[Experience in the use of Soviet-made disk prostheses EMIKS and LIKS]. / Opyt primeneniia otechestvennykh diskovykh protezov EMIKS i LIKS.

Experience in the application of and disc prostheses in 614 patients in generalized. Mitral prosthetics was conducted in 256, aortic in 229, and mitral++-aortic in 129 patients. Hospital lethality was, respectively, 3.9, 4.8, and 8.5%. In postoperative follow-up periods of up to 7 years 92.1% of patients were examined. Survival was 88.1 +/- 0.71% in the mitral, 87.0 +/- 0.62% in the aortic, and 80.2 +/- 0.84% in the mitral-aortic group. No thromboembolic complications occurred in 88.7 +/- 0.64%, 96.9 +/- 0.31%, and 88.3 +/- 0.68% of patients, respectively. In the mitral position the mid-diastolic gradient was 4.0 +/- 0.31 mm Hg on the prosthesis and 3.8 +/- 0.82 mm Hg on the prosthesis; in the aortic position the peak systolic gradient was, respectively, 23.2 +/- 0.58 and 22.4 +/- 0.7 mm Hg. At the time of examination 97% of patients belonged to I and II functional classes.

[Bicycle ergometry training during the sanatorium stage of patient rehabilitation after insertion of aortic valve prosthesis]. / Veloérgometricheskie trenirovki na sanatornom étape reabilitatsii bol'nykh posle protezirovaniia aortal'nogo klapana.

A sanatorium stage in the rehabilitation of patients who have aortic valve prosthesis is of great importance. The impact of bicycle ergometric trainings on these patients' physical rehabilitation had been little studied. Bicycle ergometric testing prior to and following the training and examination of external respiratory parameters enabled their efficiency to be increased. Bicycle ergometric trainings were demonstrated to improve the patients' status, to increase their physical working capacity, to result in a positive dynamics in heart rates and oxygen consumption. Following 1 year, the patients who had had trainings showed higher physical fitness for work, better indices in oxygen consumption, oxygen pulse, and metabolic units.

[Mechanisms of adaptation of the cardiorespiratory system to physical loads in cardiosurgical patients]. / Mekhanizmy adaptatsii kardiorespiratornoi sistemy k fizicheskim nagruzkam u kardiokhirurgicheskikh bol'nykh.

Problems related to the assessment of systemic oxygen transport and central hemodynamic parameters at exercise tests after surgical correction of congenital and acquired heart diseases are discussed. Several types of adaptation to stress have been identified. Noninvasive direct measurement of cardiac output under stress is shown to be useful as cardiac output values may be different where oxygen consumption levels are similar. It is suggested that the results may be used for functional assessment of surgical outcomes and the choice of treatment and rehabilitation strategy.

[A new approach to the qualitative assessment of the reaction to physical loading during bicycle ergometry of patients following aortic prosthesis]. / Novyi podkhod k kachestvennoi otsenke reaktsii na fizicheskuiu nagruzku pri veloérgometrii u patsientov posle aortal'nogo protezirovaniia.

The paper is concerned with the objectivization of qualitative assessment of a response to exercise testing during rehabilitation of patients after aortic valve replacement. The authors propose methods for a study of hemodynamic provision of submaximum and threshold exercises confirming significantly a higher myocardial reserve in patients after submaximum exercises. Hemodynamic characterization of different types of threshold reactions has shown that a common feature in the majority of patients is a decrease in cardiac ejection during exercise testing, mainly as a result of ino- or chronotropic depletion. A significant increase in the number of submaximum bicycle ergometric exercises is an important criterion of the efficacy of a rehabilitation program.

[Changes in ECG indices and hemodynamics during bicycle ergometry of patients following aortic valve prosthesis]. / Izmeneniia pokazatelei EKG i gemodinamiki vo vremia veloérgometrii u bol'nykh posle protezirovaniia aortal'nogo klapana.

Correlated electrocardiographic and hemodynamic changes have been demonstrated in 60 convalescent patients within 3 years after aortic valve replacement by means of bicycle ergometry (BEM) and simultaneous Kubicek's impedance rheoplethysmography. As electrocardiographic ischemic changes are more frequent during recovery, while their hemodynamic causes are different during and after exercise, BEM load increment should be intermittent in patients with aortic valve prosthesis. Exercise-induced increase of R voltage that was mostly combined with inadequate hemodynamic response and accompanied by ischemic ST depression may be an additional criterion of threshold stress.

[ECG and hemodynamic changes during the bicycle ergometry of patients following aortic valve prosthesis]. / Izmeneniia EKG i gemodinamiki vo vremia veloérgometrii u bol'nykh posle protezirovaniia aortal'nogo klapana.

Interrelated ECG and hemodynamic changes were revealed in an analysis of the results of a bicycle ergometry test (BET) with the recording of ECG in 12 accepted leads and simultaneous impedance rheoplethysmography after Kubichek in 60 patients during rehabilitation for 3 yrs after aortic valve replacement. Impedance-measuring investigation of hemodynamics after physical exercise provided valuable information on causes of ECG changes. More frequent development of ischemic changes during rehabilitation and a variety of hemodynamic causes of changes in physical exercise and in the period of restitution necessitated intermittent BET in patients with a prosthesis of the aortic valve. An increase in voltage of the R wave during BET was combined in most cases with other inadequate hemodynamic reactions and was accompanied by an "ischemic" decrease in ST, and could serve as an additional criterion of threshold exercise.

[Evaluation of patient rehabilitation effectiveness after aortic valve prosthesis based on spiroergometric study data]. / Otsenka éffektivnosti reabilitatsii bol'nykh posle protezirovaniia aortal'nogo kaplana po dannym spiroérgometricheskogo issledovaniia.

Patients after surgery introducing aortal valve prosthesis in cases of rheumatic aortal defect or defect due to bacterial endocarditis were examined using spiro- and bicycle ergometry. Two groups of patients were compared: those subjected to rehabilitation procedures and a control group undergoing no rehabilitation program. Functional results were better in post-rehabilitation patients. By the end of the rehabilitation program, the examined spiroergometric parameters were significantly closer to those of normal subjects, as compared to the controls. Spiroergometric investigation in patients with newly applied aortal valve prostheses supplements clinical data in providing a more profound functional evaluation of surgical results and rehabilitation efficiency.

[Rehabilitation of patients with an aortic valve prosthesis and coronary insufficiency]. / O reabilitatsii bol'nykh s protezom aortal'nogo klapana i koronarnoi nedostatochnost'iu.

The article deals with the problem of coronary insufficiency in patients who underwent operation for aortal valve prosthetics. Dynamic follow-up of patients with prosthesis of the aortal valve for a period of 2 years after the operation showed that signs of coronary insufficiency persist in some of them. These signs restrict the functional possibilities of the patient during entire follow-up period, and coronary insufficiency in some patients is of a latent character. The bicycle ergometry test is a primary importance in detecting latent coronary insufficiency and in appraising the degree of the insufficiency. The more severe the coronary insufficiency, the lower is the tolerance to exercise. It proves possible to reduce the degree of coronary insufficiency and increase tolerance to exercise in most patients during rehabilitation.

[Sinus rhythm restoration in atrial fibrillation after heart valve prosthesis in rheumatic defects]. / Vosstanovlenie sinusovogo ritma u bol'nykh s mertsatel'noi aritmiei posle protezirovaniia klapanov serdtsa pri revmaticheskikh porokakh.

The rehabilitation program for patients who underwent heart valve prosthetics must include restoration of the sinus rhythm. On the basis of the results of electric-pulse therapy and quinidine therapy in 88 patients, it is shown that the first method is more effective than the second, but in view of the sufficient efficacy and safety of quinidine therapy with the use of medium daily doses (not more than 2 g) it may be used in some of the patients. It is advisable to restore the sinus rhythm in periods of 3 months to 3 years after operation on the heart. Restoration of the sinus rhythm improves the general condition of patients after heart valve prosthetics, normalizes hemodynamics, increases the physical capacity for work considerably, and provides greater possibilities for the return of convalescents to their jobs.

[Method of conduction of the veloergometric test in rehabilitation of cardiosurgical patients]. / Metodika provedeniia veloérgometricheskogo testa pri reabilitatsii kardiokhirurgicheskikh bol'nykh.

Determination of the physical working capacity of patients after surgical correction of heart disease and appraisal of the functional condition of the cardiovascular and respiratory systems allow for establishing a program of physical rehabilitation and judge its efficacy during follow-up of the patient. The bicycle ergometry test in cardiosurgical patients has certain features. The submaximum and threshold loads should be distinguished. The use of step-by-step increasing interrupted test is recommended. The duration of the rehabilitation period and delayed reactions are important in appraising the reaction to the load. The use of the extrapolation method in calculating taindications for the bicycle ergometry test for cardiosurgical patients.