[Pharmacological treatment of hemorheological disorders in children with acute respiratory viral infection].

This article presents the results of monitoring in a group of children with severe forms of acute respiratory viral infection and toxic encephalopathy. Hemorheological disorder in the form of hyperviscosity syndrome has been detected in all patients with severe forms of acute respiratory viral infection. It was suggested the inclusion of cytoflavin in the complex therapy for correcting the hemorheological status. The administration of cytoflavin led to reduction of erythrocyte aggregation and general improvements in rheological indices of children with severe forms of acute respiratory viral infection and toxic encephalopathy.

[Echocardiographic diagnosis of acute rejection of transplanted heart]. / Ekhokardiograficheskaia diagnostika ostrogo ottorzheniia peresazhennogo serdtsa.

Comparing echocardiographic parameters with endomyocardial biopsy findings in 6 patients with acute crises of mild, moderate, and severe graft rejections and in 2 patients with persistent acute rejection crisis has shown that there are decreases in end-diastolic size and left ventricular end-diastolic ejection fraction volume, an increase in left ventricular myocardial mass, and thickening of the left ventricular posterior wall and ventricular septum, as evidenced by ultrasonic study. Such changes are detected in moderate and severe acute crises of graft rejection. Normalization of ultrasonic parameters of the grafted heart occurs 2-3 weeks after abolition of rejection crisis. A positive dynamics of echocardiographic parameters in persistent acute rejection crises suggests a good prognosis. Echocardiographic monitoring data obtained in the outpatient setting may serve an indication for unplanned endomyocardial biopsy.

On the mechanism of accentuation of the first heart sound in mitral stenosis.

In 10 patients with mitral stenosis, catheterization of the left ventricle and the left atrium has revealed a considerable increase in dp/dt at the moment of closure of the mitral valve in comparison with 10 healthy controls. Systolic and diastolic pressure and the contractility indicators (dp/dtmax and dp/dtmax/P) did not differ from the values found in the controls, and Vmax was even reduced. Simultaneously with the change in the dp/dt ratio at the moment of the mitral valve closure there occurred also a proportional change in the Ist heart sound amplitude. The authors therefore suggest that besides anatomical changes, a role in the accentuation of the Ist heart sound in mitral stenosis is played also by the haemodynamic factor - the dp/dt ratio at the moment of the mitral valve closure.

[The role of electrocardiographic examination in the complex evaluation of potential heart donors]. / Rol' élektrokardiograficheskogo issledovaniia v kompleksnoi otsenke potentsial'nykh donorov serdtsa.

From October, 1986 to February, 1990 eighty-five potential donors with death of the brain were examined at the Scientific Research Institute of Transplantology and Artificial Organs, USSR Ministry of Public Health. Thirty of them were used as heart donors in orthotopic transplantation of the heart; 24 (80%) were males and 6 (20%) females. The cause of death of the brain was craniocerebral trauma in 13, brain tumor in 9, hemorrhage into the brain tissue in 7 cases, and gunshot injury to the skull with damage to the brain in one case. In appraisal of the donors; in 8 (26.7%) cases the ECG did not differ from the initial one, in another 8 cases (26.7%) the ECG demonstrated electrolyte disorders in the form of hypokalemia , still in another 8 cases right bundle-branch block was encountered, in 2 (6.65%) the ECG showed transient form of cardiac fibrillation, in still another 2 cases I-II degree atrioventricular block was found, in one (3.3%) right and left bundle-branch block was demonstrated, and in one case the ECG showed diminished nutrition in the region of the posterior left-ventricular wall. All donors had disorders of homeostasis characteristic of patients with death of the brain, while the condition of hemodynamics conformed to these disorders. It is concluded on the basis of the obtained data that electrocardiographic monitoring is expedient and that it plays a role in complex appraisal of a potential heart donor.

[Chronic rejection of a transplanted heart]. / Khronicheskoe ottorzhenie peresazhennogo serdtsa.

Three cases of chronic rejection occurring 7.5, 10, and 24 months after transplantation of the heart are analysed. The clinical features of chronic rejection in the late-term periods after transplantation of the heart are discussed. The problems of clinical diagnosis of chronic rejection, the role of endomyocardial biopsy and disorders of lipid metabolism are dealt with. Tactics of saving the patient are recommended. The authors substantiate the necessity for heart retransplantation and, in the absence of a donor's heart, for two-stage transplantation of the heart through an artificial heart or a biventricular approach by means of artificial heart ventricles.