[Effect of aortic clamping on hemodynamics at reconstruction of the thoracoabdominal aorta]. / Vliianie perezhatiia aorty na gemodinamiku pri rekonstruktsii grudnoi i briushnoi aorty.

This paper describes an experience with monitoring and computerized follow up of the hemodynamic status in 60 patients at and right after reconstruction of the thoracoabdominal aorta. In addition to the routine control, measurements were made of the pressure in the large vessels and cavities of the heart, duration of each heart contraction and CI. The following parameters were computed automatically: the status of the ventricles for each heart contraction, resistance of the greater end pulmonary circulation, elasticity of the arterial, venous, pulmonary arterial and pulmonary venous reservoirs, also for each cardiac cycle. At the generally accepted monitoring the hemodynamic responses to the surgeon's manipulations on the aorta appear smoothed or are not visualized at all. The control of each heart contraction reveals the responses to application of the clamp and its removal from the aorta, with their hemodynamic significance being not questionable. Aortic clamping and clamp removal from the aorta are associated with the generalized response of the regulatory systems of the body. The slow and thoroughly controlled aortic clamping and graded, controlled blood flow restoration due to clamp removal as well as the use of sodium nitroprusside (trimetafan or isofluran are preferable) allow to avoid an abrupt stroke load of the left ventricle of the heart and, respectively, the generalized response of the regulatory systems of the body.

[Current issues of medical informatics]. / Tekushchie zadachi informatizatsii meditsinskoi nauki.

Due to the modern high standards of information technologies it is only natural to promote our medical care and to ensure a new quality of clinical services. Information technologies should be introduced into the medical field with due respect to clearly predetermined principles. Analyzed in the paper are the key reasons for a huge number of problems occurring in the sphere of medical informatics; optimal methods of medical-informatics introduction are defined.

[Infrastructure of information support to clinical medicine]. / Ob infrastrukture informatsionnoi podderzhki klinicheskoi meditsiny.

Issues are discussed related with designing an effective infrastructure of the information-and-computer support to clinical medicine with regard for the recent achievements in informatics, automated systems, medical equipment and robotics. It is suggested to focus on creating a module-type infrastructure meeting evenly both the trends towards integration and towards autonomy. A scheme of an information infrastructure constructed for Bakulev's National Center for Cardiovascular Surgery of the Russian Academy of Medical Sciences is described.

[New system for diagnosing acute circulatory disorders and assessing drug choice and dosage]. / Novaia sistema postroeniia diagnoza ostrykh rasstroistv krovoobrashcheniia i otsenki podbora i dozirovki lekarstvennykh preparatov.

The assessment of the status of a patient and diagnosis are first made strictly algorithmically. At the same time the procedure is monitored by a physician in terms of his experience and knowledge. The dialogue is made on the basis of a model and images which reflect the pattern of blood circulation. The diagnosis is made by isolating the key pathophysiological link and interpreting it by means of a clinico-mathematical classification. The usual wording based on the evaluation of the severity and stage of a pathological process is supplemented with assessments of compensatory, protective, and other adaptive changes which greatly influence the choice of a therapy. The action of drugs is evaluated by their cumulative effects on the changes in physiological functions determining their properties, direction and magnitude of alterations of the weakest link. The clinical experience has shown that the procedure is beneficial for rapid detection of clinically significant changes, choice and assessment of therapeutical efforts just during an operation and in the early postoperative period.

[An automated management system for a polyclinic]. / Avtomatizirovannaia sistema upravleniia poliklinikoi.

The authors review the main problems occurring in introduction of computer-aided technology of data collection, processing and storage at the polyclinics, scientific-counselling departments of the medical institutes and centers, taking into account the level of the development of Soviet computers and documentation science. The developing engineers and medical personnel are rather far from being fully aware of the whole complex of the problems they confront. This results in low efficacy of the use of the elaborated automated systems, giving rise to factors interfering with successful operation of the systems. The authors suggest an approach to the design of the automated medical systems. The authors suggest an approach to the design of the automated medical systems intended for uses in the indicated medical institutions, formed as a result of the lasting work related to the creation of the medical computer-aided systems, carried out a the A. N. Bakulev Institute of Cardiovascular Surgery of the USSR AMS.

[Is it practical to assess the functional state of the heart based on the shape of the Starling curves in intensive care units?]. / Real'na li otsenka funktsional'nogo sostoianiia serdtsa na osnove formkrivykh Starlinga v usloviiakh palat intensivnoi terapii?

21 patients have been monitored after open heart surgery. Clinical and model analysis of the genesis of statistical interrelations between the cardiac index (CI) and left ventricular (Plv) and right ventricular (Prv) filling pressure has been performed. It has been shown that CI dependence on Prv or Plv is characteristic of the cardiac performance only in case CI variation is mainly associated with changes in the preload. CI variations are caused mostly by changes in the corresponding half of the heart, while CI dependence on Prv (Plv) does not characterize the heart function and is not Frank-Starling's curve, with the value and angle of the regression slope failing to reflect the degree of the heart pump function damage. It is concluded that in most cases it is practically impossible to assess the cardiac function by the shape of Frank-Starling's curves in intensive care wards.

[Acute disorders of the blood circulation and cardiac insufficiency following open heart surgery]. / Ostrye rasstroistva krovoobrashcheniia i serdechnaia nedostatochnost' posle operatsii na otkrytom serdtse.

General theoretical aspects (classification of circulatory disorders and heart failure) and results of research into specific subdivisions of cardiovascular and respiratory system pathology in cardiac surgical patients are discussed. The material is aggregated by the applied clinico-mathematical approach that has been developed and introduced into clinical practice in the recent 15 years at the Bakulev Institute of Cardiovascular Surgery. The extension of the clinico-mathematical approach onto the intraoperative control and analysis of the patients' status, assessment of the anaesthetic administration and cardioplegic protection is first overviewed.

[Changes in left-ventricular contractility and diastolic rigidity and the dynamics of various indicators of blood circulation in patients after aortic valve prosthesis]. / Izmeneniia pokazatelei sokratimosti i diastolicheskoi zhestkosti levogo zheludochka i dinamika nekotorykh pokazatelei krovoobrashcheniia u bol'nykh posle protezirovaniia aortal'nogo klapana.

The relationship between the stroke output and parameters relating to left-ventricular contraction and relaxation was examined within the early hours after the implantation of prosthetic aortic valve. Quantitative analysis demonstrated a close correlation between left-ventricular performance and diastolic regidity. Left-ventricular diastolic regidity is shown to make a more important contribution than contractility to the formation of stroke output. For this reasons, a therapy aiming only to improve myocardial contractility in patients after prosthetic aortic valve implantation failed to effectively improve their clinical condition.

[Experience with the creation of microcomputer-based automated case history system]. / Opyt sozdaniia avtomatizirovannoi istorii bolezni na osnove mikroEVM.

The article sums up the experience in using an automated case history handling system at the Bakulev Institute of Cardiovascular Surgery for improving treatment and raising research efficiency. The system is designed for collecting, storing, processing and giving out information about the results of diagnosis and treatment of patients in the form convenient for the physician. It is based on the dialogue principle in respect of setting, searching and processing medical data and on the principle of independent work of the personnel with the system terminals installed in different clinical departments.