[The role of specific endothelial granules in changes of myocardium microvessel reperfusion at open-heart operations under hypothermia]. / Rol' spetsificheskikh éndotelial'nykh granul v reperfuzionnykh izmeneniiakh mikrososudov miokarda pri operatsiiakh na otkrytom serdtse v usloviiakh gipotermii.

For patients with congenital heart defects, a comparative analysis was carried out of specific endothelial granules and morphological properties of perfusion capacity of microvessels at various stages of reperfusion after prolonged circulatory arrest. At all stages of reperfusion, the quantity of specific granules in microvessel endothelium dramatically dropped, as compared with the control group. At the early stages of reperfusion, the level of granule exocytosis does not lead to any statistically significant changes in perfusion characteristics in the right atrium microvessels, as compared with the control group. Conversely, at the late stages of reperfusion, degranulation of endothelial cells is enhanced, and physiological mechanisms intended to remove the microvessels from circulation are replaced with pathological ones. These results suggest the existence of a threshold in exocytosis of specific endothelial granules, whose exceeding may switch on some pathological mechanisms in blood flow regulation.

[Endomyocardial biopsy in the diagnosis of myocarditis and cardiomyopathies]. / Biopsiia endomiokarda v diagnostike miokarditov i kardiomiopatii.

Fifty patients with the following suspected diseases were examined: examined: congenital heart disease (25), rheumatic heart disease (7), infectious-allergic myocarditis (12), fibroelastosis of the endocardium (3), alcoholic cardiomyopathy (2), drug cardiomyopathy (1). Catheterization biopsy of the endo- and myocardium was accomplished with a special bioptome after catheterization of the heart. No complications occurred during or after biopsy. The results of histologic and histochemical examination of the bioptates of the cardiac muscle are discussed. On the basis of the data in the literature and personal experience, it is concluded that biopsy of the endo- and myocardium may be undertaken to specify the etiology and pathogenesis of cardiomyopathy. The method is comparatively safe.

[Classification of acquired aortic stenosis (based on electrocardiographic study data)]. / O klassifikatsii priobretennogo aortal'nogo stenoza (po dannym élektrokardiograficheskogo issledovaniia).

The article is based on the case records of 192 patients with acquired aortic stenosis and interpretation of the ECG of 187 patients. In this group, 143 patients underwent operation and 8 died in the period of their examination. The purpose of the examination consisted in determining whether or not the ECG could characterize the stage of the cardiac disease. Four types of electrocardiographic changes of the ventricular complex characteristic of left-ventricular hypertrophy were distinguished. On comparing clinical and electrocardiographic findings, no clear dependence was revealed between the clinical manifestations of the stenosis and the severity of the hypertrophic process in the muscle of the left ventricle according to the ECG data. The information gained by means of ECG is confirmed by the results of pathomorphological examination. The authors suggest a clinical classification of acquired aortic stenosis based on the function changes in the left-ventricular myocardium as determined from the ECG.

[Ultrastructure of cardiomyocytes during mitral valve replacement in non-perfusion hypothermia]. / Ul'trastruktura kardiomiotsitov pri protezirovanii mitral'nogo klapana v usloviiakh besperfuzionnoi gipotermii.

The ultrastructure of biopsy specimens obtained from the left ventricle was examined at varying stages of mitral valve replacement under non-perfusion hypothermal protection (at 27-28 degrees C). In patients with clinical stage IV mitral incompetence, cardiomyocytes were shown to combine signs of marked hypertrophy and decompensation. Despite the initial plastic muscular cell incompetence, there are only small changes in their ultrastructure and myofibril contracture in the pre-occlusion period, which subside by the end of long-term (up to 37 min) occlusions. For the myocardium, reperfusion is the most damaging, but the damages, though widely diverse, are regarded mainly as moderate and reversible. Over again the electron microscopic finding provide good evidence for the feasibility of performing complicated cardiac surgeries with prolonged reversible exclusion of blood circulation under non-perfusion hypothermia.

[Myocardial function in patients with congenital pulmonary valve stenosis]. / Funktsional'noe sostoianie miokarda u bol'nykh s vrozhdennym klapannym stenozom legochnoi arterii.

The studies of metabolism and morphology of the myocardium, and of ECG parameters in 72 patients with valvular pulmonary stenosis conducted with biopsy and autopsy material has demonstrated that while the workload on the right ventricle grows and the severity of the pathological process increases, the oxidative capacity of the myocardium also increase, the indices of its energy supply decrease, the degree of myocytes hypertrophy grows, and the number of mitochondria and the coefficient of their energy efficacy decrease. A correlation was established between the degree of these changes and the severity of electrocardiographic signs of hypertrophy and disorders in the repolarization process in the right ventricle.

[Intravital study of energy metabolism in the liver in mitral valve stenosis]. / Prizhiznennoe izuchenie energeticheskogo obmena pecheni u bol'nykh mitral'nym stenozom

In 42 patients with mitral stenosis an intravital study was conducted comparing the liver energy exchange with the biochemical blood serum parameters and morpho-histochemical characteristics of the biopsy material. A correlation was established between the energy exchange and the clinical stage of the disease, the pigment function of the liver and the severity of its structural changes.

Involution of changes in lesser circulation after closure of prolonged aortopulmonary anastomosis.

Possibilities of involution of changes in lesser circulation after closure of experimental aortopulmonary anastomosis were studied. 37 observations at various intervals after closure of anastomosis (several minutes to 13.5 months) in 25 dogs were analyzed. Before closure the anastomosis had functioned for 1-7 months. The results of histological examinations of lungs, pressure measurements in lesser circulation, heart weight, electrocardiographic and spirographic examinations were analyzed. It was found that complete involution of changes in lesser circulation was possible only in first month of existence of anastomosis, in this case with changes of both "early" and "late" types. "Late"-type changes after four months function of anastomosis had both reversible and irreversible character, whereas "early"-type changes became irreversible already after three-month duration of anastomosis. With the "late"-type changes, the operation itself (closure of anastomosis) was accompanied by symptoms of pulmonary vasomotor paresis and heart failure, whereas in the presence of "early"-type changes the operation elicited no morphological or functional changes.

[A method of pharmacologic support in experimental operation on the dry heart]. / Metod farmakologicherskogo obespecheniia operatsii na sukhom serdtse v éksperimente.

The method of prolonged (up to 35 min) reversible circulatory arrest at anesthetized dogs consists of body external cooling, main vascular occlusion with cardioplegia, cardiac function recovery and animal body warming. Special reference was made to anesthetic security of the experiment. The method provides the study of hypothermic protective mechanisms, the improvement of surgical techniques up to organ transplantation, as well as the observation of long-term results.

Effect of calcium antagonists on ultrastructure of myocardial microvessels during open heart surgery under conditions of pharmacological and cold cardioplegia.

Ultrastructure of myocardial microvessels was examined during surgical correction of congenital heart disease (ventricular septal defect) under conditions of cold and pharmacological low-potassium cardioplegia without perfusion. Addition of calcium antagonist verapamil to cardioplegic solution prevented postischemic damage to vascular and perivascular structures occurring during reperfusion and body temperature rise.

Changes in myocardial metabolism and ultrastructure of myocardial microvessels during pharmacological and cold cardioplegia under hypothermic conditions without perfusion.

A combination of pharmacological and cold cardioplegia in with hypothermia without perfusion in open-heart surgery guarantee the reversible character of shifts in energy and free radical balance in the myocardium. However, this procedure can impair coronary micricirculation due to structural and functional changes in microvessel endothelium. Our results demonstrate that new cytoprotective approaches are extremely needed for cardiac protection during surgery.