[Opportunity of operative traumatism decrease in patients with complicated tricuspid valve defect]. / Vozmozhnosti snizheniia travmatichnosti operatsii u bol'nykh s oslozhnennymi trekhklapannymi porokami serdtsa.

This study examined the results of surgical trivalve of 44 patients with trivalve heart defect. In all the patients the heart defect was combined with two and more complicating factors: advanced III-degree calcinosis of the valves, cardiomegaly, cardiac fibrillation, left atrium thrombosis, high pulmonary hypertension. In 20 patients the operative intervention on the heart was repeated. The analysis of the results allowed to recommend some surgical techniques which allowed to decrease surgical traumatism in patients with complicated trivalve heart defect. Low traumatism was possible because of incomplete removal of the calcium masses extending on the fibrotic ring and outside, use of two-row counter U-suture on linings for the prosthesis fixing, transdoubleatrial approach without isolation of the heart from the adhesions in dense pericardial obliteration, correction even insignificant trivalve heart defect or relative valve incompetence.

[The possibilities for the transcranial monitoring of the blood flow in the circle of Willis arteries during operations on the brachiocephalic arteries and in heart operations]. / Vozmozhnosti transkranial'nogo monitoringa krovotoka v arteriiakh villizieva kruga vo vremia operatsii na brakhitsefal'nykh arteriiakh i pri operatsiiakh na serdtse.

The paper gives the results of arterial blood flow monitoring in the circle of Willis via transcranial Doppler during 81 reparative operations on brachiocephalic arteries (including carotid endarterectomy from the internal carotid artery in 32 patients). Transcranial monitoring of blood flow supports the fact that there is a collateral reflow along the cerebral arteries during removal of the common carotid artery and that there is a relationship between the status of great arteries and arteries of Willis' circle. The paper also summaries the results of a comprehensive ultrasound study of 9 patients who have undergone reparative and plastic operations on the cardiac valves during extracorporeal circulation and general hypothermia. Blood flow was intraoperatively monitored in the arteries of the basis cerebri by using transcranial duplex scanning with colour Doppler flow mapping to evaluate not only hemodynamics, but also the embolic situation, as well as to check up how air was removed from the cardiac cavities by transesophageal echocardiography.

[Catheter balloon valvuloplasty: new possibilities in the surgical treatment of mitral stenosis]. / Kateternaia ballonnaia val'vuloplastika--novye vozmozhnosti v khirurgicheskom lechenii mitral'nogo stenoza.

A total of 170 catheter balloon valvuloplastic (CBV) operations for rheumatic mitral stenosis were carried out in patients aged 19 to 68, 30 of these in pregnant women, at A. V. Vishnevsky Institute of Surgery, Russian Academi of Medical Scients, from 1988 to 1994. Characteristic features of such operations are a minor surgical trauma and no necessity in deep narcosis and artificial circulation. Analysis of the immediate results and of the data of five-year follow-up brings the authors to a conclusion about the efficacy of the new method of treatment of this heart disease and about the physiological nature of forming an adequate route of blood flow into the right ventricle with a balloon. Comparing various balloon catheters for valvuloplasty and methods to carry out this procedure, the authors emphasize the advantages of the instruments and method developed by professor V. A. Silin et al. (St. Petersburg). The possibility of correction of mitral stenosis by CBV in pregnant women appears to be particularly important. Retrospective analysis of the immediate results and follow-up data helped the authors not only formulate the indications for this intervention, but permitted them to develop an original system of comprehensive clinical and instrumental assessment of the degree of involvement of the mitral valve and subvalvular structures, and of hemodynamic disorders.

[A method for preventing an air embolism in repeat operations on the heart with artificial circulation without cardiolysis]. / Metodika profilaktiki vozdushnoi émbolii pri povtornykh operatsiiakh na serdtse s iskusstvennym krovoobrashcheniem bez kardioliza.

An effective method has been developed for prevention of air embolism in cardiopulmonary bypass surgery on the open heart without heart isolation from intergrown tissues. The method consists in filling and washing heart cavities with carbon dioxide before removing the clamps from the aorta. This method does not involve routine prophylactic measures such as heart dislocation and puncture of left-ventricular apex, heart ventricles massage to remove air, etc. Operation without heart isolation from intergrown tissues helps markedly reduce blood loss, make the operation less traumatic and shorter.

[Catheter-balloon valvuloplasty in mitral valve stenosis (selection of the method of procedure, immediate results and the criteria of patient selection]. / Kateternaia bollannaia val'vuloplastika pri mitral'nom stenoze (vybor sposoba operatsii, neposredstvennye rezul'taty, kriterii otbora bol'nykh.

Catheter-balloon valvuloplasty (CBV) was carried out in 80 patients with rheumatic mitral stenosis, whose ages ranged from 22 to 68 years. Seventeen of these patients were operated on for mitral valve restenosis; I-II degree calcinosis of the mitral valve was revealed in 18 patients; seven women underwent surgery in the 24th-32nd week of pregnancy. After applying various methods (19 cases) the authors used in the last series of operations (61 cases) the Silin-Sukhov method using an original dilatation catheter with a balloon measuring in diameter up to 34 mm, which allowed pressure of up to 8 atm. to be produced during a working cycle no longer than 8 sec. As the result of CBV, the area of the mitral orifice was enlarged by no less than twice in all patients, the pressure gradient through the mitral valve and systolic pressure in the pulmonary artery reduced. The total number of complications which called for operative treatment was 3.75%. CBV is a still developing method, but already today it may be considered the method of choice in the treatment of uncomplicated forms of mitral stenosis, in I-II degree calcinosis, and when the risk of the traditional surgical intervention on the heart is increased.

[The diagnosis and surgical procedure in calcified subtotal thrombosis of the left atrium in rheumatic heart defects]. / Diagnostika i khirurgicheskaia taktika pri kal'tsinirovannom subtotal'nom tromboze levogo predserdiia pri revmaticheskikh porokakh serdtsa.

The authors share their experience with surgical treatment of 5 patients. The methods of thrombectomy from the left auricle used in their work as well as prophylactics of recurrent thrombosis are thought to improve results of treatment of rheumatic heart disease.

[A method of removing air from the cavities of the heart and great vessels during surgery with extracorporeal circulation]. / Metodika udaleniia vozdukha iz polostei serdtsa i magistral'nykh sosudov pri operatsiiakh s iskusstvennym krovoobrashcheniem.

A strictly successive method for removing air from the heart cavities and great vessels after the intracardiac stage of the operation was elaborated from study of the experience of foreign heart surgeons and experience in the use of various measures for the control of air embolism at the Vishnevsky Institute of Surgery, AMS USSR. The techniques of puncture of the heart cavities and vessels and their massage for complete evacuation of the air is described. These manipulations are combined with thorough decompression of the atria and ventricles to relieve the load suffered by them after cardioplegia. The author applied the described method in 647 patients who underwent operation for congenital, rheumatic, and other heart diseases. Signs of air embolism were not revealed in the postoperative period in these patients.

[Use of therapeutic plasmapheresis in heart surgery patients with hepatic insufficiency]. / Primenenie lechebnogo plazmafereza u kardiokhirurgicheskikh bol'nykh s pechenochnoi nedostatochnost'iu.

Therapeutic plasmapheresis is a highly effective method in the preparation of patients with hepatic insufficiency for operation on the heart under conditions of extracorporeal circulation. It leads to reduction of the bilirubin level and normalization of the main values of hepatic function. The positive effect of therapeutic plasmapheresis is less manifest in acute hepatorenal insufficiency developing after operation with extracorporeal circulation. The best effect of therapeutic plasmapheresis in the postoperative period was produced in patients in whom hemorrhages and the low cardiac output syndrome were removed.

[The dynamics of cardiac dimensions following mitral valve prosthesis in patients with rheumatic heart disease complicated by cardiomegaly and subjected to repeated surgery]. / Dinamika razmerov serdtsa posle protezirovaniia mitral'nogo klapana pri revmaticheskom poroke, oslozhnennom kardiomegaliei, u povtorno operirovannykh bol'nykh.

A total of 36 patients with cardiac output above 1000 ml per 1 m2 of body surface underwent repeated operations. As to the endurance of physical loading 10 patients corresponded to the III and 26 patients to the IV functional classes according to the Classification of the New York Association of Cardiologists. In the postoperative period 18 patients with the 1st degree of heart enlargement showed a decrease in the size of the heart. In 8 patients with cardiomegaly of the II-III degree the heart volume remained unchanged. Five patients died from progressing myocardial insufficiency. As far as the endurance of physical load is concerned 16 patients corresponded to the 1st and 12 patients to the II-III functional classes. Based on the data obtained it may be concluded that with respect to the patients with cardiomegaly of the III degree the prospects of surgical correction of acquired heart diseases are unfavourable.

[Diagnosis of aortic valve calcinosis with a view to the surgical treatment of aortic valve disease]. / Diagnostika kal'tsinoza aortal'nogo klapana v aspekte khirurgicheskogo lecheniia aortal'nykh porokov serdtsa.

Combined roentgenologic/echocardiographic diagnosis of aortic valve calcinosis was made in 135 patients operated on for a rheumatic aortic heart disease. Four degrees of aortic valve calcinosis were identified: 1) isolated fine points of calcinosis, as revealed by echolocation and specific treatment of the removed valves; 2) small-focal calcinosis as revealed roentgenologically in 79.2% of cases and by echolocation, in 93%; 3) large-focal, and 4) wide-spread calcinosis, the latter two being detectable both roentgenologically and echocardiographically in all cases. The 4-degree classification of aortic valvular lesions allows a detailed assessment of the nature of the affection that is important for the choice of surgical procedure.