectorcardiogram in evaluating the myocardial functional state in ischemic heart disease]. / Znachenie predserdnoi vektorkardiogrammy v otsenke funktsional'nogo sostoianiia miokarda u bol'nykh ishemicheskoi bolezn'iu serdtsa.

The results of examination of 61 patients suffering from ischemic heart disease are analysed. All were subjected to catheterization of the right and left parts of the heart, left ventriculography, and selective coronarography. Some parameters of intracardiac hemodynamics, including the end diastolic pressure in the left ventricle, were determined. Atrial vectorcardiogram was recorded after I. T. Akulinichev's system (with mV = 100 mm). Comparison of the parameters of the atrial P loop of the vectorcardiogram with the findings of heart catheterization showed a direct dependence between the atrial changes recorded on the vectorcardiogram and the value of the left ventricular end diastolic pressure. Signs of overexertion of the left atrium grow with an increase in the end diastolic pressure. Quantitative dependence between these parameters is demonstrated. When the end diastolic pressure grows higher, overexertion of the left atrium is naturally joined by overexertion of the right atrium. Atrial vectorcardiography may be an important invasive method for appraising the functional condition of the left ventricular myocardium in patients with ischemic heart disease.

[Differential diagnosis of lesions of the left coronary artery trunk and multiple hemodynamically-significant stenoses of the coronary arteries]. / Differentsial'naia diagnostika porazheniia stvola levoi koronarnoi arterii i mnozhestvennykh gemodinamicheski znachimykh stenozov koronarnykh arterii.

Clinical manifestations were compared in coronary patients with different sites and spread of coronary atherosclerosis, in order to assess the feasibility of differential diagnosis of left coronary arterial (LCA) trunk lesions versus multiple coronary arterial stenoses. Four groups of patients were examined: isolated third- or fourth-degree LCA trunk stenosis (15 patients, group 1); third- or fourth-degree stenosis of the anterior interventricular branch (AIVB) and the circumflex branch (CB) (44 patients, group 2); third- or fourth-degree stenosis of AIVB, CB or the right coronary artery (RCA) (77 patients, group 3); and third- or fourth-degree stenosis of AIVB, CB, the diagonal branch or RCA (33 patients, group 4). The clinical condition of patients with isolated LCA branch lesions was much worse than that of patients with multiple coronary arterial stenosis. Differential diagnosis is based on the severity of the pain syndrome, the spread of ischemic zone on resting ECG, the scope of past myocardial infarction, stress tolerance and the magnitude of ST depression in response to exercise.

[Problem in the selection of patients with ischemic heart disease for surgical treatment (summary of 15 years' experience)]. / Problema otbora bol'nykh ishemicheskoi bolezn'iu serdtsa dlia khirurgicheskogo lecheniia (obobshchenie 15-letnego opyta).

A review of data reported in Soviet and foreign literature and the authors' own experience allowed specifying a number of clinical and angiographic criteria for the selection of coronary patients for surgical treatment. Clinical criteria include the pain syndrome, progressive angina pectoris, severe pain with a sharp ST displacement during an effort, low physical stress tolerance, and heart rhythm disorders. Angiographic criteria include total coronary arterial involvement reaching 75%, intact peripheral channel in all coronary arteries fit for aortocoronary shunting and satisfactory myocardial contractility.

[Surgical treatment of severe forms of ischemic heart disease]. / Khirurgicheskoe lechenie tiazhelykh form ishemicheskoi bolezni serdtsa

Over 400 operations of an indirect revascularization of the myocardium have been performed at the A.I. Bakulev institute of Cardiovascular Surgery of the USSR Academy of Medical Sciences. Since 1970, the direct method have been developed, predominantly those of aorto-coronary bypass. Careful examination of 709 patients was carried out, 445 of them were subjected to selective coronary angiography, 108 were operated on. In 1974, 56 operations were undertaken, among them 36 aorto-coronary bypasses, in 6 of them with a preliminary endarterectomy from the coronary artery, 8 double bypasses, 6 procedures for acute myocardial infarction, 5 combined operations of aorto-coronary bypass and resections of cardiac aneurysms, and 15 resections of postinfarction aneurysms of the heart. Twelve patients died in the postoperative period, mainly due to acute cardiac insufficiency. The high figures of mortality are caused not only by the faults of the surgical procedures but also by the grave initial state of the patients (multiple coronary lesions large focal cardiosclerosis due to preceeding infarctions, high degree of initial cardiac insufficiency). The improvement of the results of surgery for the ischaemic heart disease will depend on the perfection of the surgical technique, on proper selection of the patients, and on the precise determination of the indications for such treatment.

[Dependence of myocardium function on the degree of coronary bed involvement in chronic ischemic heart disease patients with and without previous myocardial infarct]. / Zavisimost' funktsional'nogo sostoianiia miokarda ot stepeni porazheniia kronarnogo rusla u bol'nykh khronicheskoi ishemicheskoi bolezn'iu serdtsa, perenesshikh i ne perenesshikh infarkt miokarda.

A total of 104 patients with chronic ischaemic heart disease were examined. The left ventricle myocardial function was studied by determining the signs of overload of the atria by the method of enhanced atrial vectorcardiography, which were compared to the data of heart catheterization, and of left ventriculography. This showed the reliability of the non-invasive methods of investigation. The degree of lesions of the coronary bed was determined in the bicycle ergometric tests and by selective coronarography. A group of patients who had not suffered myocardial infarction showed trends of progressing signs of myocardial insufficiency corresponding to the degree of the damage of the coronary bed. In a group of patients, who had suffered myocardial infarction, myocardial insufficiency was more manifest, however, even in them the degree of myocardial lesion was closely associated not only with the presence of the scar changes but also with the degree of the damage of the coronary bed.

[Experience in the surgical treatment of combined atherosclerotic lesions of the coronary arteries, abdominal aorta and arteries of the lower limbs]. / Opyt khirurgicheskogo lecheniia sochetannykh ateroskleroticheskikh porazhenii koronarnykh arterii, briushnoi aorty i arterii nizhnikh konechnostei.

A comprehensive clinicoangiographic and functional examination was made of 180 patients with combined coronary and vascular abnormalities. With this, a diagnostic algorithm was developed, which determined the authors' approach to evaluation of the severity of patients and the choice of surgical policy. A total of 150 patients were operated on, the total mortality being 7.3%. The examination of operative and hospital mortality rates in patients with combined abnormalities showed that pre-aortocoronary bypass surgery before a reconstructive vascular operation in patients with severe coronary diseases made it possible to avoid serious coronary events in the following postoperative period.

[Detection of cardiac insufficiency by computer-assisted monitoring of the response of intra-cardiac hemodynamics to exercise test in patients with ischemic heart disease with similar lesions of the coronary arteries (patient selection for the aortocoronary bypass)]. / Vyiavlenie serdechnoi nedostatochnosti s pomoshch'iu monitorno-kom'iuternogo analiza vnutriserdechnoi gemodinamiki na nagruzochnyi u bol'nykh ishemicheskoi bolezn'iu serdtsa z odinakovym porazheniem koronarnykh arterii (na étape otbora k operatsii aortokoronarnogo shuntirovaniia).

Preoperative identification of cardiac insufficiency in patients with ischemic heart disease (IHD) has proved essential for the success of surgery on the coronary arteries. To provide for an objective assessment of the contractile function of the myocardium in selecting candidates for surgery among IHD patients with over 70-percent narrowing of one, two, and three coronary arteries, use was made of the central hemodynamics indices in response to the loading test during right heart catheterization with computer-assisted monitoring and mathematical analysis. Two patient groups were distinguished during the hemodynamic loading test: group I showing a high and effective chronotropic reserve (+X) and group II presenting a negative chronotropic reserve (-X). It was established that with equal numbers of narrowed coronary arteries and similar clinical manifestations, the estimates of myocardial contraction may differ which determines indications for surgery and preoperative care.

[Morphofunctional criteria for the selection of patients with ischemic heart disease and associated arterial hypertension for surgical treatment]. / Morfofunktsional'nye kriterii otbora stradaiushchikh ishemicheskoi bolezn'iu serdtsa o soputstvuiushchei arterial'noi gipertoniei dlia khirurgicheskogo lecheniia.

After examination of 255 patients with ischemic heart disease (IHD) and concomitant arterial hypertension (AH) two groups were distinguished according the level of arterial pressure. Group 1 was formed of 89 patients (arterial pressure below 180/80 mm Hg), group 2--of 166 patients (arterial pressure above 180/100 mm Hg). Survival was determined according to certain morphofunctional indices (total affection of coronary arteries, left ventricular output fraction, left ventricular end diastolic pressure, tolerance to physical effort) in nonoperated on and operated on patients suffering from IHD and concomitant AH. It was found that the operation affects positively the "quality" of life more than the survival.

[Indications for aortocoronary shunting in relation to ejection fraction and segmental activity of the left ventricle (data of the coronarography, ventriculography and intra-cardiac hemodynamics)]. / Pokazaniia k operatsii aortokoronarnogo shuntirovaniia v zavisimosti ot fraktsii vybrosa i segmentarnoi aktivnosti levogo zheludochka (po dannym koronaroventrikulografii i vnutriserdechnoi gemodinamiki).

The left-ventricular ejection fraction, reflecting the contractile capacity of the myocardium according to the clinical data, is the most objective criterion in indication for the operation for aortocoronary shunting. The indices of central hemodynamics appearing in response to the exercise test during intracardiac catheterization of the right heart and monitor-computer control with mathematical analysis were used in objective appraisal of the left-ventricular ejection fraction in selecting for surgical treatment patients suffering from ischemic heart disease with normal and reduced ejection fraction of the left ventricle. Two gradations of patients with ischemic heart disease were set apart during the hemodynamic exercise test: the first--patients with a high and effective chronotropic reserve--subgroup I("+X") and the second--patients with a poor and ineffective chronotropic reserve--subgroup II("--X"). It was found that in a single-valued left-ventricular ejection fraction (normal or low) in patients with ischemic heart disease there may be the presence or absence of latent cardiac insufficiency according to the results of the hemodynamic exercise test which must be determined in indications for surgical treatment.

[Coronary circulation in patients with ischemic heart disease with various degrees of arteriosclerosis obliterans of the leg during selection surgical treatment]. / Sostoianie koronarnogo krovobrashcheniia u bol'nykh ishemicheskoibolezn'iu serdtsa s razlichnoi stepen'iu stenoziruiushchego ateroskleroza sosudovnizhnikh konechnostei pri otbore k khirurgicheskomy lecheniiu.

First in the literature, the relationship between the coronary and lower limb circulation is detailed on the basis of objective findings. Comparison of the two patient groups (the patients categorized according to the degree of lower limb ischemia revealed by Doppler ultrasound echocardiography) in respect to the clinicomorphofunctional characteristics of the coronary flow in IHD patients suggested the absence of a significant correlation between them. Varying severity of lower limb ischemia does not influence the gravity of IHD manifestation in the same patients.