[Load tests in silent myocardial ischemia and latent heart failure in patients with IHD and intermittent claudication]. / Nagruzochnye proby pri bezbolevoi ishemii miokarda i skrytoi serdechnoi nedostatochnosti u bol'nykh IBS i peremezhaiushcheisia khromotoi.

244 patients with ischemia of the lower limbs were treated surgically in the specialized cardiovascular center. No lethal outcomes were reported because previously derived algorithm of detecting silent myocardial ischemia in patients with intermittent claudication and load tests (bicycle ergometry and drug stress tests) had allowed the surgeons to ascertain the extent of coronary damage and detect subclinical cardiac failure. Valid assessment of cardiac factors enabled the right choice between surgical and therapeutic methods and staging of the procedures.

[Arrhythmia in patients with ischemic heart disease and indications for surgical treatment]. / Narusheniia ritma u bol'nykh ishemicheskoi bolezn'iu serdtsa i pokazaniia k khirurgicheskomu lecheniiu.

The authors analysed 171 patients with ischemic heart disease (IHD) and life-threatening and non-threatening arrhythmias before and after surgical treatment. The control group was composed of 34 patients with IHD (of a similar severity of the principle disease) but without arrhythmias. Life-threatening arrhythmias of the third arrhythmic group persisted even after effective revascularization of the myocardium and resection of the aneurysm. To reveal the zones of elective instability in this group of patients preoperative electrophysiological examination must be conducted with programmed stimulation of the heart for subsequent simultaneous correction of coronary circulation and the conducting system of the heart. Inoperable patients suffering from IHD with threatening arrhythmias (according to coronary pathology) are considered, in the absence of contraindications on the part of the viscera, to be potential recipients for heart transplantation. Patients with IHD and non-threatening arrhythmias should be kept under observation and given corrective drug therapy. The question concerning their operative treatment is decided upon according to the standard indications for IHD.

[Surgical treatment of rhythm disorders with simultaneous correction of heart valve defects]. / Khirurgicheskoe lechenie narusheniia ritma s odnovremennoi korrektsiei porokov klapanov serdtsa.

Twenty-five patients (14 males and 11 females aged 11 to 45 years) with rhythm disorders and valvular defects were operated on. Supraventricular paroxysmal tachycardia was the most common of rhythm disorders occurring in 15 cases, with Ebstein's anomaly in 11, mitral valve incompetence in 2, combined mitral defects in 1 and aortic stenosis in 1 of those. Atrial fibrillation was recorded in 7 patients, with Ebstein's anomaly in 2, mitral stenosis in 2, mitral incompetence in 2 and mitral prolapse in 1 of those. Nodal tachycardia was found in 1 patients with Ebstein's anomaly and in 1 patient with mitral valve incompetence. Left-ventricular tachycardia was diagnosed in a female patient with mitral prolapse. The operations were simultaneous and comprised two steps; they were performed under extracorporeal circulation and drug- and cold-induced cardioplegia, with the elimination (surgical interruption) of accessory conduction pathways or removal of arrhythmogenic areas as the first step, and reconstructive surgery on heart valves as the second step.

[Late results in surgically and non-surgically treated ischemic heart disease patients with arrhythmias in relation to the extent of the myocardial lesion]. / Otdalennye rezul'taty u neoperirovannykh i operirovnnykh bol'nykh ishemicheskoi bolezn'iu serdtsa s aritmiiami v zavisimosti ot stepeni porazheniia miokarda.

A total of 269 coronary patients with arrhythmias were followed up for 6 months to 12 years. Coronaroventriculography was performed in 264 patients. The five-year survival rate was shown to be directly proportionate to the site and spread of postinfarction cardiosclerosis in arrhythmic coronary patients. In patients with aneurysms of the heart, it was 40.6%, with a further decline over the years. Left-ventricular final diastolic pressure (FDP) and outflow fraction is an objective indicator of myocardial contractility. Five-year survival is 69.3% in cases of the normal FDP, and drops significantly (by 20 %) where it is elevated. As a rule, survival rates were much higher in postoperative patients (following aortocoronary shunts or left-ventricular aneurysm resections), irrespective of myocardial contractility values.

[Fate of ischemic heart disease patients depending on the nature of the coronary artery lesion]. / Sud'ba bol'nykh ishemicheskoi bolezn'iu serdtsa v zavisimosti ot kharaktera porazheniia koronarnykh arterii.

The natural course of ischemic heart disease was followed up in 240 patients in periods of 1 to 7 years (average follow-up period 3 years). In all patients the character of affection of the coronary arteries was verified by angiography. The coronary arteries were normal or had mild changes in 27 patients. Obstruction of arteries (50 to 100%) was found in 189 patients. The study made it possible to establish the prognostic significance of angiographic and clinical data. Survival was highest when the coronary arteries were normal or only mildly changed as well as in isolated affection of a single artery. The disease followed a severe course with high mortality in involvement of three coronary arteries with grade III--IV stenosis.