[Dynamics of venous blood return in normal conditions and in patients with obstructive lung disease]. / Dinamika venoznogo vozvrata krovi v norme i u bol'nykh s obstruktivnymi zabolevaniiami legkikh.

The venous blood flow in the jugular, cubital, and inferior cava veins was studied in 7 healthy individuals and in 22 patients with chronic obstructive bronchitis by means of bichamber Doppler ultrasonography and direct measurement of venous pressure. The diameter of the veins, blood flow rate, and venous pressure were found to be greatly determined by the intrathoracic pressure variations during the respiration cycle. It is suggested that distention of the peripheral veins, which is the commonly accepted sign of right-ventricular insufficiency, in patients with drastic bronchial obstruction is a consequence of disturbed mechanics of respiration, namely, increase of intrathoracic pressure during expiration, which impairs the return of venous blood to the right parts of the heart.

[Current status of the problem of chronic cor pulmonale]. / Sostoianie problemy khronicheskogo legochnogo serdtsa.

Studies of great number of patients with chronic nonspecific pulmonary disease suggest that high levels of pulmonary hypertension are only observed in cases of pulmonary-arterial thromboembolism and primary pulmonary hypertension. In other pulmonary diseases, the significance of pulmonary hypertension seems to be overestimated, as blood pressure in the pulmonary circulation network has values, indicative of the absence of gross morphologic changes of the vascular bed of the lungs. The available indirect methods for the diagnosis of pulmonary hypertension in chronic nonspecific pulmonary disease patients with rather small blood pressure in the pulmonary circulation network are shown to be of little value. Large functional reserves of the right cardiac ventricle which make it possible to cope with a sudden pressure overstrain (to say nothing of the slowly augmenting one) are pointed out. It follows therefore that either as yet unknown factors contribute to the pathogenesis of chronic pulmonary heart decompensation, or there is virtually no decompensation, while the demonstrated clinical symptoms of systemic circulatory congestion are of extracardiac origin. Various aspects of the assessment of the role of pulmonary hypertension and clinical symptoms of decompensated pulmonary heart will be discussed in the next communication.

[Role of the rise of pressure in the pulmonary artery in the distribution of perfusion and gas exchange in bronchial obstruction]. / Rol' povysheniia davleniia v legochnoi arterii v raspredelenii perfuzii i gazoobmene pri bronkhial'noi obstruktsii.

The experiments on the dogs revealed that the damage of lobar bronchus conduction resulted in the decrease of O2 tension in pulmonary venous blood of this lobe. The decrease in the ventilation and blood flow was found in the zone of obstruction by using tracers 133Xe and 99mTc. The pressure rise in the pulmonary artery caused by the spread of bronchial obstruction is one of the factors promoting the redistribution of perfusion into the reserve zones of lungs. The decrease of pressure by the ganglio-blocking preparation results in the increase of arterial hypoxemia.

[Electro- and phonocardiographic diagnosis of interatrial septal defect and pulmonary hypertension in patients over 20 years old]. / Elektro- i fonokardiograficheskaia diagnostika defekta mezhpredserdnoi peregorodki i legochnoi gipertenzii u bol'nykh starshe 20 let.

Combined findings in 89 patient over 20 with an interatrial septum defect (IASD) have shown that the frequency of pulmonary hypertension increases with age. Electrocardiographic criteria of pulmonary hypertension do not allow a reliable diagnosis with pressures below 50 mm Hg. Tone I amplitude, Q - Tone I duration, the extent of splitting and correlation of Tone II components cannot be used as PCG criteria of pulmonary hypertension either. The Q - "systolic murmur peak" interval decreases as pulmonary arterial pressure goes up. Systolic murmur amplitude is not relevant for the diagnosis of either the IASD, or pulmonary hypertension. Diastolic murmurs associated with secondary IASD are a more frequent finding, but show no distinctive features.

[Reaction of the cardiovascular and respiratory systems to physical exertion in secondary interatrial septal defects before and after surgical treatment]. / Reaktsiia serdechno-sosudistoi i dykhatel'noi sistem na fizicheskuiu nagruzku pri vtorichnykh defektakh mezhpredserdnoi peregorodki do i posle khirurgicheskogo lecheniia.

Under similar conditions observations were performed in 157 humans: 9 patients with secondary defects of the interatrial septum (DIS-II), 122 patients within 1-15 years after surgery for the defect in question and 26 healthy humans. In addition to the known disturbances in hemodynamics of the small circulation circle accompanying DIS-II there were also disorders in the large blood circulation circle and respiration. The disorders were most pronounced under physical exercise. After operation the hemodynamics was found to be almost normal. The pattern of response to physical exercise in most operated patients was in full conformity with that of healthy people.