[Derangements of contractility of left ventricular myocardium in patients subjected to coronary bypass surgery. Methods of their correction].

Coronary bypass grafting with the use of cardiopulmonary bypass was performed in 119 patients (age 41-75 years) with stable angina. In addition to standard therapy in pre and post operative periods patients of group 1 (n=40) received mildronate (750 mg/day for 3 days then 750 mg twice weekly), patients of group 2 (n=41) received trimetazidine (70 mg/day). Patients of group 3 (n=38) received no "metabolic" drugs. The use of cardioprotectors mildronate and trimetazidine facilitated improvement of total and local myocardial contractility both before and after surgery, and caused limitation of development of myocardial stunning, associated with derangement of local contractility in post operative period.

[Surgical treatment of giant aneurysms of ascending parts and arch of the aorta in condition of deep hypothermia and circulatory arrest with artificial assisted circulation]. / Khirurgicheskoe lechenie gigantskikh anevrizm voskhodiashchego otdela i dugi aorty v usloviiakh glubokoi gipotermii i ostanovki krovoobrashcheniia s perifericheskim podkliucheniem apparata iskusstvennogo krovoobrashcheniia.

Sternotomy in giant (10 cm and more in diameter) aneurysms is highly dangerous due to possibility of injury of aneurysmatic wall with fatal bleeding. That is why sternotomy in condition of artificial circulation (AC) and cooling of patients to 29-30 degrees C are preferred. Two cases of successful surgical treatment of critical patients with giant aneurysms of ascending parts and arch of the aorta in condition of femoro-femoral AC, hypothermia (20 degrees C) and circulatory arrest are presented. One of the patients had a giant false posttraumatic aneurysm of an ascending part of the thoracic aorta with fistula between aneurysm and pulmonary artery. Suturing of defects of ascending aorta and pulmonary artery wall, aneurysmorrhaphia of pulmonary artery were performed. The other patient with acute disruption of a giant dissected aortal aneurysm and hemomediastinum underwent prosthesis of ascending part and arch of the aorta.

[Clinical aspects, diagnosis and surgical treatment of rupture of the mitral valve chordae]. / Klinika, diagnostika i khirurgicheskoe lechenie razryva khord mitral'nogo klapana.

The authors generalize experience in surgical treatment of 121 patients with mitral incompetence caused by rupture of the chordal threads. Prosthetics of the mitral valve was conducted in 103 patients, plastic correction--in 18 patients. Study of the etiomorphological aspects of the problem showed destruction of the fibrous framework of the chorda to be a compulsory component of rupture of the chordae of various origin. At the same time, there are some similar clinico-diagnostic manifestations of rupture of the chordae, which allows this form of mitral valvular disease to be set apart as an independent syndrome. Echocardiographic study is the most informative method in the diagnosis of the disease, it reveals rupture of the chordae in over 95% of cases. The immediate and late-term results of plastic operations and prosthetics were compared. Plastic operations are preferable in a favorable situation because survival after them is higher and thromboembolism does not develop even if anticoagulant therapy is not applied.