[Catheter-balloon valvuloplasty in mitral valve stenosis (selection of the method of procedure, immediate results and the criteria of patient selection]. / Kateternaia bollannaia val'vuloplastika pri mitral'nom stenoze (vybor sposoba operatsii, neposredstvennye rezul'taty, kriterii otbora bol'nykh.

Catheter-balloon valvuloplasty (CBV) was carried out in 80 patients with rheumatic mitral stenosis, whose ages ranged from 22 to 68 years. Seventeen of these patients were operated on for mitral valve restenosis; I-II degree calcinosis of the mitral valve was revealed in 18 patients; seven women underwent surgery in the 24th-32nd week of pregnancy. After applying various methods (19 cases) the authors used in the last series of operations (61 cases) the Silin-Sukhov method using an original dilatation catheter with a balloon measuring in diameter up to 34 mm, which allowed pressure of up to 8 atm. to be produced during a working cycle no longer than 8 sec. As the result of CBV, the area of the mitral orifice was enlarged by no less than twice in all patients, the pressure gradient through the mitral valve and systolic pressure in the pulmonary artery reduced. The total number of complications which called for operative treatment was 3.75%. CBV is a still developing method, but already today it may be considered the method of choice in the treatment of uncomplicated forms of mitral stenosis, in I-II degree calcinosis, and when the risk of the traditional surgical intervention on the heart is increased.

[Treatment of mitral valve stenosis in pregnant women by the method of balloon valvuloplasty]. / Lechenie mitral'nogo stenoza u beremennykh sposobom kateternoi ballonnoi val'vuloplastiki.

Catheter-balloon mitral valvuloplasty was performed in 7 females with rheumatic mitral stenosis on the 19th-32nd week of pregnancy. Four patients were operated on with signs of cardiac insufficiency, two--in a state of pulmonary pre-edema. Edema of the lungs in one patient continued developing on the operating table. The results of the treatment were good in all cases. The area of the mitral orifice increased from 0.9-1.75 to 2.4-3.5 cm2. The pressure gradient between the left atrium and the left ventricle dropped from 25-40 to 2-8 mm Hg. This was attended by the disappearance of the diastolic murmur and the clinical manifestations of stasis in pulmonary circulation in all patients. The development of mitral regurgitation after the operation was not encountered in any of the patients. The period of roentgenoscopy lasted 17.5 min. on the average. Screens were used to protect the fetus from the direct effect of the X-rays. Pregnancy ended in delivery in 6 patients; spontaneous labor at term occurred in 4, cesarean section had to be performed in one patient with placenta previa; one woman gave birth to twins on the 36th week of pregnancy. All the babies were healthy. Catheter-balloon valvulotomy does not yield to closed mitral commissurotomy in efficacy. The fact that it is only mildly injurious and does not need general anesthesia make this intervention preferable for pregnant women suffering from mitral stenosis.

[Morphofunctional criteria for the selection of patients with ischemic heart disease and associated arterial hypertension for surgical treatment]. / Morfofunktsional'nye kriterii otbora stradaiushchikh ishemicheskoi bolezn'iu serdtsa o soputstvuiushchei arterial'noi gipertoniei dlia khirurgicheskogo lecheniia.

After examination of 255 patients with ischemic heart disease (IHD) and concomitant arterial hypertension (AH) two groups were distinguished according the level of arterial pressure. Group 1 was formed of 89 patients (arterial pressure below 180/80 mm Hg), group 2--of 166 patients (arterial pressure above 180/100 mm Hg). Survival was determined according to certain morphofunctional indices (total affection of coronary arteries, left ventricular output fraction, left ventricular end diastolic pressure, tolerance to physical effort) in nonoperated on and operated on patients suffering from IHD and concomitant AH. It was found that the operation affects positively the "quality" of life more than the survival.

[Coronary circulation in patients with ischemic heart disease with various degrees of arteriosclerosis obliterans of the leg during selection surgical treatment]. / Sostoianie koronarnogo krovobrashcheniia u bol'nykh ishemicheskoibolezn'iu serdtsa s razlichnoi stepen'iu stenoziruiushchego ateroskleroza sosudovnizhnikh konechnostei pri otbore k khirurgicheskomy lecheniiu.

First in the literature, the relationship between the coronary and lower limb circulation is detailed on the basis of objective findings. Comparison of the two patient groups (the patients categorized according to the degree of lower limb ischemia revealed by Doppler ultrasound echocardiography) in respect to the clinicomorphofunctional characteristics of the coronary flow in IHD patients suggested the absence of a significant correlation between them. Varying severity of lower limb ischemia does not influence the gravity of IHD manifestation in the same patients.