[State of the hypophyseal-adrenal system during surgical correction of heart defects under various anesthesiological methods and at distant periods after surgery]. / Sostoianie gipofizarno-nadpochechnikovoi sistemy pri khirurgicheskoi korrektsii porokov serdtsa v usloviiakh razlichnogo anesteziologicheskogo obespecheniia i v otdalennye sroki posle operatsii.

The concentration of 11-HOCS in the blood plasma was measured in 278 patients with heart diseases operated on under various anesthesias at different stages of surgical correction of the defects and in the immediate postoperative period. Plasma ACTH level was measured in 137 of these operated on under deep hypothermia and hypothermal perfusion. The hormonal response was the most expressed in patients operated on under normothermia, whereas in patients exposed to hypothermia the reaction was minimal. 141 patients were examined in remote periods after surgery. Blood plasma 11-HOCS level was normal in the cases with good and satisfactory results of surgical treatment, whereas in those with poor results it was higher or lower than normally.

[The state of the hypophyseal-adrenal system during surgical correction of heart diseases under conditions of different anesthesia and in distant periods after surgery]. / Sostoianie gipofizarno-nadpochechnikovoi sistemy pri khirurgicheskoi korrektsii porokov serdtsa v usloviiakh razlichnogo anesteziologicheskogo obespecheniia i v otdalennye sroki posle operatsii.

Blood plasma levels of 11-HOCS were measured in 278 patients with heart diseases operated on under different anesthesia at various stages of surgical correction of the diseases and during the immediate postoperative period. Blood plasma ACTH levels were measured in 137 patients operated on under deep hypothermal protection and hypothermal perfusion. The most manifest hormonal response was observed during surgery under normothermia, whereas under conditions of hypothermal perfusion the reaction to intervention was the minimal. A total of 141 patients were examined in remote periods after surgery. Blood plasma 11-HOCS levels were normal in patients with good and satisfactory results of surgical treatment and increased for decreased in those with unsatisfactory results.

[Characteristics of carbohydrate metabolism regulation during correction of congenital heart defects and hypothermic protection without perfusion]. / Osobennosti reguliatsii metabolizma uglevodov pri korrektsii vrozhdennykh porokov serdtsa v usloviiakh besperfuzionnoi gipotermicheskoi zashchity.

Carbohydrate metabolism and insulin status have been studied in 89 patients with congenital heart valve defects operated on in conditions of profound perfusion-free hypothermic protection. It has been established that anesthesia, hypothermia, and surgical trauma are accompanied by hyperinsulinemia, which had nothing to do with the introduction of exogenic hormone. Insulin effect is attenuated and insulin resistance develops, which leads to a drop not only in glucose consumption but also in the consumption of glycolysis products. Single insulin injection during induction to anesthesia at a dose of 0.5 U/kg was insufficient for normalization of carbohydrate homeostasis. Glycolysis activation with a considerable increase in blood pyruvate level has been observed, which decreases lactate/pyruvate coefficient informative value at different stages of surgical treatment of heart valve defects.

[Hormonal regulation during cardiac surgery operations on the "dry" heart]. / Sostoianie gormonal'noi reguliatsii pri kardiokhirurgicheskikh operatsiiakh v usloviiakh "sukhogo" serdtsa.

Central and peripheral compartments of hypophyseo-adrenal regulation, the state of renin-angiotensin-aldosterone system (RAAS) and thyroid-stimulating functions of hypophysis have been assessed in 72 patients with heart valve defects operated under profound hypothermal perfusion. It has been established that cardiopulmonary bypass surgery with profound hypothermia is accompanied by moderate and reversible changes in the above parameters. The activity of hypophyseo-adrenal system and RAAS reaches the maximum during a warming-up period and then gradually decreases. TSH content considerably decreases in the early postoperative period. Cardiopulmonary bypass surgery with profound hypothermia causes more pronounced changes in neurohormonal regulation than heart valve correction under hypothermal perfusion, which might be associated with blood flow arrest in major vessels causing changes in peripheral metabolic processes.

[Characteristics of the adrenocortical reaction of a heart valve prosthesis during non-perfusion hypothermal protection]. / Osobennosti adrenokortika'lnoi reaktsii pri protezirovanii klapanov serdtsa v usloviiakh besperfuzionnoi gipotermicheskoi zashchity.

Correction of acquired diseases of the heart performed under conditions of nonperfusion hypothermal defense (29-28 degrees C) in 68 patients was followed by a moderately pronounced adreno-cortical reaction reaching its maximum in the period of heating and having a tendency to decrease on the third day after operation. The absence of a pronounced relationship between the degree of growth of 11-OCS in plasma, duration of occlusion and continuation of the restorative period confirm the adequacy and effectiveness of the method of hypothermal defense in prosthesis of the heart valves.