[Cardiorespiratory exercise tolerance tests: a preoperative surgical risks assessment in elderly patients].

This study focuses on the most topical issue: non-cardiac surgery safety in elderly patients. According to different authors data, the mortality rate due to cardiovascular pathology %, and postoperative cardiac events incidence -from 2 to 4.4 %. For this reason we decided to conduct prospective risk assessment in the most dificult elderly patients group. Within the framework of this study we performed cardiorespiratory exercise testing (KAREN-test) in 17 elderly patients with various located colon cancer Concomitant diseases were: ischemic heart disease (12 patients), postinfarction cardiosclerosis (4 patients), arterial hypertension (12 patients), rhythm disturbances of varying degrees (11 patients), CHF (2 patients), and others. Patients were aged from 58 to 94 years. Subsequently, 14 of 17 patients were operated on, 11 of them underwent radical intervention. Cardiorespiratory exercise tolerance test was carried out according to moderate treadmill-test protocol for elderly patients developed in our clinic. Test duration was more than 4 minutes in all patients. During exercise stress peak, submaximal heart rate was observed in all patients, the peak oxygen consumption to a maximum current oxygen consumption ratio amounted to 94% on the average in a group, the oxygen consumption at the aerobic threshold level exceeded 11 mI/min/kg in all patients. There was no acute myocardial infarction and cerebrovascular events during perioperative period; the hospital mortality rate was 0%. Actual age by itself is not a contraindication for surgery. KAREN tests should become one of the key components for the assessment and treatment tactics choice.

[Valve-preserving reconstructive surgical procedures on pulmonary artery root in Fallot's tetralogy].

Original surgical method of dilated valvuloplasty is described. In moderate isolated hypoplasia of the fibrous ring of the pulmonary artery this method permits one to perform organ-preserving reconstruction of this zone without transannular plastic operation. Schemes of the surgery, experimental data and clinical experience based on surgical treatment of 31 patients with Fallot's tetrad in combination with hypoplasia of the fibrous ring of the pulmonary artery are presented. Short- and long-term results of the defect correction are reported.

[Double disposition of the major vessels from the right ventricle of the Fallot tetralogy type]. / Dvoinoe otkhozhdenie magistral'nykh sosudov ot pravogo zheludochka po tipu tetrady Fallot.

Forty-six patients with double disposition of the major vessels from the right ventricle in combination with stenosis of the pulmonary artery, in sub-aortal and bi-committed defects of the interventricular septum have undergone biventricular intraventricular correction. The most specific and accurate anatomic characteristics were: 1) position of the major vessels (particularly side-to-side); 2) location of two and a part of the third aortal sinuses above the right ventricle; 3) bilateral cone; 4) absence of aorto-mitral contact; 5) location of valves of aorta and pulmonary artery on the same level. One (2,2%) patient died during surgery due to progressed cardiac insufficiency. One (2,5%) patient died 2 years after radical correction of the defect due to progressive dysfunction of the right ventricle.

[Short and long-term results of surgical correction of the aortal valve dysplasia]. / Blizhaishie i otdalennye rezul'taty khirurgicheskoi korrektsii displazii aortal'nogo klapana.

Nearest and long-term results of surgical treatment of 108 patients with dysplasia of aortal valve were analyzed. Necessity of individual approach to choice of method of surgical correction (prosthesis or valvuloplasty of aortal valve) depending on degree of dysplasia and/or secondary valvular pathology, it anatomic variants, presence of concomitant infectious endocarditis and age of patients is noted. This permitted to reduce hospital lethality from 8.8 to 3.9%. Survival in 1, 5 and 10 years after prosthesis and valvuloplasty of aortal valve was 92.3 +/- 3.3, 86.8 +/- 4.8 and 85.7 +/- 5.7% versus 100, 94.1 +/- 4.1, 94.1 +/- 4.1% respectively. Quality life in remote period was evaluated as good in 80.3% operated patients, as satisfactory--in 11.1% and unsatisfactory--in 8.6%.

[Enalapril treatment of residual pulmonary hypertension in patients operated rheumatic mitral valve defects]. / Lechenie rezidual'noi legochnoi gipertenzii énalaprilom u bol'nykh, operirovannykh po povodu revmaticheskikh mitral'nykh porokov serdtsa.

A pilot trial of efficiency of enalapril maleate in the treatment of residual pulmonary hypertension was made in 22 patients operated for rheumatic mitral valve defects. Degree I, II and III of pulmonary hypertension was registered in 5, 13 and 4 patients, respectively. Thus, the patients had NYHA functional classes III and IV (22.7 and 77.3%, respectively. Enalapril given for 6 months in a mean daily dose 12.3 +/- 1.57 mg/m2 (5-30 mg a day) normalized pressure in the pulmonary artery in 18.2% of patients. 50% of patients showed hypertension degree I, only one female retained hypertension degree III. To the end of the treatment the functional classes were the following: II--in 68.2%, III--in 27.3% and IV--in 4.5%.

[The clinico-functional assessment and work capacity of patients undergoing repeated operations on the mitral valve]. / Kliniko-funktsional'naia otsenka i trudosposobnost' bol'nykh pri povtornykh operatsiiakh na mitral'nom klapane.

A complex of examinations (ECG, echocardiographic and X-ray evaluations of heart volumes and cavities, treadmill-test) was performed in 82 patients before and after reoperations on the mitral valve. The type of recorrection was found to be associated with the degree of positive dynamics of the results. The data obtained contradicted to hyperdiagnoses of primary medical-labor examination commission establishing the II group of invalidism in 86 +/- 4% (M +/- m) of the examined patients. As a result of an analysis of all the data obtained the number of such patients was reduced up to 34 +/- 5%. A new approach to solving the problem of medical-labor examination was shown to be necessary for patients reoperated for mitral disease of the heart.

[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.

[Detection and quantitative evaluation of functional disorders of the tricuspid valve during conducting of the treadmill test in patients with mitral valve defects]. / Vyiavlenie i kolichestvennaia otsenka narushenii funktsii trekh- stvorchatogo klapana pri provedenii tredmil-testa u bol'nykh mitral'nom porokom serdtsa.

A multi-stage treadmill test was performed in 80 patients with mitral valvular disease and 24 healthy subjects. In organic involvement of the tricuspid valve, there was a decrease in oxygen uptake increase to 0.36 metabolic units at Stage 3 of the proposed treadmill test protocol versus 1.02 units (p less than 0.05) in patients without this valve disease or healthy individuals. The sensitivity and specificity of the oxygen uptake stabilization as a diagnostic sign accounted for 75% and 91%, respectively. The stabilization was demonstrated to reflect pulmonary effective oxygenized blood flow derangement. It is concluded that the load leading to oxygen uptake stabilization quantitatively shows the severity of hemodynamic tricuspid valve dysfunctions.

[Prognosis of long-term results of aortic and mitral valve prosthesis by the data of treadmill test]. / Prognozirovanie otdalennykh rezul'tatov protezirovania mitral'nogo i aortral'nogo klapanov serdtsa po dannym tredmil-testa.

The treadmill test was conducted in 328 patients who underwent prosthetics of the aortic or mitral valve for rheumatic heart disease. The object of the test was evaluation of the heart pumping function according to the dynamics of the oxygen debt, pulmonary hypertension according to the pseudoanaerobic threshold, and decompensation of metabolic acidosis according to the appearance of the hypocapnic reaction. The findings were compared with the results of preoperative examination. The results of the preoperative treadmill test were found to be in accord with the probability of a positive effect of prosthetics. Depending on an increase of the critical loads level this probability rose from 2 to 87% in mitral and from 25 to 100% in aortic prosthetics. It is shown that development of lactoacidosis decompensation in addition to the heart pumping function defect significantly aggravates the late-term results of the operation.

[The diagnosis of coronary failure in patients with aortic and mitral valve defects]. / Diagnostika koronarnoi nedostatochnosti u bol'nykh s aortal'nym i mitral'nym porokami serdtsa.

The incidence of angina pectoris was investigated and the treadmill test was carried out to assess the presence of myocardial ischemia and heart pump function in 238 patients suffering from mitral and aortal heart disease. Comparison with the coronarography readings has demonstrated that the diagnostic value of the painful syndrome in the health status and anamnesis does not exceed 24%. The appearance of an angina pectoris attack in combination with ischemic alterations on the ECG raised the diagnostic value up to 50%. The authors have distinguished a symptom-complex including the development of angina pectoris, appearance of the ischemic signs on the ECG with the integrity of heart pump function, increasing the diagnostic value of the test up to 83-100%. The integrity or insufficiency of heart pump function were shown to allow differentiation between atherosclerotic and relative coronary insufficiency. The conclusion is drawn about the necessity of carrying out the treadmill test according to the program in patients suffering from heart disease with suspected coronary insufficiency.

[Assessment of central hemodynamics by pump function and sizes of heart chambers in cardiac surgery patients]. / Otsenka tsentral'noi gemodinamiki po nasosnoi funktsii i razmeram polostei serdtsa u kardiokhirurgicheskikh bol'nykh.

In 198 cardiosurgical patients the treadmill test was performed with the noninvasive evaluation of the pump function of the heart and anaerobic threshold. The results were compared with echocardiographic sizes of the left atrium (LA), systolic and diastolic sizes of the left ventricle (CLV and DLV). It was shown that in patients with mitral stenosis the pump function of the heart reliably corresponded to the size of the LA, in mitral regurgitation--O of the DLV, in aortal defects--that of the CLV and DLV. After isolated prosthezing of the heart valves the correlation found was not retained. It was proved that the maximum consumption of O2 did not reliably correlate with LA, CLV and DLV.

[Clinical significance of functional classification of hemodynamic disorders in cardiac surgical patients with heart defects]. / Klinicheskoe znachenie funktsional'nykh klassifikatsii narushenii gemodinamiki u kardiokhirurgicheskikh bol'nykh porokami serdtsa.

A multistage treadmill test was conducted according to a developed program of noninvasive appraisal of heart pumping function in 128 patients with rheumatic mitral or aortic valvular diseases before and in 95 patients 1-3 yours after prosthesis of the heart valves. It is proved that functional classifications employing maximum load indices reflect central hemodynamics less adequately than does noninvasive appraisal of the heart pumping function, particularly before operation in seriously ill patients. It is shown that on the basis of classifications according to the O2-debt dynamics, in distinction from maximum O2 consumption, the course of the immediate postoperative period and the late-term results of the operation can be predicted and the initial signs of the dysfunctions of the heart valve prosthesis revealed.

[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.