Coronary endarterectomy during off-pump coronary artery bypass surgery.

Coronary endarterectomy (CEA) is often combined with coronary artery bypass grafting (CABG), which is performed on cardiopulmonary bypass (CPB). Recent advances in off-pump surgical technique and cardioanesthesiology, along with the increasing number of patients with high risk of CPB complications made it possible and desirable to execute CEA on a beating heart. Russian scientific literature lacks reports on these interventions. The study was aimed at evaluation of off-pump CEA feasibility and early outcomes. From 59 patients with ischemic heart disease (IHD), who underwent combined CABG and CEA, off-pump technique was used for 16 (27.1%) patients, including 12 men and 4 women, mean age 55.3 +/- 6.4. All of them had long-lasting history of IHD; 2 patients had angina CCS class II, 12--class III and 2 patents--class IV. Total number of anastomoses was 51 for 16 patients or 3.18 per patient. Open endarterectomy was used in 7 (9%) CEAs, semi-closed--in 9 (11.5%) CEAs. The technique of atherosclerotic plaque extraction, coronary artery reconstruction and bypass was similar in both groups. Complete revascularization was achieved for all patients. At discharge clinical improvement was evident in patients with functional classes 0-1. Diffuse involvement of coronary arteries is not considered to be contraindication for CABG. Simultaneous CEA with off-pump technique helps to achieve complete myocardial revascularization and good early outcomes, comparable with the results of conventional CPB-assisted procedures.

[Changes in the ultrastructure and DNA and protein content in human atrial myocytes in cardiac hyperfunction due to mitral valve defects]. / Izmeneniia ul'trastruktury, soderzhaniia DNK i belka v miotsitakh predserdiia cheloveka pri giperfunktsii serdtsa, vyzvannoi porokami mitral'nogo klapana.

Biopsies from human right auricles were obtained during open heart surgery, prior to valve replacement, from six patients (aged from 20 to 49 years) with rheumatic heart disease. DNA and the total protein contents were measured in isolated myocytes by means of the two wave-length scanning cytophotometry after the double Feulgen and Naphthol yellow S staining procedure. In all the biopsies polyploid hypertrophied myocytes predominate. The hypertrophic, nondegenerated cells and the cells with degenerative changes of varying severity (in the first place, changes of contractile apparatus and membranes) are present. The highest degree of cell ploidy occurs in patients of functional class IV according to the New York Heart Association classification, 72 to 98% of cells displaying octaploid and higher DNA values. With the increase in ploidy of myocytes in series 2c----4c----8c----16c----32c----64c the protein content increases only as 2.0----3.0----5.8----7.8----13.0----16.8. Neither direct correlation between the ploidy level and the degree of cell degeneration, no inverse correlation between the degree of degeneration and the value of ejection fraction was observed.

[The surfactant system and ultrastructure of the lungs after surgical correction of cardiac defects during extracorporeal circulation]. / Surfaktantnaia sistema i ul'trastruktura legkikh posle khirurgicheskoi korrektsii porokov serdtsa v usloviiakh iskusstvennogo krovoobrashcheniia.

Using bronchoalveolar lavage (BAL), two-dimensional thin-layer chromatography, and electron, microscopy, the surfactant system and ultrastructure of the lung were examined in 32 patients with mitral valvular disease before cardiac interventions, after closed mitral commissurotomy, and surgeries under extracorporeal circulation (EC). The magnitude of changes in the pulmonary surfactant and structure was shown to be determined by the degree of circulatory decompensation and to vary with duration of the disease. In 23.7% of the patients, there were significant changes in the pulmonary surfactant system and ultrastructure, which were characterized by phospholipid metabolic disturbances in the surfactant, destructure of osmophilic lamellated corpuscles of type II alveolocytes (AII), decrease in their relative volume, a substantial increase in the minimal BAL superficial tension, and aerohematic barrier fibrosis. Concurrent with the magnitude of morphological changes in the lung, time of EC, composition of a perfusate, the presurgical abnormality of the surfactant system is essential to the development of its postperfusion insufficiency and pulmonary dysfunction. The pulmonary ultrastructural alterations in these patients were expressed by impairment in capillary endotheliocytes, their accumulation of leucocytic aggregates, interstitial and intracellular edemas, partial alveolar collapse, destructive-and-necrotic and compensatory-and-adaptative changes in AII. The above abnormalities were seen in 27.7% of the patients operated on under EC.

[Remote results of the surgical treatment of aortic coarctation by the indirect isthmoplasty method]. / Otdalennye rezul'taty khirurgicheskogo lecheniia koarktatsii aorty metodom nepriamoi istmoplastiki.

Indirect isthmoplasty of the narrow portion of the aorta was performed in 79 patients. Immediate and nearest results have shown the effectiveness of the method in most patients. Remote results were studied in 55 patients, in 47 of them (85%) within the period of from 11 to 23 years after the operation. Unsatisfactory results were found in 28 patients (53%). In 18 patients (34%) the failure was caused by formation of an aneurysm in the site of plasty of the aorta with a synthetic flap. The frequency of the complication was found to depend on the term after surgery. In most cases (14) the aneurysms were formed because of disintegration of the suture material.