[Surgical treatment of the aortic arch aneurysm. Immediate results]. / Khirurgicheskoe lechenie anevrizmy gugi aorty. Blizhaishie rezul'taty.

There was performed the retrospective analysis of 23 consecutive patients, to whom beside the ascending aorta aneurysm correction the aorta arch prosthesis was done in conditions of deep hypothermia, the blood circulation arrest with retrograde cerebral perfusion via vena cava superior. For an acute layering and aneurysm of aorta with pericardium tamponade or hemothorax occurrence 16 (69.6%) of patients were operated on in emergency. Hospital mortality had constituted 21.7%, including after an urgent operation performance--25% and elective surgery--14.3%.

[Method of surgical treatment of mitral valve stenosis depending on the extent of its calcinosis]. / Vybor sposoba khirurgicheskogo lecheniia stenoza mitralnogo klapana v zavisimosti ot stepeni vyrazhennosti ego kaltsinoza.

On the basis of studying the immediate and long-term results of treatment of 329 patients with calcinated mitral stenosis, the progressive aggravation of the immediate outcome of the operation in II and III-IV degree of mitral valve calcinosis is demonstrated. The data have been confirmed by actuarial analysis of the patients' survival and stability of a good result. The authors consider it expedient to perform mitral commissurotomy only in patients without valvular calcinosis and I degree calcinosis. In more severe affection, mitral valve replacement is indicated.

[Paravalvular insufficiency following heart valve prosthesis]. / Paraklapannaia nedostatochnost' posle protezorivaniia klapanov serdtsa.

The features of the morphology of paravalvular insufficiency (PVI) were studied on the basis of analysis of 5,113 prosthetic replacements of the heart valves. From the clinical results and noninvasive and invasive data the authors revealed the peculiarities of the disorders of hemodynamics and functional condition of patients with PVI. Information on the specific features and the results of 35 repeated operations in PVI are discussed. Analysis showed 26.4% survival among patients 5 years after surgery. Bearing in mind the severity of the complication the authors emphasize the importance of its prevention.

[The physical rehabilitation at a sanatorium of patients wearing aortic valve prostheses]. / Fizicheskaia reabilitatsiia bol'nykh s protezami aortal'nogo klapana v usloviiakh sanatoriia.

Methods and results of physical rehabilitation of 81 patients with prostheses of the aortal valve in conditions of a health resort are reported. The authors revealed a 29.2% increase of physical, working capacity and a reduction (8.2%) of oxygen expenditures per unit of work. Increase of intensity of training loads improved the results of physical rehabilitation. The role of health resort treatment in the system of postoperative rehabilitation of patients with heart valve prostheses is emphasized.

[Quantitative dynamic assessment of their physical status as a result of sinus rhythm recovery in patients after mitral commissurotomy]. / Kolichestvennaia otsenka dinamiki fizicheskogo sostoianiia v rezul'tate vosstanovleniia sinusovogo ritma u bol'nykh posle mitral'noi komissurotomii.

Submaximum bicycle and respiration ergometry was conducted before and after sinus rhythm recovery by means of electric impulse stimulation in 41 patients with atrial fibrillation after effective mitral commissurotomy. Physical working capacity was reduced considerably (by 25.8%), while oxygen spending per unit of work increased by 58.5% in patients with atrial fibrillations, as compared to normal subjects. After sinus rhythm was recovered, physical working capacity increased by 106%, while oxygen spending per 1 kgm work declined by 34.2%. Sinus rhythm recovery is essential as an element of postoperative rehabilitation in cardiosurgical patients.

[Late results of mitral recommissurotomy]. / Otdalennye rezul'taty mitral'nykh rekomissurotomii.

Late results of 394 operations for mitral restenosis (or 90.6% of discharged cases) were reviewed, the average duration of follow-up being 5.6 +/- 0.6 years. Late results were good in 41.9%, satisfactory in 27.2% and poor in 19.5% of the patients. Long-term mortality was 11.4%. Moderate valvular regurgitation did not significantly affect the outcome of surgery. Long-term outcomes were shown to deteriorate progressively with the increment of valvular calcinosis. The comparative actuarial analysis in long-term outcomes of mitral commissurotomies and recommissurotomies showed no significant variations. It is emphasized that mitral recommissurotomy is a promising approach to surgical treatment of mitral restenosis.

[State of hemodynamics and myocardial contractility according to intracardiac findings long after valve prosthesis for acquired heart defects]. / Sostoianie gemodinamiki i sokratitel'noi sposobnosti miokarda po dannym vnutriserdechnykh issledovanii v otdalennye sroki posle protezirovaniia klapanov pri priobretennykh porokakh serdtsa.

Intracardiac findings before and late after valvular prosthesis application were analysed in 36 patients with intact prosthetic function. In cases of good surgical outcomes, major hemodynamic parameters normalize or improve considerably by the late postoperative period. Domestic prostheses (MKS-25, MKC-27, and AKC-02, AKC-06), although causing a diastolic pressure gradient of about 6.5 mm Hg on the mitral valve and a systolic pressure gradient of about 25-30 mm Hg on the aortal valve, on the whole provide a good and stable hemodynamic effect.

[Valve prosthesis in the surgical treatment of acquired heart defects]. / Protezirovanie klapanov v khirurgicheskom lechenii priobretennykh porokov serdtsa.

The authors describe their experience with cardiac valve prostheses in 2446 patients with acquired heart diseases and hospital mortality of 21.7%. The surgical methods and the tactics in concomitant diseases are described. The methods of plastic operations on the tricuspid valve are presented. Late results of prostheses of the cardiac valve were studied in 1594 patients. Good late results were recorded in 65.9% of cases, satisfactory in 17.1%, unsatisfactory in 4.3%. The late mortality was 12.7%. Analysis of the late complications is given and the ways for increasing the efficacy of cardiac valve prostheses are suggested.

[Effect of the preoperative status indices on the late results of aortic valve prosthesis]. / Vliianie nekotorykh pokazatelei predoperatsionnogo sostoianiia na otdalennye rezul'taty protezirovaniia aorta'nogo klapana.

The authors studied late results of replacement of the aortic valve by a ball prosthesis in 292 patients up to 11 years. Good results were obtained in 82.2% of the patients, satisfactory in 7.4%, unsatisfactory in 3%; 7.4% of patients died during late periods. The factors that deteriorate the late results of aortic valve prosthesis are the duration of subjective symptomatics over 5 years before the operation, the presence of the right ventricular decompensation, cardiomegaly, high end diastolic pressure in the left ventricle, neglected stage of the disease. These data are confirmed by the analysis of actual curves of survival and stability of the good late results of the operation.

[Rehabilitation problems with heart valve prosthesis patients]. / Voprosy reabilitatsii bol'nykh a protezami klapanov serdtsa.

A vast experience of over 1500 patients with prostheses of the heart valves is being summarized. A method of physical and psychological rehabilitation of these patients is described and data are given proving the efficacy of such measures: increased physical endurance in work by 92%, decrease of psychic disorders by 41.5%. The efficacy of the sanatorium stage of post-operative treatment is shown. Not infrequently the degree of invalidity of patients with cardiac valve prostheses is exaggerated, it is stressed that the use of exercise tests by the rehabilitation commission is essential.

[Psychological aspects of the rehabilitation of patients after the surgical treatment of heart defects]. / Psikhologicheskie aspekty reabilitatsii bol'nykh posle khirurgicheskogo lecheniia porokov serdtsa.

Modern methods of clinico-psychological examination employed in 726 patients with heart diseases disclosed psychopathological changes in 18.7% of patients with congenital and in 82.1% of cases with acquired heart diseases. Oeration with extracorporeal circulation had no detrimental effect on the psychic development of children. Some psychic deviations were encountered in patients after correction of heart diseases, in particular, a cardioprosthetic psychopathological syndrome in patients with artificial heart valve prostheses. Patients who undergo operation for a heart disease require purposeful psychic rehabilitation. The methods and the main principles of such rehabilitation are described and its efficacy is demonstrated.

[Late results of mitral commissurotomies]. / Otdalennye rezul'taty mitral'nykh komissurotomii.

The late results of 1,205 operations for mitral commissurotomy were studied. The investigation embraced 88.3% of patients discharged from the clinic after surgery. The follow-up period was 8 years and 9 months on average. The late postoperative result was good in 47%, satisfactory in 26.4%, and poor in 16.4% of patients. Late mortality was 10.2%; 75% of patients were alive 15 years after the operation. The effect of the stage of the disease, the volume of the reverse blood flow on the mitral valve and the presence and extent of its calcification on the late results of the operation was studied. Longterm follow-up testifies to the high efficacy of closed mitral commissurotomy.