[DIAGNOSIS OF ISCHEMIC HEART DISEASE CAUSED BY TORTUOSITY OF CORONARY ARTERIES].

This article is devoted to the problems of diagnostics of coronary artery tortuosity phenomenon. Given the lack of literature about the role of phenomenon tortuosity of coronary arteries in the genesis of ischemic myocardial damage, the purpose of study was to determine the clinical relevance as well as necessity for prevention and treatment of this vascular anomaly. Therefore were analyzed medical history, laboratory and clinical database as well as data functional studies of the heart and cardiovascular system in 1404 patients which were divided into four groups on the results of coronary angiography. The results of the study indicate tortuosity of coronary arteries may be independent and additional burdening factor in the development of ischemic heart disease.

[Plasty of the left atrium in the isolated mitral valve prosthesis implantation].

Possibilities of the procedures conduction of the left atrium (LA) plasty in a mitral valve prosthesis (MVP) were studied. There were examined 553 patients, in whom surgical treatment in the clinic was conducted. In all the patients MVP was conducted for isolated mitral valve failure and dilatation of LA. In 371 patients (the main group) MVP and LA plasty were conducted, in 182 (control group)--LA was not corrected. Morphometric indices of left cardiac cameras, survival, stability of the operation good results in late terms have witnessed high efficiency of MVP with LA reduction in comparison with such in a control group. Late results of MVP in conjunction with LA reduction exceed such in a control group, witnessing expediency of the proposed methods of surgical treatment application.

[Diagnosis and treatment of biatrial myxomas of the heart]. / Diagnostika i lechenie biatrial'nykh miksom serdtsa.

Of the multiple myxomas of the heart (MH) the bilateral myxomas were revealed in 57.1%. Of 4 patients before the operation the correct diagnosis was established only in one. Meticulous data on clinical signs, diagnosis and surgical treatment peculiarities of patients with bilateral MH were adduced. Morphological peculiarities of the tumor were analyzed. Special attention was paid to the necessity of clinical and surgical guard toward revelation of undiagnosed tumors, the choice of optimal approaches to the heart cavities while performing radical operation. Basing on results of histological studying of operational specimen it was established that MH is originated from transformed vessels of interatrial septum.

[Intravenous catheter embolism]. / Intravenoznaia kateternaia émboliia.

Ethiology, diagnosis, prognosis and the way of the intravenous catheter embolism (ICE) elimination are depicted. The results of endovascular removal of foreign bodies from the cardiac chambers and main vessels are presented. Recommendations concerning the patients with ICE conducting are given.

[Surgical correction of failures associated with corrected transposition of the main vessels]. / Khirurgicheskaia korrektsiia porokov, soputstvuiushchikh korrigirovannoi transpozitsii magistral'nykh sosudov.

Experience of surgical correction of failures, concomitant with corrected transposition of main vessels (CTMV) in 29 patients was summarized. For pulmonary artery (PA) stenosis demolition in 10 patients the conduits of various design were applied, for moderate left atrioventricular valve (LAVV) insufficiency--its prosthetics. Surgical treatment mortality was 20.7%. Late follow-up results of the operation was studied up in 16 (66.7%) patients. Mean period of observation constituted 3.3 years. Good result was noted in 7 patients, fair--in 9. Lowering of contractile ability of "arterial" ventriculus and the LAVV insufficiency progress were the causes of follow-up results changing for worse. Application of conventional methods of treatment do not put away the basic disorder--CTMV.

[The first experience with A. Jatene's operation in complete transposition of the major vessels in newborn and nursing infants]. / Pervyi opyt operatsii A. Jatene pri polnoi transpozitsii magistral'nykh sosudov u novorozhdennykh i grudnykh detei.

The authors analyze their experience gained in the treatment of newborns and infants aged under one with complete transposition of the main vessels; arterial change-over method was employed. Five infants with complete transposition of the main vessels aged 14 to 70 days (27.6 days on an average) weighing 3.2 to 3.9 kg (3.7 kg, on an average) was operated on from January to June, 1992. All the patients presented with D-type complete transposition of the main vessels; interventricular septum was intact in four and defective in one patient. All the operations were performed under conditions of cardiopulmonary bypass with deep hypothermia (17 degrees C). Complete circulation arrest was employed in all the cases. Two of the five patients died, this making hospital mortality 40%. Death was caused by acute cardiac failure which developed in the postperfusion period and was fatal.

[The prognostic assessment of the reversibility of myocardial dysfunction in patients with ischemic heart disease after aortocoronary bypass]. / Prognosticheskaia otsenka obratimosti disfunktsii miokarda u bol'nykh ishemicheskoi bolezn'iu serdtsa pri aortokoronarnom shuntirovanii.

Forty-six patients with ischemic heart disease with considerable dysfunction of the myocardium were subjected before operation of aortocoronary shunting to veloergometry with calculation of indices of the central hemodynamics by the method of tetrapolar rheoplethysmography, echocardioscopy before and after taking nitroglycerin. Close interrelation was noted between the increase of the stroke volume during veloergometry, increased fraction of output after taking nitroglycerin and improved contractile capacity of the myocardium after aortocoronary shunting.

[Paravalvular insufficiency following heart valve prosthesis]. / Paraklapannaia nedostatochnost' posle protezorivaniia klapanov serdtsa.

The features of the morphology of paravalvular insufficiency (PVI) were studied on the basis of analysis of 5,113 prosthetic replacements of the heart valves. From the clinical results and noninvasive and invasive data the authors revealed the peculiarities of the disorders of hemodynamics and functional condition of patients with PVI. Information on the specific features and the results of 35 repeated operations in PVI are discussed. Analysis showed 26.4% survival among patients 5 years after surgery. Bearing in mind the severity of the complication the authors emphasize the importance of its prevention.