[Factors determining the functional state of regulatory systems in athletes after return from altitude conditions].

We have studied a group of athletes who compete in speedpower disciplines. The athletes spent a period of time at the altitude of 2100 meters and the state of their regulatory systems was measured on their return to normal conditions. We have shown that training at the altitude improves the functional state, shifts the vegetative balance towards the prevalence of vagus influences, and improves stamina. The positive effects remain as long as 25-26 days after return from the altitude. At the same time for sportsmen after training at the level of sea in a state of relative rest and central and sympathetic influences prevail at the functional loading. In addition, the factor of the unstable states also begins to play a certain role forming of reaction of organism on loading.

[Surgical treatment of Taussig-Bing anomaly in children in the first year of life].

The history of surgical treatment, clinical features, and main variants of correction of Taussig-Bing anomaly in children during the first year of life is briefly reviewed including original data obtained in the Department of Urgent Surgery of newborn and first-year infants, A. N. Bakulev Research Centre of Cardiovascular Surgery for the period of 2000-2006.

[Diagnostic algorithms and features of clinical course of congenital heart diseases in infants with lung anomalies].

The paper discusses the influence of lung anomalies on the progress of congenital heart diseases (CHD) in infants, as well as diagnostic value of radiography and ultraspeed computed tomography (CT). The four-year experience of the authors includes preoperative examination of 178 infants with CHD (mean age 5.8 +/- 0.6 months, mean weight 5.2 +/- 0.3 kg). Lung anomalies were determined in 24 patients (13.5%) on plain films and in 85 patients (47.8%)--by means of CT. The stenosis of main bronchi in combination with lobar emphysema and lung hypoplasia were found to be the most frequent and severe predictors of respiratory disorders. The obtained data suggest that CT examination may be recommended in infants with CHD for precise diagnostics of associated lung anomalies and further prevention or early management of respiratory complications.

[Urgent surgical correction of ventricular septal defects in children of first months of life].

The article presents the results of urgent surgical correction of ventricular septal defects (VSDs) and a range of associated congenital heart diseases (CHDs) in 123 children of the first 6 months of life, hospitalized between 1988 and 2002 in a severe or critical condition. In 102 patients the progression of clinical symptoms was caused by a big single VSD and in 21 patients--by multiple VSDs. 70 patients had significant associated CHDs. Significant extracardiac anomalies were revealed in 75 patients. The condition of 55.3% of children had deteriorated due to pneumonia. Correction of defects with cardiopulmonary bypass was performed after urgent examination and intensive therapy. Hemodynamically significant VSD were closed in 117 (95.2%) patients. Two patients were reoperatied due to the presence of residual VSD. Partial or full simultaneous correction of associated CHDs was performed in 68 patients. 93.5% of patients with isolated VSDs survived the operation. The survival rate of patients with associated CHDs and extracardiac anomalies was 81.5%. Postoperative mortality risk factors were found to be critical condition at hospitalization and preoperative activity of infectious process (P < 0.01 and < 0.05, respectively). Accumulation of experience and introduction of a special approach allowed an 8-time decrease of the hospital mortality, which has not exceeded 3.4% within last 3 years. Good and excellent follow-up results were obtained in 98% of the survived patients within 10 to 67 months after operation. Precise diagnostics of associated CHDs and extracardiac anomalies, intensive preoperative treatment and weighed estimation of indications and risk factors allow significant improvement in the results of primary correction of VSD and accompanying cardiovascular anomalies in children of the first months of life in a heavy and critical condition upon admission.

[Peritoneal dialysis in the newborn and infants after radical correction of complex congenital heart defects]. / Peritoneal'nyi dializ u novorozhdennykh i grudnykh detei posle radikal'noi korrektsii slozhnykh vrozhdennykh porokov serdtsa.

The efficiency of peritoneal dialysis (PD) was evaluated in newborns and infants with multiple organ dysfunction (MOD) after cardiosurgery. In 1996-2001 at A. N. Bakulev Cardiovascular Surgery Center, Russian Academy of Medical Sciences, PD was used as permanent renal replacement therapy (RRT) in 19 newborns and infants aged under 1 year after radical correction of congenital heart diseases. The mean age of infants was 6.2 +/- 4.3 months, body weight 6.1 +/- 1.7 kg. Radical correction of congenital heart diseases was carried out in all patients. The immediate postoperative period was complicated by MOD in all patients. Pronounced cardiac, respiratory, and renal insufficiency was observed in all cases. The main indication for the beginning of PD was oligouria, hypervolemia, edematous syndrome with progressive cardiorespiratory insufficiency. Multiple-modality intensive care including PD resulted in positive changes in the clinical status of infants by days 4-5 of PD: hemodynamic values, gaseous exchange function of the lungs, and laboratory values improved. Hence, PD as an RRT method in newborns and infants subjected to radical cardiosurgery proved to be effective in the complex of intensive care measures for MOD. This sufficiently simple method, requiring no expensive equipment, adequately corrects hyperhydration and hypervolemia, metabolic and electrolyte disorders, and other MOD symptoms in newborns and infants.

[Morphofunctional analysis of right ventricle cardiomyocytes in patients with Fallot's tetrad during first year of life]. / Morfofunktsional'nyi analiz sostoianiia kardiomiotsitov pravogo zheludochka bol'nykh s tetradoi Fallo pervogo goda zhizni.

Material of intrasurgical biopsies of the right ventricular (RV) myocardium of 28 patients with Fallot's tetrad was studied with light and electron microscopy. RV cardiomyocytes were hypertrophic and showed signs of growth and differentiation. Myofibrillogenesis intensity directly correlated with the pressure gradient between RV and pulmonary artery. At the same time there was a structural alteration of mitochondria and formation of a specialized population of intermyofibrillar mitochondria. Continuing myofibrillogenesis in cardiomyocytes may be one of the causes of decreased myocardial contractility.

[The use of modified ultrafiltration in correcting complex congenital heart defects in newborn and nursing infants]. / Primenenie modifitsirovannoi ul'trafil'tratsii pri korrektsii slozhnykh vrozhdennykh porokov serdtsa u novorozhdennykh i grudnykh detei.

Modified ultrafiltration (MUF) was used in radical correction of complex congenital heart disease in 61 newborns and infants. The children were divided into 2 groups: group 1, 46 patients subjected to MUF, and group 2, 15 children operated on without MUF. Hemodynamic, hematological, biochemical, and immunological parameters were monitored. MUF in the newborns and infants helped adequately correct the hemohydrobalance due to ultrafiltration in the patient and hemoconcentration of the remaining volume in artificial ventilation device; it normalized the hematocrit values without additional infusion of donor blood. Elimination of inflammation mediators and cytokines recommends MUF for the treatment of newborns and infants.

[Catheter therapy of congenital cardiovascular defects]. / Kateternaia terapiia vrozhdennykh porokov serdtsa i sosudov.

The authors analyze the experience gained in catheter operations performed at their Department over the recent 28 years. A total of 500 balloon (Rashkind) and 35 knife (Park) atrioseptostomies were performed in critical patients with different "blue" congenital diseases over this period. An immediate hemodynamic effect at the operation table was attained in 95% of patients. Transluminal balloon valvuloplasty (TLBVP) was performed in 372 patients with valvular stenosis of the pulmonary artery. The results of this operation depend on the patient's age, anatomy of the defect, and correct choice of the diameter of balloon catheter. This intervention is particularly effective in patients aged under 1. In patients with combined valvular and infundibular stenosis the results of TLBVP depend on the severity of stenosis and age of patient. An attempt at TLBVP of congenital aortal stenosis was undertaken in 67 patients. Valvuloplasty was carried out in 57 patients. The operation was effective in 13 (62%) out of 21 patients aged under 1. The mortality in this group was 5.5%. Balloon valvuloplasty of the pulmonary artery was carried out in 71 patients with cyanotic congenital heart diseases. The intervention helped eliminate the critical state, rise the systolic pressure in the pulmonary artery, improve blood saturation with oxygen, and evade the operation for creation of a systemic-pulmonary anastomosis. Isolated and postoperative stenoses of pulmonary arteries were removed in 65 patients. Six Johnson and Johnson stents were effectively implanted to 3 patients with rigid postoperative stenoses; in 32 patients transluminal balloon angioplasty (TLBAP) for coarctation and recoarctation of the aorta brought about a satisfactory immediate hemodynamic effect. TLBAP of Blalock-Taussig's stenosed anastomosis were performed in 60 patients with various cyanotic congenital heart diseases. Its results were good in 39 (65%) patients, satisfactory in 19 (31.7%), and unsatisfactory in only 2 (3%) cases. Of the novel endocardial interventions, dilatation of the conduit following Rastrelli's operation, creation of a defect of the atrial septum after Fontain's operation, and embolization of the coronary-cardiac fistulas and of patent ductus arteriosus were carried out. This review demonstrates wide use of endocardial surgery methods in the treatment of some congenital heart diseases; in many cases such treatment may be an alternative to surgical interventions.

[Anatomic correction of transposition of the great arteries in infants:experience of the first 10 operations]. / Anatomicheskaia korrektsiia transpozitsii magistral'nykh arterii u grudnykh detei: opyt pervykh 10 operatsii.

In the period March 1992 to January 1993, ten patients with transposition of great arteries (TGV) whose age ranged from 9 days to 8 months and body weight 3.2 to 7.2 kg were operated on using the arterial switch. A single-stage anatomic correction was made in 2 patients with patent arterial duct, 4 with ventricular septal defect (VSD), one with multiple VSD. Three patients with common TGA underwent correction in 2 stages: arterial switch followed prior constriction of the pulmonary artery switch followed prior constriction of the pulmonary artery and subclavian-pulmonary anastomosis. In all cases of single VSD, it was closed with a flap made from the Gore-Tex material. In the whole series of operations, 2 patients died: one being on the operating table due to anesthesiological errors, the other due to coronary blood flow disorder 3 hours after surgery. Six of the 8 discharged patients were followed 3-8 months after surgery. Two patients needed digitalis. No sign of myocardial ischemia was detected in antibody. All the patients were found to have normal left ventricular pump function. These surgeries are the first in our country and so our little experience may be of interest for national specialists.

[Disorders of cardiac rhythm and conductivity after radical correction of tetralogy of Fallot in young children]. / Narusheniia serdechnogo ritma i provodimosti posle radikal'noi korrektsii tetrady Fallo u detei rannego vozrasta.

Analysis of electrocardiograms in 55 children who underwent operation for Fallot's tetralogy at early age showed that the frequency and severity of postoperative disorders of rhythm and conductivity were determined by the degree of trauma inflicted by the used surgical techniques. Data obtained in the early and late-term postoperative periods confirm the expediency of performing surgical correction of the anomaly as early as possible by means of surgical methods which cause little injury. The results of the study are recommended for use in choosing the surgical tactics, for functional appraisal of the operative results.

[The late sequelae of the systematic action of a complex of real diving factors on the pulmonary ventilatory function of deep-sea divers]. / Otdalennye posledstviia sistematicheskgo deistviia kompleksa faktorov real'nykh pogruzhenii na ventiliatornuiu funktsiiiu legkikh vodolazov-glubokovodnikov.

Parameters which characterize lung volumes, absolute and relative flow rates, breathing reserve, were found unchanged with increasing age and record of active dive service, and in some deep-divers these parameters were growing up. This was disclosed due to comparative analysis of lung ventilatory function changes in divers through certain amount of years of professional occupation. At the same time a significant decrease in small to middle calibre bronchi patency was noted. In 30% of experienced deep-divers the mean maximal forced expiratory flow at 75% forced vital capacity (FEF75) decreased to 39% of predicted value at one-second forced expiratory volume (FEV1) being normal. Maximal expiratory flow at 50% forced vital capacity (FEF50) were in inferior normal limit (52% of predicted value).

[The readaptation of the respiration, blood circulation and body oxygen regimen in aquanauts after saturation dives to depths of up to 450 m]. / Readaptatsiia dykhaniia, krovoobrashcheniia i kislorodnogo rezhima organizma akvanavtov posle saturatsionnykh pogruzhenii na glubiny do 450 m.

Main trace posthyperbaric and postdecompression responses to respiration, circulation and oxygen profiles, dynamics of their reduction in 99 aquanauts at pressure of 46 kgs/cm2 (0.46 mPa) during 14-30 day period have been studied. The respiratory changes were found to be characterized by: ventilatory function disorders which followed the obstructive-restrictive pattern; discoordination of ventilation regulation and slowing down of respiratory gas transport through aerohematic barrier. The hemodynamic shifts have been manifested as cardiac rhythm instability, heart pump function followed by decreased cardiac contractions on exercise exposures. The economy and efficiency of body oxygen profiles in a respiration loop become lower than that in hemodynamic loop. The rate of the alveolar oxygen supply is decreased to the levels lower than the rates of oxygen supply by arterial and mixed venous blood. The long-term functional rearrangement of respiratory gas transport followed by the phase changes combined with the specific and nonspecific reactions persisting over a period of 30-60 days and more longer after decompression, is existed.

[The results of the surgical treatment of aortic coarctation in nursing infants with a sharp decrease in left ventricular pumping function]. / Rezul'taty khirurgicheskogo lecheniia koarktatsii aorty u grudnykh detei s rezkim snizheniem nasosnoi funktsii levogo zheludochka.

Two-dimensional echocardiography was conducted in 24 patients, aged from 14 days to 12 months, suffering from coarctation of the aorta (CA) with the left ventricular (LV) ejection fraction (EF) less than 30%. The symptom of LV fibroelastosis was found in only 16.7% of patients. In the first 7 days after correction of CA the LV end-systolic volume reduced by 20% and the EF increased by 1.5 times, which may be explained by removal of LV post-loading. The values of the LV pumping function improved in the late periods due to restoration of myocardial contractility. In infants operated on in the first 3 months of life the dynamics was more favorable, the EF reached 68 +/- 3.8% while in those operated on after the age of 3 months it reached only 50.8 +/- 2.5% (p < 0.05). The authors discuss problems of compensatory hypertrophy and myocardial contractile capacity as the main mechanisms responsible for LV pumping function in CA.

[The use of polytetrafluoroethylene vascular prostheses (Gore-Tex) for subclavian-pulmonary anastomosis in children with tetralogy of Fallot]. / Primenenie sosudistykh protezov iz politetrafliuoroétilena (Gore-Tex) dlia podkliuchichno-legochnogo anastomoza u detei s tetradoi Fallo.

The paper provides the results of a modified subclavian pulmonary anastomosis by employing Gore-Tex vascular prostheses in 91 babies with Fallot's tetrad whose age was 10 days to 32 months and weight was 3.6 to 15 kg. In 89 patients, the operation was performed by using a prosthesis, 4-6 mm in diameter, without crossing the subclavian artery, whereas in 2 patients, this was done by lengthening the crossed short subclavian artery. In the early postoperative period, 2 (2.2%) patients died, anastomosis thrombosis requiring a reoperation, occurred in 3 (3.3%) patients; other non-fatal complications were observed in 8 (8.8%) patients. A clear-cut effect of the operation was seen in all patients. SaO2 rose from 54 +/- 18 to 80.0 +/- 8%. In the long-term (6-60 months) postoperative periods, a total of 77 patients were examined: anastomosis function proved to be impaired in 4 (5.2%), all the vascular prostheses, 6 mm in diameter, were patent up to 60 months of surgery. The thrombosis probability for anastomosis, 5 mm in diameter, was 5% during 12 months of operation and 16% during 24-60 months. Three patients needed therapeutical management of heart failure. Other serious complications, including deformity of the pulmonary artery or upper extremity, were not found in the examinees. In the palliative treatment of Fallot's tetrad, subclavian pulmonary anastomosis via the Gore-Tex vascular prosthesis can be the method of choice in the first-year-old infants and has some substantial advantages over the classical Blelock-Taussig anastomosis.

[The treatment of critical valvular stenosis of the pulmonary artery by the balloon valvuloplasty method in patients in the first 3 years of life]. / Lechenie kriticheskogo klapannogo stenoza legochnoi arterii metodom ballonnoi val'vuloplastiki u bol'nykh pervykh 3 let zhizni.

The work generalizes the experience of the Bakulev Institute of Cardiovascular Surgery in balloon valvuloplasty of valvular pulmonary stenosis in 58 children of the first 3 years of life: 8 were 1 to 6 months of age, 10 were 7 to 12 months of age, 18 were 13 to 24 months old, and 22 were 25 to 36 months old. Cyanosis was found in 27 of them. As the result of balloon valvuloplasty, the systolic pressure gradient between the right ventricle and the pulmonary artery reduced from 114.7 +/- 12.6 to 31.4 +/- 7.2 mm Hg in children under 1 year of age, from 143 +/- 12.6 to 40.1 +/- 8.3 mm Hg in children aged from 1 to 3 years. In patients with cyanosis, saturation of arterial blood with oxygen increased to 92%. The late-term results were studied in follow-up periods of 6 to 36 months in 35 patients, by means of catheterization and angiocardiography in 15 of them. Analysis showed balloon valvuloplasty to be effective. Balloon valvuloplasty was repeated in 5 patients with critical stenosis because a hemodynamic effect was not achieved by the first dilatation.