[Immediate results of surgical correction of combined pathology of the aortic valve and coronary arteries].

The authors analyzed an experience of surgical treatment in patients with aortic valve failure and ischemic heart disease. All patients have been operated in clinic of hospital surgery No 2 of State Pavlov Medical University. The work presented basic approaches to the management and strategy choice of the treatment of these patients. On the basis of given research, the authors suggested to perform a reconstruction of aortic valve by using original method in combination with coronary bypass surgery, which allowed avoiding a prosthetic-patient inadequacy. At the same time, it could improve an intracardiac haemodynamics and postoperative course.

[A comparison of the pulsatile and nonpulsatile regimens of artificial blood circulation in operations of aortocoronary shunting].

The work is based on a clinical-laboratory analysis of the pulsatile and non-pulsatile regimens of artificial blood circulation. During operation under investigation were indices of gases of the arterial and venous blood. They were compared with those of gases obtained using the monitor of transcutaneous gases of blood. In the postoperative period a comparison was made between clinical and biochemical indices of blood and coagulogram. The data obtained have shown less negative influence of pulsatile regimen of blood circulation which manifests itself during artificial blood circulation as an increased delivery and extraction of oxygen by tissues, after operation--as improved blood indices.

[Intracardial transplantation of mononuclear cells of the autologous bone marrow in complex treatment of patients with valvular heart diseases].

The authors present the first clinical experience with intramyocardial transplantation of the mononuclear fraction of cells of the autologous bone marrow in complex surgical treatment of 10 patients with valvular heart disease. The cellular transplantation was fulfilled intraoperatively when making a prosthetic mitral (5 patients) and aortal (5 patients) valves on the open heart under conditions of extracorporeal circulation. Simultaneously direct revascularization of the myocardium (aorto-coronary and mammary-coronary shunts) was performed in 4 patients (1--with a mitral and 3--with aortal heart diseases). An investigation of the results of the examination including ECG, EchoCG and investigation of the myocardium perfusion using one-photon emission computed tomography fulfilled in the early postoperative period and within 6-12 months after operation has shown that the cell cardiomyoplasty with mononuclear fraction of cells of the autologous bone marrow improves the myocardium perfusion, however, in the early postoperative period the appearance of transitory impairments of the heart rate is possible.

[Functional status of the intima and thrombocytic hemostasis in patients with symptoms of atherosclerosis of the cerebral and peripheral vessels]. / Funktsional'noe sostoianie intimy i trombotsitarnogo gemostaza u bol'nykh s proiavleniiami ateroskleroza mozgovykh i perifericheskikh sosudov.

The indices characterizing the state of lipid metabolism, endothelium of arteries and thrombocytic hemostasis were investigated. It was shown that in the zone of atherosclerotic stenosis of the arteries there were marked transformations of the endothelium followed by a decrease of their anticoagulatory properties. The cause and effect relationship between the disturbed thrombocytic hemostasis and lesions of the endothelium in atherosclerosis was confirmed. It is these factors which are the cause of frequent thromboembolic complications, especially in patients with lesions of the cerebral arteries. It is necessary to include methods of correction of the disturbed thrombocytic hemostasis in the complex treatment of patients with atherosclerosis.

[Complications after angioplasty and stenting of coronary arteries in ischemic heart disease patients]. / Oslozhneniia angioplastiki i stentirovaniia koronarnykh arterii u bol'nykh s ishemicheskoi bolezn'iu serdtsa.

The authors have made an analysis of most frequent complications of angioplasty and stenting of coronary arteries in 1900 patients with various forms of ischemic heart disease. The mechanisms, pathomorphology, angiographic and clinical manifestations of such complications as dissection of the coronary artery intima, acute occlusion of the coronary artery, "no-reflow" syndrome, perforation and rupture of the coronary artery, acute thrombosis in the stent area and other complications are considered in detail. Special medical strategy, both therapeutic and surgical, is proposed for each case. The authors propose a number of prophylactic measures allowing to avoid the complications described or to minimize them. Intraoperative lethality in this group of patients was 0.5% (10 patients), during the first week after endovascular intervention 26 patients died (1.4%).

[Dyslipoproteinemia and prognosis of the course of ischemic heart disease after coronary bypass]. / Dislipoproteinemiia i prognoz techeniia ishemicheskoi bolezni serdtsa posle koronarnogo shuntirovaniia.

The article deals with the observation of 88 patients with ischemic heart disease, 62 of them had coexistent dyslipoproteidemia. More pronounced atherosclerotic lesions of the coronary artery were found to develop in patients with dyslipoproteidemia influencing the degree of ischemic heart disease before coronary bypass. Within the period of 10 years after operation dyslipoproteidemia patients have 3.5 times higher risk of the development of myocardial infarction, more than 2 times higher risk of reappearance of stenocardia and death from cardiovascular diseases. Patients with dyslipoproteidemia have 2 times higher probability of generalization of the atherosclerotic process in patients with is chemic heart disease at later terms after coronary bypass.

[The surgical treatment of aneurysms of the abdominal aorta]. / Khirurgicheskoe lechenie anevrizm briushnoi aorty.

Based on an experience with treatment of 107 patients with aneurysms of the abdominal aorta subjected to planned or urgent operations the authors discuss the problems of the clinical course, diagnosis, indications for operative treatment, the technique of operative interventions and their results. In planned operations lethality was 4.1%, in ruptures of the aneurysm-64.2%. One year after the operations 90% of the patients were practically healthy, 5 years later they were 70%.

[Surgical treatment of ischemic heart disease using internal thoracic artery and partial ileal bypass]. / Khirurgicheskoe lechenie ishemicheskoi bolezni serdtsa s primeneniem vnutrennei grudnoi arterii i chastichnogo ileoshuntirovaniia.

The authors recommend complex two-stage treatment of ischemic heart disease, including a reconstructive operation on the coronary arteries and an operation for correcting the disturbed plasma lipid spectrum (partial ileal bypass). The results of operative treatment of 150 patients with the use of the internal thoracic artery were studied. The authors emphasize the advantages of this operation over one using an autovein graft. Complex operative treatment was conducted in the clinic in 60 patients with a good clinical effect. The authors also recommend operation for partial ileal bypass as an independent intervention in dyslipoproteinemia and diffuse affection of the coronary arteries.

[Surgical treatment of chronic ischemic heart disease]. / Khirurgicheskoe lechenie khronicheskoi ishemicheskoi bolezni serdtsa.

The authors suggest a new complex approach to the surgical treatment of ischemic heart disease. Operation of coronary shunting for the restoration of the coronary blood flow, operation of partial ileoshunting for correction of hyperlipoproteinemia, plexotomy for removal of the vasospastic component. The sequence of the operations may vary, each one can also be undertaken independently. The operations were conducted on 315 patients. The follow-up period is up to 8 years. Patency of the mammary-coronary shunts was 93.5%, of autologous veins shunt--65%. Disappearance of the signs of coronary spasm++ and stable normalization of the lipid spectrum are noted.

[Internal thoracic artery in coronary surgery]. / Vnutrenniaia grudnaia arteriia v koronarnoi khirurgii.

The authors emphasize advantages of using the internal thoracic artery for mammary-coronary shunts in patients with ischemic heart disease. 257 operations have been performed in the clinic since 1964. Among them there were operations of mammary-coronary anastomosis (after V. I. Kolesov) and mammary-coronary shunts. Long-term results were followed-up which evidence high effectiveness of operative treatment. In 109 patients control angiographic examinations were fulfilled at different terms (up to 12 years). Patency of mammary-coronary shunts was 83.5% as compared with ACSh where it was about 63%.