[Surgical tactics in patients with ischemic heart disease, extensive cicatricial myocardial lesions and circulatory insufficiency]. / Khirurgicheskaia taktika u bol'nykh ishemicheskoi bolezn'iu serdtsa s obshirnymi rubtsovymi porazheniiami miokarda i nedostatochnost'iu krovoobrashcheniia.

The article discusses the results of surgical treatment of patients suffering from ischemic heart disease with extensive cicatricial affections of the myocardium and circulatory insufficiency. Thirteen patients of group I were treated by various reconstructive operations (resection of an aneurysm, formation of an aortocoronary shunt, septoplasty), 10 patients of group 2 underwent orthotopic heart transplantation. Perioperative and long-term (up to 3 years) mortality rates were, respectively, 7.6 and 8% in group I and, respectively, 30% and zero in group 2. The unfavorable prognosis of survival and medicamentous therapy in such patients, the lack of donors, and the acceptable results of reconstructive operations are evidence that they should be undertaken whenever possible. The main criteria of the selection of patients for a reconstructive operation are the values of regional contractility of the left ventricle, the severity of the dystrophic processes in the preserved segments, and the condition of the coronary arteries.

[Heart transplantation. The current problems of patient selection, examination and treatment]. / Transplantatsiia serdtsa. Aktual'nye voprosy otbora, obsledovaniia i lecheniia bol'nykh.

An analysis was made of the work carried out by the Department of Coronary Surgery and Heart Transplantation as regards heart transplantations during 1988. As many as 119 patients, hypothetical heart recipients, received medical advice. The Department refused hospitalization to 42 patients because of the nonconformity to the indications and contraindications to heart transplantation. 77 patients were admitted to the Department. During examinations and treatment, 53 persons were discharged from hospital. 8 patients died before donor's hearts were received. Donor's hearts were transplanted to 10 patients. 3 persons died from severe infectious complications on days 12, 15 and 43 after the operation. Following the operation 7 patients have been surviving from 4 to 17 months. The patients' status remains satisfactory. The functional parameters of the donor's heart are within normal. Taking into consideration the lack of the treatment methods for patients with terminal heart lesions, it is necessary that the number of operations be increased. A great importance in this case is attached to the joint efforts of internists and cardiologists, aimed at the screening and examination of potential heart recipients.

[Changes in the contractile function of the myocardium in various methods of excluding the heart from the circulation during the surgical correction of acquired heart defects]. / Izmeneniia sokratitel'noi funktsii miokarda pri razlichnykh sposobakh vykliucheniia serdtsa iz krovoobrashcheniia vo vremia khirurgicheskoi korrektsii priobretennykh porokov serdtsa.

Changes in myocardial contractile function were studied during 46 operations with extracorporeal circulation on patients with acquired heart diseases; the operations were performed with the use of cold cardioplegia and electrical fibrillation of the heart. The dependence of the decrease in myocardial contractilicy on the method of cardioplegia, the duration of the heart arrest, and the parameters of extracorporeal circulation is analysed. The results obtained are evidence that it is necessary to improve the method for protecting the myocardium during operations with extracorpeal circulation.