Recanalisation of occluded peripheral arteries by excimer laser.

Laser recanalisation was attempted in 24 patients with total segmental occlusions of the lower extremity arteries and the aortic arch branches. All patients were men aged 40-82 years, in 20 the lesions were caused by atherosclerosis, in three by Buerger's thromboangiitis and in one by postembolic occlusion. Angioplasty was performed using excimer lasers with a wavelength of 308 nm and with monofiber waveguides in the transcutaneous transcatheter mode. Recanalisation of the vessel throughout the length of the obliterated segment was successful in 13 out of 24 patients. In all patients with thromboangiitis, energy losses were less than in atherosclerotic occlusions and no problems were experienced in patients with severe calcification. A high percentage of failures is a result of imperfect technology and low effectiveness of control, this must be improved. The Vishnevsky Institute of Surgery in collaboration with the Institute of General Physics has been developing a method of recanalisation of occluded arteries using excimer laser radiation. This paper is a preliminary analysis of our first clinical results.

[Laser surgery in occlusive diseases of peripheral arteries]. / Lazernaia dezobliteratsiia perifericheskikh arterii pri okkliuziruiushchikh porazheniiakh.

The first experience with the use of an excimeric laser in the treatment of 24 patients with segmental occlusion of the peripheral arteries is discussed. It proved possible to recanalize the obstructed segment of the vessel for its whole distance in 13 patients. Analysis of the complications shows that further technological development of the method is necessary. Hemodynamic adequacy of restoration of the vascular lumen by laser recanalization in combination with balloon dilatation is demonstrated. Significant decrease of the risk of operative intervention, accelerated rehabilitation of patients, and an essential economical effect may be the advantages of the method.

[Changes in heart size after surgical correction of rheumatic defects complicated by cardiomegaly in reoperated patients]. / Izmenenie razmerov serdtsa posle khirurgicheskoi korrektsii revmaticheskikh porokov, oslozhnennykh kardiomegaliei, u povtorno operirovannykh bol'nykh.

Twenty-nine patients with a cardiac volume ranging from 1074 to 1596 ml/m2 and with varying left ventricular myocardial contractility abnormalities underwent surgical therapy for acquired valvular disease. The volume of the heart became normal in 16 patients with hypokinesia of one of the left ventricular walls. There was no positive changes in cardiac sizes in 12 patients with hypokinesia of one or two left ventricular walls. Only one patients with left ventricular lateral wall and apical hypokinesia had an enlarged cardiac volume following the surgery.

[Myocardial asynergy of the left ventricle in patients with aortic stenosis]. / Asinergii miokarda levogo zheludochka u bo'lnykh s stenozom us'tia aorty.

Left ventriculograms obtained from 21 patients without any intracardiac hemodynamic abnormalities were analyzed by using the correlation method. The analysis revealed three functional areas of the left ventricle and defined normal values of their systolic and diastolic pulses. Hypo- and hyperkinesia of the functional areas in the left ventricle were quantitatively determined. Left ventricular cinematics was studied in 105 patients with aortic stenosis. Most patients of them were demonstrated regional cinematic abnormalities of various genesis. Local or total hypokinesia was detected in 62 per cent; hyperkinesia of its upper areas was found in a third; 7 per cent had normal dynamics of contraction in all the functional areas. It should be taken into account heterogeneous responses of the left ventricle to systolic overload while performing all investigations and studies or making clinical and prognostic assessments.

[Debatable problems of intravascular dilatation of the brachiocephalic artery]. / Diskussionnye voprosy éndovaskuliarnoi dilatatsii brakhiotsefal'nykharterii.

Roentgen--guided endovascular dilatation (RED) was conducted in 23 patients with atherosclerotic stenoses of branches of the arch of the aorta, in 20 with stenoses of the subclavian artery, and in 3 with stenoses of the brachiocephalic trunk. Before dilatation the patients had a systolic pressure gradient of 25 to 55 mm Hg in the region of the stenosis and constriction of the arterial lumen by 40 to 80%. Systolic pressure gradient disappeared completely in 17 cases and persisted at a level of 10 to 40 mm Hg in 7 cases. During RED of the left subclavian artery a complication, acute thrombosis of the distal part of the artery, occurred in one case. Indications for dilatation of stenosed subclavian arteries were elaborated on the basis of the accumulated experience.