[Inhalation induction anesthesia: special indications or a routine procedure?].

The efficacy, safety and expediency of various types of the induction anesthesia before the long-lasting major surgery were analyzed. The combination of inhalation of sevoflurane in maximal concentration with phentanil allowed the effective and safe induction and trachea intubation on the 3-4th minute on the background of the nimbex myoplegia. The monoinduction with sevoflurane provides the sufficient analgesia not earlier then after 7-9th minute, which allows the safe intubation at a time. Therefore, the study proved, that the inhalation induction with sevoflurane in various modifications, could be the standard method of inductive anesthesia.

[Cellular aspects of hypertrophic cardiomyopathy pathogenesis: the role of cardiomyocyte polyploidy and activation of the proliferating cell nuclear antigen in the myocardium].

Mechanisms of hypertrophy development in hypertrophic obstructive cardiomyopathy (HOCM) have not been enough investigated. In our study, there have been examined patients with severe HOCM at different ages, including children, and patients with essential arterial hypertension (EAH). There was found, that HOCM in children compared to adults was characterized by considerable interventricular septum (IVS) hypertrophy and it was accompanied by the acceleration of cardiomyocyte polyploidy. The average ploidy level of cardiomyocytes in children with HOCM was higher than analogous indices in adults. The average ploidy level of nuclei, the part of PCNA-positive nuclei and polyploidic nuclei of cardiomyocytes in aduls with HOCM were authentically higher than in patients with EAH. Activation of the nuclear antigen in stromal cells was detected only in patients with HOCM. Our findings provide evidence of an important role of cardiomyocyte polyploidy and activation of the proliferating cell nuclear antigen in development of the myocardial hypertrophy in patients with HOCM.

[Surgical treatment of pediatric hypertrophic obstructive cardiomyopathy using an original approach].

The authors offer an original technique of surgical correction of pediatric hypertrophic obstructive cardiomyopathy (HOCM), which allows excision of the hypertrophied area and elimination of the obstruction from the cone part of the right ventricle (RV) without penetrating into the LV cavity. 15 children aged 5 to 15 years have been operated on in Bakulev Scientific Center for Cardiovascular Surgery using this technique. 8 of the patients had simultaneous obstruction of the left and right ventricular outflow tract (LVOT and RVOT), 1 patient had RV obstruction. Medical therapy had failed in all cases. The follow-up period was 28 +/- 7 months. EchoCG examination, performed after the surgical treatment, found a decrease of the intraventricular gradient in LV from 72.9 +/- 8.9 to 12.7 +/- 5.5 mmHg; the mean gradient in RVOT also reduced from 43.6 +/- 5.7 to 4.3 +/- 2.7 mmHg. According to the EchoCG, septal thickness reduced from 31.5 +/- 6.5 to 16.5 +/- 4.1 mm. Sinus rhythm was noted in all the patients after the surgery and during the follow-up. The method proposed by the authors is preferable in surgical treatment of children with various forms of hypertrophic cardiomyopathy unresponsive to medical treatment and is a method of choice in a significant number of cases.

[Surgical treatment of supraventricular tachyarrhythmias using laser]. / Khirurgicheskoe lechenie nadzheludochkovykh takhiaritmii s ispol'zovaniem lazera.

Much importance is attached lately to the use of lasers in surgical treatment of tachyarrhythmias. The advantages of the laser radiation are as follows: the possibility of using it on a contracting heart, its exact and selective effect, infliction of even damages in preservation of the structure, reduction of damage to the myocardium as a whole. At the Bakulev Institute of Cardiovascular Surgery, USSR AMS, 52 operations were carried out in the management of supraventricular tachyarrhythmias by laser radiation: 27 operations for laser isolation of the atrioventricular node, 15 operations for laser isolation of the atria and bases of the pulmonary veins (11 in combination with laser isolation of the atrioventricular node), 3 operations for ablation of ectopic foci in the atria and ventricles, 4 operations for ablation of the bundle of His, and 3 operations for removal of Maheim's nodoventricular tract. Among the patients who were operated on, 12 had atrial flutter, 21--atrial fibrillation, 11--paroxysmal atrioventricular nodal tachycardia, 5--ectopic supraventricular tachycardia, and 3 patients had paroxysmal tachycardia due to the presence of Maheim's nodoventricular tract. The method of laser isolation of the atrioventricular node was developed. It is performed on a working heart under conditions of normothermal extracorporeal circulation by Nd-YAG laser radiation under electrophysiological control. Antegrade conductivity was reduced to 420-510 msec. Among 56 patients who underwent operation 39 had sinus rhythm, 10 had Degree II-III block, and 7 patients had a recurrence.(ABSTRACT TRUNCATED AT 250 WORDS)

[Electrophysiological diagnosis and surgical treatment of supraventricular tachycardia]. / Elektrofiziologicheskaia diagnostika i khirurgicheskoe lechenie nadzheludochkovykh takhiaritmii.

In 1981-1988, 515 operations were made in patients with supraventricular tachycardias (SVT) refractory to preventive antiarrhythmic therapy at the A. N. Bakulev Institute of Cardiovascular Surgery, USSR Academy of Medical Sciences. Nodal tachycardias were observed in 51 (10%) patients, ectopic SVT were found in 32 (6%), atrial fibrillation and flutter were seen in 140 (27%), and preexcitation syndromes were present in 292 (57%). The current surgical therapy of SVT returns to socially active lifestyle, abolishes tachycardias and eliminates sudden death in 97% of patients with parietal accessory pathways and atrial fibrillation. Transvenous fulguration is the method of choice in artificially inducing atriovetricular block (97% positive outcomes), in radically abolishing nodal tachycardias (100%), and Type I idiopathic atrial flutter (88%).