[Course of pulmonary hypertension in patients operated for rheumatic mitral heart disease]. / Techenie legochnoi giprtonii u bol'nykh, operirovannykh po povody revmaticheskikh mitral'nykh porokov serdtsa.

AIM: To study changes in pulmonary hypertension in patients with isolated mitral valvular defects of rheumatic etiology after surgical correction and in the early postoperative period. MATERIALS AND METHODS: Central hemodynamics in heart chamber probing before operation and intraoperatively were measured in 98 patients with rheumatic mitral defects (41 males, 57 females, mean age 39.5 +/- 8.74). Manometry before and after the defect correction, intraoperative catheterization (cath. Swan-Ganz) for hemodynamics 24-h follow-up were made. RESULTS: After valvular defect correction 90(91%) patients had residual pulmonary hypertension, stage II-III in 41%. CONCLUSION: Patients operated for rheumatic heart disease complicated by pulmonary hypertension often suffer from residual pulmonary hypertension. This requires pharmacological correction.

[Program of examination for patients with isolated mitral valve defects to evaluate the degree of pulmonary hypertension]. / Programma obsledovaniia bol'nykh s izolirovannymi mitral'nymi porokami serdtsa dlia otsenki stepeni legochnoi gipertenzii.

98 patients with isolated rheumatic mitral valve defects of the heart entered the study. Their central hemodynamics was studied intraoperatively before surgical correction of the defect. The results were compared to those provided by conventional noninvasive methods: chest x-ray, ECG, echo-CG, external respiration function test. Correlation analysis using computer intellect PolyAnalyst v.1.01R helped to design a program and practical nomogram which can quantitatively determine the degree of pulmonary hypertension on the basis of digital values of Rv1 wave amplitude (ECG) and right ventricular cavity size (echoCG).

[Primary tumors of heart]. / Pervichnye opukholi serdtsa.

The analysis of 36 years' experience in surgical treatment of 162 patients with benign and malignant primary tumors of the heart, verified by morphological examination, is presented. The possibility of their timely and intra vital revealing is noted in cases of clinical alertness which makes possible to suspect this disease and purposefully examine these patients using preferably echocardiography and computed tomography. The scope of the operations and their success depend on morphological characteristics of the tumors and the extent of neoplastic process. However, by now short- and long-term results of surgical treatment evidence, that predominant part of this category of patients is potentially curable, provided that these neoplasms of the heart were revealed at an initial stage.

[Diagnostic and prognostic aspects of myxoma syndrome]. / Diagnosticheskie i prognosticheskie aspekty miksomnogo sindroma.

The analysis is presented of clinicomorphological and laboratory characteristics of myxoma syndrome which are of prognostic value. Early diagnosis of the syndrome is essential in making decision on the intraoperative and long-term postoperative treatment policy.

[Reoperations for recurrent atrial septal defect]. / Povtornye operatsii pri vtorichnom defekte mezhpredserdnoi peregorodki.

The authors discuss seven cases of recurrent atrial septal defect (ASD) without an inferior border which were treated by surgery. A typical clinical picture of the anomaly with arterial hypoxemia being the leading symptom was encountered in all cases. The main cause of the complications was overestimation of the indications for Lewis' operation, i.e. ASD suturation. A good clinical result was produced in all cases of a repeated intervention with ASD repair with a graft.

[Blood vessels of the myocardial microcirculatory bed after radical correction of tetralogy of Fallot]. / Sosudy mikrotsirkuliatornogo rusla miokarda pri radikal'noi korrektsii tetrady Fallo.

The intraoperative right ventricular myocardial biopsy specimens taken from 54 patients during radical correction of Fallot's tetrad were used to examine the microcirculatory vessels during combined pharmacological ice-chip cardioplegia (PICC) and reperfusion. The combined PICC was shown to fail to exclude myocardial microcirculatory vessel lesions, namely: ultrastructural evidence for edema and destructive changes in the membrane structures of endothelial cells, expanded interendothelial contacts, basal membrane stratification. The lesions were more marked in patients with cyanotic heart disease in cardioplegia lasting more than 65 min. Coronary blood flow recovery was accompanied by evolving endotheliocytic cytoplasmic edema, phenomena of microclasmatosis, microvascular obstruction with cell fragments and membrane structures. This impaired microcirculation, promoted interstitial edema and dystrophic cardiomyocytic changes and might be followed by acute heart failure in the postoperative period.

[Evaluation of late results of radical correction of tetralogy of Fallot based on treadmill test]. / Otsenka otdalennykh rezul'tatov radikal'noi korrektsii tetrady Fallo po dannym

The treadmill test was conducted, according to an elaborated program for evaluating insufficient pumping function of the left/right heart and the threshold of +lactic acidosis decompensation, in 53 patients before and in 86 patients after radical correction of Fallot's tetralogy. Insufficiency of left-heart pumping functions occurred after the operation significantly less frequently in patients with a monocuspic graft (14 +/- 7%; M +/- m) and more frequently in suture plastics (54 +/- 14%). A similar tendency was also authentic for right-ventricular ejection and decompensation of acidosis load. It was proved that patients with a monocusp are distinguished by higher and most stable results for a period of 5 years after the correction. Lower results were characteristic of transannular plastics and of patients who were operated on through a longitudinal approach; the lowest results occurred in suture plastics through a transverse approach. It was found that ++re-shunting of the ventricular septal defect levels the results of the various types of correction of the anomaly. It is shown that the criteria of insufficiency of the heart pumping function may be used in the diagnosis of latent stenoses and regurgitations of the infundibulum of the heart and the pulmonary artery whose functional significance is revealed only during a load.

[Familial myxomas of the heart]. / O semeinykh miksomakh serdtsa.

An analysis has been made of the clinical, diagnostic, surgical and morphological aspects of familial cardiac myxomas, potentialities of their intravital diagnosis and prevention. No morphological differences were established between familial and sporadic cases of cardiac myxoma.

[Surgical aspects of radical correction of tetralogy of Fallot]. / Khirurgicheskie aspekty radikal'noi korrektsii tetrady Fallo.

The article deals with the analysis of variant anatomy of Fallot's tetralogy due to hypoplasia of the pulmonary trunk on basis of morphometric and intraoperative examination of 141 patients 4 to 43 years of age (15.3 +/- 3.26) who underwent radical correction of the anomaly; 48 (34%) of these patients were operated on after various palliative operations. On grounds of detailed study of the variants of the relations of anomalies of the cardiac anatomical structures in Fallot's tetralogy the authors elaborated operative proceedings by means of which mortality after radical correction fell to 6.5%.

[Predicting the volume and hemodynamic outcome of radical correction of tetralogy of Fallot on the basis of angio- morphometry]. / Prognozirovanie ob''ema i gemodinamicheskikh rezul'tatov radikal'noi korrektsii tetrady Fallo po dannym angiomorfometrii.

Using the findings from angiographic examination of 91 patients with Fallot's tetrad, the authors developed an angiomorphometric protocol which may predict the feasibility of radical correction of the defect prior to an operation and hemodynamic parameters in the immediate postoperative period, peak right/left ventricular systolic pressure ratios, in particular. The reasons for discrepancy of estimated and measured right/left ventricular systolic pressure ratios were defined and their time course was followed up 12 hours after radical Fallot's tetrad correction in relation to the type of plastic operations.

[Diagnosis and surgical treatment of traumatic damage to the sinus of Valsalva following penetrating wounds of the heart]. / Diagnostika i khirurgicheskoe lechenie travmaticheskogo povrezhdeniia sinusov Val'sal'vy posle pronikaiushchikh ranenii serdtsa.

The authors had three patients with traumatic damage of the sinus of Valsalva, caused by penetrating injury of the thorax inflicted with a knife. The patients were brought to the clinic in a grave condition with decompensation of systemic and pulmonary circulation. The anomaly called for emergency surgical correction under conditions of extracorporeal circulation. The diagnosis was based on the complaints, medical history, clinical picture, the results of functional methods of examination including echocardiography and catheterization with angiocardiography. The operations consisted in total correction of the heart anomaly. The immediate and late-term results were good.

[Ultrasonic diagnosis of congenital membraneous subvalvular aortic stenosis]. / Ul'trazvukovaia diagnostika vrozhdennogo membranoznogo podklapannogo stenoza ust'ia aorty.

The paper reviews a 10-year experience with complex ultrasonic diagnosis of membraneous subvalvular aortic stenosis, a rare congenital defect. Fifteen subjects operated on for this abnormality were examined. Profound systolic closure of the aortic cusps, concentrated left ventricular myocardial hypertrophy, linear-shaped echo signals generated by the membrane in the subaortic area, turbulent systolic blood flow in the ascending aorta are the most significant signs for the diagnosis of the membraneous subvalvular aortic stenosis.

[Treadmill test in objective evaluation of late results of radical correction of tetralogy of Fallot]. / Tredmil-test v ob''ektivnoi otsenke otdalennykh rezul'tatov radikal'noi korrektsii tetrady Fallo.

The many-stage treadmill test was carried out according to a worked-out program in 41 patients before and in 55 patients after radical correction of Fallot's tetrad (40 healthy individuals were the controls). The pump function of the heart (oxygen debt dynamics), the anaerobic threshold (complex of gas analytical indices), and the efficacy of blood flow in lesser circulation (O2 consumption plateau) were appraised. The results proved to be best according to all criteria in patients with trans-annuloplasty of the conus arteriosus and pulmonary trunk with the use of a monocusp graft, and poorest in patients who were operated on through a transverse approach. This regularity was also encountered in 31 patients who were studied in follow-up periods of 3 years after the operation.

[Comparison of the characteristics of myocardial function and metabolism in patients with tetralogy of Fallot]. / Sopostavlenie kharakteristik funktsii i metabolizma miokarda u bol'nykh s tetradoi Fallo.

The authors studied the results of examination of the myocardium in patients with Fallot's tetralogy by means of two methods during radical correction of the congenital anomaly: invasive intraoperative myocardiography and appraisal of myocardial metabolism. High probability of the detection of dysfunction of the myocardium and disorders of of oxygen-dependent metabolic processes in it were revealed. A conclusion is drawn on the expediency of using invasive intraoperative myocardiography as a method of functional diagnosis in surgery of congenital heart diseases for appraising the condition of the myocardium.

[Quantitative assessment of hemodynamics function in treadmill test in patients after radical correction of Fallot's tetrad]. / Kolichestvennaia otsenka funktsii gemodinamiki v tredmil-teste u bol'nykh posle radikal'noi korrektsii tetrady Fallo.

Long-term examination findings in 78 patients after radical correction of Fallot's tetralogy and preoperative assessment of the circulatory status in 68 patients using treadmill test are analysed. The quantitative estimates of circulatory defects at different levels at later postoperative terms (from 6 months to 6 years) depended on the type of plastic surgery of the outflow part of the right ventricle and pulmonary trunk: suture plasty, right ventricular outflow plasty with a xeno-pericardial flap, and transannular plasty with the use of a mono-septal xeno-pericardial graft. Preoperatively, 59.0 per cent patients were attributed to functional class IV and 41.0 per cent patients to class III. After the radical tetralogy correction, most patients (55.0 per cent) were related to the functional class I. The advantages of using mono-septal xeno-pericardial grafts for plastic surgery of the right ventricular outflow and pulmonary trunk are demonstrated.

[The first experience with clinical use of monocuspid xenopericardial transplants]. / Pervyi opyt klinicheskogo primeneniia monostvorchatykh kseno- perikardial'nykh transplantatov.

The article discusses experience in radical correction of Fallot's tetrad with hypoplasia of the pulmonary trunk in 43 patients by means of plastics with monocuspid xenopericardial grafts (MXG). Their processing was based on enzymatic chemical treatment of the xenopericardium. The function of the MXG was evaluated with quantitative registration of regurgitation by the method of dilution of electroimpedence indicators. Mortality in the group of patients with MXG was 8.0%, which did not differ from that in the group of patients with satisfactorily developed pulmonary trunk and its branches, and characterized the promising character of the use of this method of pulmonary trunk plastics.

[Atrioplasty in surgical correction of mitral valve defect complicated by left-sided atriomegaly]. / Atrioplastika pri khirurgicheskoi korrektsii mitral'nogo poroka, oslozhnennogo levoi atriomegaliei.

Surgical treatment of 40 patients with mitral valvular diseases and left atriomegaly is analysed. The dimensions of the giant left atrium in this group of patients must be reduced because it causes compression of the posterobasal part of the left ventricle, constriction of the lumen of the left main bronchus or compression of the inferior and middle lobes of the right lung. Left atrioplasty has a favorable effect on the course of the immediate postoperative period and reduces significantly hospital mortality among this grave contingent of patients.

[Cardio-hemodynamics in patients with Fallot's tetrad during operative and early postoperative period]. / Kardiogemodinamika u bol'nykh s tetradoi Fallo v operatsionnom i rannem posleoperatsionnom periodakh.

Studies of hemodynamics in 22 patients with Fallot's tetrade in the operative and early post-operative periods were analysed. The stroke and cardiac output were studied in all patients as well as the pressure in the cavities of the heart with subsequent calculation of coefficients PRV/PLV, PPA/PRV, and P.P-Q diagrams were constructed to characterize the pathophysiological processes in the heart ventricles. Correction of the anomaly was considered adequate in PRV/PLV less than or equal to 0.6. Coefficient PRV/PLV greater than 0.6 calls for additional analysis for the purpose of identifying residual stenosis or blood dumping at the level of the interventricular septum.