[Electrocardiotherapy using pericardoscopy].

The standard transvenous electrocardiostimulation (ECS) is currently used in many specialized hospitals. The authors offered and launched systematic application of simple but available technique of epymiocardiac ECS using pericardoscopy since middle of 80th. According to this principle, the authors developed some diversities of manipulation which are distinctive due to their availability, reliability and supersafety. The method could be recommended for wide-spread usage in practice because of high efficacy, few complications and absence of fatal outcomes in correct intervention. Described methods used in treatment of considerable quantity of patients and adapted to real work conditions of public health hospitals.

Pericardioscopic implantation of electrodes for myocardial electrocardiostimulation.

Endocardial placement of electrodes for myocardial electrostimulation is a standard procedure. In the past, myocardial electrode placement was not performed routinely mainly because of the trauma of surgical access to the heart. We have developed for the first time an endoscopic approach. It is based on the use of a rigid endoscope with a diameter of 20 mm, which is introduced via a subxyphoideal skin incision into the pericardium. A sutureless, screw-in electrode is positioned via the endoscope. 129 patients were treated successfully without method-related lethality. An advantage especially for our large country is the possibility of performing this procedure in distant hospitals without the need of X-ray facilities. The equipment can be carried in an attaché case. Further developments could include two-chamber ECS using disposable kits ready for on-the-spot use.

[Mammary-coronary artery anastomosis in current cardiological surgery]. / Mammaro-koronarnyi anastomoz v sovremennoi kardiokhirurgii.

The article generalizes the experience in the treatment of 193 patients with ischemic heart disease by operation for direct mammary-coronary anastomosis (MCA). The author discusses technical aspects of the operation, in particular the use of vacuum vessel suturing apparatuses for its accomplishment, problems of extracorporeal circulation, and the long-term results. It is concluded that MCA is one of the most effective, reliable, and economical operations and should be used more widely in the management of ischemic heart disease.

[Surgical treatment and prevention of myocardial infarct]. / Khirurgicheskoe lechenie i predotvraschenie infarkta miokarda

In modern surgery of coronary arteries both surgical therapy of early stages of acute infarction and its surgical prophylaxis in preinfarction conditions seem to be quite feasible. 100 consecutive operations for ischemic heart disease are analysed. The principal type of surgery is a mammary coronary anastomosis. Among the mentioned patients one had a progressive acute myocardial infarction, resulting in death, and 14 patients were in primary preinfarction conditions. A surgical classification of acute disturbances in coronary circulation is described. Marked segmental stenoses of large coronary vessels underlie preinfarction status. Mosaic electrocardiotopography is of great value in recognition of preinfarction conditions. An early recognition and urgent surgical intervention are absolutely necessary in preinfarction state patients.