[Effectiveness of roentgeno-endovascular dilatation in the treatment of renovascular hypertension]. / Effektivnost' rentgenoéndovaskuliarnoi dilatatsii v lechenii renovaskuliarnoi gipertenzii.

The techniques and methodology of roentgeno-endovascular dilatation, used as part of the treatment for renovascular hypertension in 50 patients with 66 arterial stenoses of varying etiology, are described. The factors that may affect the efficacy of the procedure are discussed: the duration and etiology of the disease, stenosis localization, the number of affected renal arteries, plasma renin activity in renal veins, the dilating catheter used, etc. The stenosed portion of an artery could not be passed in 4 patients. In 38 (82.6%) of 46 patients, whose stenosed renal arterial segments were successfully passed and roentgeno-endovascular dilatation was attempted, systemic arterial BP eventually returned to normal or diminished.

[5-year experience with roentgenologically controlled endovascular nitinol prosthesis]. / 5-letnii opyt rentgenoéndovaskuliarnogo protezirovaniia nitinolovym protezom.

Clinical application of roentgeno-endovascular++ prosthesis was initiated in March, 1984, following 2-year developments and experimental implantations of endoprostheses made from an alloy with a mould storage effect. An effect of implantation of the endoprosthesis into the arterial wall by covering it with an nonhyperplastic, nonadhesive neointima. In 103 patients, 121 endoprosthesis implantations had been made into the iliac, femoral, and popliteal arteries over 5 years, 76.8% of the patients had had a severe concurrent disease. The age of the patients ranged from 21 to 72 years. Positive results were obtained in 93.7% of all the implantations. The long-term results were studied during 0.5-5.0 years' follow-ups. Poor results were obtained with endoprosthesis of the superficial femoral and popliteal arteries, which was associated with impaired distal limb blood flow. Indications for endoprosthesis were defined. The technique may be used in critical ill patients in whom direct surgical interventions are contraindicated due to concurrent abnormalities. The methods developed make it possible to successfully make endoprosthesis of the great arteries via a transcutaneous puncture access under local anesthesia.

[Potentials and prospects of universal controlled catheterization in the diagnosis of heart and vascular diseases]. / Vozmozhnosti i perspektivy universal'noi upravliaemoí kateterizatsii v diagnostike zabolevanii serdtsa i sosudov.

The results of the clinical use of the Medi-Tech universal controlled catheterization system for angiography and the Soviet [formula; see text] design are discussed. The examination was conducted 394 times on a total of 262 patients whose ages ranged from 4 1/2 to 79 years. The high efficacy (97.2%)of the use of a controlled catheter in catheterization of the cavities of the heart and pulmonary artery is shown. It is noted that the controlled system has great possibilities in carrying out complex selective and superselective contrast studies of th vessels and in catheterization of aortopulmonary and subclavian-pulmonary anastomoses in tetrad of Fallot through a venous approach. The advantages of the universal controlled catheter in study conducted for many purposes are emphasized.

[Computer tomography in cardiology. 1. Methods]. / Komp'iuternaia tomografiia v kardiologii. Soobshchenie I. Metodika.

The authors discuss the methodology of the computer-aided tomography of the heart which is to include dynamic scanning with, if indicated, synchronous ECG paralleled with the intravenous bolus administration of the contrast medium. The synchronization with ECG makes it possible to obtain a computer-aided tomographic image of the heart at any phase of the cardiac cycle. Computer-aided tomography was performed in 306 patients with various forms of heart disease. Five levels of scanning can be identified under normal conditions which present all structural elements of the heart.

[Computed tomography in cardiology: the diagnostic aspects]. / Komp'iuternaia tomografiia v kardiologii: nekotorye voprosy diagnostiki.

Computerized tomography (CT) was used to investigate 306 patients with a variety of heart and aortal diseases: acquired and congenital defects, coronary disease, tumors of the heart, pericarditis, aortic aneurysm. CT allows the assessment of certain functional (end-systolic and end-diastolic volumes, the ejection fraction, the motility of left-ventricular walls, systolic myocardial thickening) as well as anatomical parameters of the heart structure: the condition of the pericardium, heart cavities, induration and calcification of the valve apparatus, myocardial thickness, the presence of intra-cavity formations, and the state of the aorta, pulmonary artery, vena cava and pulmonary veins, including the assessment of the patency of aortocoronary shunts.

[Roentgeno-endovascular dilatation of the brachiocephalic arteries]. / Rentgenoendovaskuliarnaia dilatatsiia brakhiotsefal'nykh arterii.

The article describes the technique of radiological endovascular dilatation (RED) of stenosed brachicephalic arteries. RED was attempted in 28 arteries (18 subclavian, 7 vertebral, 2 common carotid and 1 internal carotid) in 22 patients. In one patient RED of the third portion of the left subclavian artery was supplemented with endovascular prosthesis--transcutaneous transcatheter introduction at the site of the previous stenosis of a spiral-shaped prosthesis from nitinol (a nickel-titanium alloy). Technically good results of dilatation was achieved in 21 of the 22 patients, clinical effect in 20 patients. Some angiographic criteria of the selection of patients for RED of the brachicephalic arteries are described.

[Interrelationship of cardiac output and myocardial contractility]. / Vzaimosviaz' serdechnogo vybrosa i sokratimosti miokarda.

On examination of 56 persons, 4 were found to have no abnormalities of the cardiovascular system, in all of the others the diagnosis of ischemic heart disease was confirmed. The cardiac output was determined by means of a thermodiluter. The stroke work index, the total peripheral resistance, and the segmental contraction of the left-ventricular wall were calculated. Changes in the stroke volume in response to a stress test, left ventriculography, were studied. It was found that changes in the stroke volume do not correlate with the clinical and coronarographic manifestations of the disease and the condition of the contractility of segments of the left-ventricular wall in the absence of clinical symptoms of circulatory insufficiency. The trend of stroke volume changes recorded during the stress test showed a dependence on the volume and degree of left-ventricular asynergy. Changes in the stroke volume were determined by the initial value of the cardiac output. High sensitivity of the left-ventricular function curve in detecting dysfunction of the left ventricle as well stroke volume-total peripheral resistance feedback were revealed.

[Post-infarct cardiac aneurysm: clinical picture and contractile function of the myocardium in the remote period after surgical treatment]. / Postinfarktnaia anevrizma serdtsa: klinika i sokratitel'naia funktsiia miokarda v otdalennom periode posle khirurgicheskogo lecheniia.

Late results of surgery for chronic postinfarction aneurysm of the heart were reviewed in 48 patients. Comprehensive clinical and instrumental investigation demonstrated that aneurysm resection alone or in combination with aorto-coronary shunting or ventricular septoplasty resulted in clinical improvement in 60.4% of patients. However, surgery had basically no positive effect on left-ventricular myocardial contractility and pulmonary hemodynamics. The lack of positive changes in myocardial contractility is due to marked asynergy (akinesia) developing around the post-operative scar. The late postoperative outcome depends on both the type (akinetic or dyskinetic) of heart aneurysm, and timely referral for surgical treatment.

[Segmental contractility--criterion of the integral function of the left ventricle in patients with ischemic heart disease]. / Segmentarnaia sokratimost'--kriterii integral'noi funktsii levogo zheludochka u bol'nykh ishemicheskoi bolezn'iu serdtsa.

The expulsion fraction was examined with reference to qualitative and quantitative parameters of segment contractility of the left-ventricular wall in 68 coronary patients. Segment contractility of the left-ventricular wall can provide the basis for the interpretation of the left-ventricular integrative function in these patients. Its qualitative assessment can characterize the general condition of the myocardium, whereas its quantitative features may contribute to the elucidation of mechanisms involved in compensatory relationships between the damaged and intact myocardium of the left ventricle.

[Myocardial function in the late period after an operation for aortocoronary shunting]. / Funktsiia miokarda v otdalennom periode posle operatsii aortokoronarnogo shuntirovaniia.

Thirty patients with coronary heart disease were examined prior to and 18.3 +/- 3 months after surgery, with 66% of the shunts proving to be patent. All patients were divided into 3 groups: group I--14 (47%) patients with patent shunts, group II--10 (33%) patients with partially patent shunts and group III--6 (20%) patients with occluded shunts. The group I and II patients displayed an improvement in the segmentary contractility and the integral function of the left ventricle as compared to the preoperative values. The group III patients showed a negative time-course of the segmentary and integral function of the left ventricle. In all cases of the impaired patency of the aortocoronary shunts there was progression of the atherosclerotic process in the basin of the shunted artery.

[A first experience with and possibilities of roentgenovascular dilatation of stenosis of the coronary arteries]. / Pervyi opyt i vozmozhnosti rentgenoéndovaskuliarnoi dilatatsii stenozov koronarnykh arterii.

First experience with roentgeno-endovascular dilatation of a coronary artery is described, and reported data are reviewed. Roentgeno-endovascular dilatation is indicated for patients with a single 10-12-mm-long coronary arterial stenosis of hemodynamic significance, localized proximally in the left coronary arterial network, or along the trunk of the right coronary artery, where left ventricular function remains intact and the history of the disease is rather short (not more than 1.5 years). Contraindications for roentgeno-endovascular dilatation currently include local coronary arterial stenosis localized at a major branching-off junction; coronary arterial stenosis of more than 15 mm in length; multiple coronary arterial stenoses; stenosis affecting several major arteries; calcification of coronary arterial wall; left ventricular scarry changes in myocardial area of expected revascularization; absence of indications for aorto-coronary shunting.

[Factors determining the success of the surgical treatment of chronic postinfarct heart aneurysm]. / Faktory, opredeliaiushchie uspekh khirurgicheskogo lecheniia khronicheskoi postinfarktnoi anevrizmy serdtsa.

Evaluation of instrumental findings in relation to clinical course of the early postoperative period in 105 patients operated on for chronic postinfarction aneurysm of the heart demonstrated that regional left-ventricular contractility, particularly that of unscarred myocardial tissue, is the principal determinant of surgical success, followed by the severity of attendant coronary sclerosis and, consequently, the adequacy of the chosen surgical procedure. Preoperative congestive heart failure, indicative of disrupted left-ventricular myocardial compensatory potential, is an aggravating factor.

[Diastolic coronary gradient during Valsalva's test in patients with ischemic heart disease]. / O dinamike diastolicheskogo koronarnogo gradienta pri probe Val'salvy u bol'nykh ishemicheskoi bolezn'iu serdtsa.

Thirty-five patients including 26 with coronary heart disease and 9 with a pain syndrome non-typical of angina were studied. All patients were subjected to Valsalva's standardized test during which the pressure was measured in the aorta and the heart left ventricle paralleled by simultaneous ECG registration at the three standard leads and at AVR lead. The test sensitivity equalled 50%, the test specificity was 88.9%. Both healthy subjects and coronary heart disease patients displayed a reduction of the diastolic coronary gradient during Valsalva's test, mostly due to the increased diastolic pressure in the left ventricle, which corresponded to the dissemination of coronary atherosclerosis (by coronographic findings). The mechanisms contributing to the development of ischemia associated with Valsalva's test include a fall in coronary perfusion, tachycardia and the reflectory influence of the pulmonary receptors.

[Contractile function of the myocardium of the left ventricle in patients with isolated lesions of the aortic valve]. / Sokratitel'naia funktsiia miokarda levogo zheludochka u bol'nykh s izolirovannym porazheniem aortal'nogo klapana.

Seventy-five patients (aged 17-53) with an isolated lesion to the aortal valve have been examined. The study of correlations between clinico-instrumental and angiocardiographic findings has shown that the isotonic overload of the left ventricle as against the isometric one causes more pronounced changes in the contractility of the left ventricular myocardium which are expressed in an increased heart volume, the development of electrocardiographic manifestations of the left ventricular overload, a considerable enhancement in the myocardium weight and in the residual and end diastolic volumes of the left ventricle. The value of the gradient of the systolic pressure in patients with isolated aortal ostium stenosis determines the intensity of myocardial alterations. In patients with aortal valve insufficiency, the value of the pulse pressure is directly correlated with the myocardial state. The contractile function of the left ventricular myocardium in patients with combined cardiac aortal disease is dependent on the predominance of isotonic or isometric overloads of the left ventricle.

[Myocardial function in the period immediately after aortocoronary bypass]. / Funktsiia miokarda v blizhaishem periode posle operatsii aortokoronarnogo shuntirovaniia.

Thirty patients with coronary heart disease were examined before and then 1.5 +/- 0.2 months after the operation of aortocoronary shunting. A total of 68% of the shunts proved patent. All patients were divided into 3 groups: group 1-14 (47%) patients with patent shunts, group 3-12 (40%) patients with partially patent shunts, group 3-4 (12%) patients with occluded shunts. The patients of the first two groups showed no changes in either the segmentary contractility of the left ventricular wall or in the time-course of the ejection fraction and left ventricular volumes. The patients of group 3 demonstrated the deterioration of both hemodynamic indices and parameters characterizing the segmentary contractility of the left ventricular wall which was caused by thrombosis of the aortocoronary shunt resulting in the development of ischemia or myocardial infarction in the zone of the shunted coronary artery.

[Clinico-hemodynamic correlations in patients with a postinfarct aneurysm of the left ventricle]. / Kliniko-gemodinamicheskie sootnosheniia u bol'nykh s postinfarktnoi anevrizmoi levogo zheludochka serdtsa.

Eighty-four patients with left-ventricular post-infarction aneurysm were examined, 74 of those showing clinical signs of circulatory insufficiency. Selective coronarography and left roentgenocinematoventriculography were performed in all cases. Volumetric parameters and the ejection fraction were estimated for the total and contractile segment of the left ventricle. Statistical treatment of the data thus obtained demonstrated a relationship between the segmental contractility and manifestation of clinical signs of circulatory insufficiency. The limits were established for increments in residual and end-diastolic volumes that lead to the development of clinical manifestations of circulatory insufficiency. An increased end-diastolic pressure seems to be indicative of reduced elasticity (pliancy) of the left-ventricular myocardium, as reflected in markedly disturbed segmental contractility of the left-ventricular wall.

[Changes in the coronary blood flow rate during selective coronary angiography and nitroglycerin administration]. / Izmeneniia skorosti koronarnogo krovotoka pod vliianiem selektivnoi koronarografii i priema nitroglitserina

The effect of selective coronary angiography on the amount of the coronary blood flow is discussed. The effect of sublingual nitroglycerin administration on the level of the coronary flow was also studied. The coronary flow was measured with the aid of intracoronary injection of Xe133 prior to selective coronary angiography, and on the 3rd, 6th and 10th minutes following the termination of the radiocontrast examination. The coronary blood flow was shown either to remain unchanged, or to decrease slightly on the 3rd minute after the termination of angiography, as compared with the value of this parameter prior to the examination. On the 6th minute some increase of the coronary flow is observed, on the average 12%, which subsequently returns to the initial level. Sublingual intake of nitroglycerin results in an increase of the coronary flow, both prior to and following coronary angiography.

[Transcutaneous transcatheter use of laser recanalization of coronary arteries in patients with ischemic heart disease]. / Chrezkozhnoe chrezkateternoe primenenie lazernoi rekanalizatsii koronarnykh arterii u bol'nykh ishimicheskoi bolezn'iu serdtsa.

The paper discusses the potential possibility and effectiveness of X-ray endovascular laser recanalization (ELR) of the coronary arteries in order to treat coronary atherosclerosis in patients with coronary heart disease. The intervention was performed in 4 patients (into the anterior interventricular artery in 3 and into the right coronary artery in 1). In 3 of 4 cases, X-ray ELR proved to be successful, in one case the intervention failed due to technological reasons. Recanalization of a completely occluded segment of the coronary artery with a residual stenosis of no more than 40% was observed in two cases. Laser recanalization of profound local coronary stenosis was made in the mid-third of the vessel in one case. It can be stated that X-ray ELR of the coronary artery may extend the scope of X-ray surgical therapeutical tools of the treatment of coronary atherosclerosis. At the same time, accumulation of clinical experience and further improvement of laser and laser catheter engineering are essential in defining the value and possible scope for the application of this method.

[Comparative evaluation of the myocardial contractile indices of the left ventricle in ischemic heart disease]. / Sravnitel'naia otsenka pokazatelei sokratimosti miokarda levogo zheludochka u bol'nykh ishemicheskoi bolezn'iu serdtsa.

The indices of hemodynamics and myocardial contractility rate (end diastolic and end systolic volumes, ejection fraction, average rate of shortening of circumferential fibres, and average normalized rate of systolic ejection) were studied in 44 patients with ischemic heart disease to appraise the informative value of each parameter and reveal myocardial dysfunction. Calculations were done on an electronic computer system. The data obtained were compared with the findings in practically healthy persons. It was found that increase of the residual volume is the first sign of disturbed myocardial contractility and correlates well with the extent and volume of impaired contractility of the left ventricular segments. A decrease of the ejection fraction is noted only with an increase of the residual volume, the degree of the decrease correlating most closely with the degree of the decrease of the rate indices. The number and localization of the affected segments of the left ventricular wall have an effect on the contractile function of the myocardium.

[Computerized tomography in evaluating the function of aortocoronary shunts]. / Kom'piuternaia tomografiia v otsenke funktsii aortokoronarnykh shuntov.

An examination was made of 38 patients undergone aortocoronary bypass surgery. Comparing the density of content in the aorta and shunt before and after bolus contrast in computerized tomography makes it possible to evaluate the patency of the aortocoronary shunt. A shunt patency coefficient (SPC) was proposed, which fitted the ratio of density differences in the shunt to those in the lumen of the ascending aorta before and after the injection of a contrast agent. SPC equal to 0.5 or more is indicative of a good patency of the aortocoronary shunt, but that being 0.3 or less suggests no or extremely poor function of the shunt. SPCs that are equal to 0.3-0.5 are transient indicators of its patency.