[Single-photon emission computed tomography in diagnosis of left ventricular post-infarction aneurysm]. / Odnofotonnaia émissionnaia tomografiia miokarda v diagnostike postinfarktnoi anevrizmy levogo zheludochka.

AIM: To assess value of single-photon emission computed tomography with (99m)Tc-sestamibi ((99m)Tc MIBI SPECT) for detection of post-infarction left ventricular aneurysm in patients with coronary artery disease. MATERIAL: Fifty nine patients were operated upon because of coronary heart disease. In 27 patients with post-infarction left ventricular aneurysm modified Dor operation (aneurysmectomy with endoventricular circular patch plasty reconstruction) was performed. In 24 patients with extended cardiosclerosis direct myocardial revascularization was conducted. RESULTS AND CONCLUSION: Comparison of (99m)Tc MIBI SPECT data obtained at rest and during dobutamine stress test revealed some diagnostic features characteristic of patients with left ventricular post-infarction aneurysm. Quantitative and qualitative assessment of viability of myocardium in basal and "borderline" zones influenced not only the volume of revascularization, it was important for preliminary determination of post-infarction left ventricular aneurysm resection level, selection of type of plasty, prognostication of complications in immediate and remote postoperative periods.

[Ganglion block in cardiopulmonary bypass surgery]. / Ganglionarnaia blokada pri operatsiiakh na serdtse s iskusstvennym krovoobrashcheniem.

Ganglion blockers increase the antinociceptive defense in anesthesiological support of cardiopulmonary bypass operations for mitral and aortic valve failure. Benzohexonium decreased total peripheral vascular resistance, increased cardiac and stroke indexes, and increased systolic potency of the heart. Ganglionar blocking was associated with an increase of systemic oxygen transport, arrhythmias developed rarely, blood concentrations of epinephrine, norepinephrine, ACTH, vasopressin, and leukinferon were lower.

[Brain protection in open heart surgery in patients with infective endocarditis]. / Zashchita golovnogo mozga pri operatsiiakh na otkrytom serdtse u bol'nykh infektsionnym éndokarditom.

Effect of nimotope on cerebral metabolism and incidence of mental disorders in patients operated on under forced ventilation of the lungs (FVL) was studied in 32 patients subjected to replacement of mitral and aortic valves for infective endocarditis. Nimotope was used for preventing hypoxic disorders of the CNS. The drug was injected starting from the stage of operation before FVL. Cerebral hypoxia was diagnosed using lactate-oxygen index (LOI) and other cerebral metabolic coefficients. LOI increased in all patients immediately after FVL, being much higher in the patients without cerebral protection. Moreover, numerous neurotic and mental disorders were observed in this group of patients during the early postoperative period. By contrast, no mental disorders, disorders of memory or attention were detected in the patients treated with nimotope. These data indicate that nimotope decreases the unfavorable effect of FVL on the CNS function in patients with infective endocarditis. The difference of lactate content in arterial blood and in the internal jugular vein bulb and LOI can be used for the diagnosis of brain ischemia in heart surgery with FVL.

[The characteristics of the anesthesiological support for surgical interventions in patients earlier operated on the heart]. / Osobennosti anesteziologicheskogo obespecheniia khirurgicheskikh vmeshatel'stv u bol'nykh, ranee operirovannykh na serdtse.

The article presents an analysis of the authors' experiences with anesthesiological maintenance of operations on patients after revascularization of the myocardium, implantation of permanent cardiostimulant and heart value prosthesis. Main risk factors responsible for severe complications were found to be congestive heart failure, myocardial infarction which took place 6 months before the operation, certain forms of arrhythmias, unstable stenocardia, pronounced stenosis of the aortic valve, age older than 70 years, diabetes mellitus. The comprehensive preoperative preparing, choice of the adequate methods of anesthesia and maintenance of the up-to-date intraoperative monitoring create the conditions for a less risk of the surgical treatment.

[The ultrastructure of the blood-air barrier and of the large (granular) epitheliocytes (type-2 alveolocytes) in patients with acquired defects and ischemic heart disease before and after surgical treatment]. / Ul'trastruktura aérogematicheskogo bar'era i bol'shikh (granuliarnykh) épiteliotsitov (al'veolotsitov vtorogo tipa) u bol'nykh c priobretennymi porokami i ishemicheskoi bolezn'iu serdtsa do i posle khirurgicheskogo lecheniia.

Ultrastructure of air-hematic barrier and efficiency of alpha-tocopherolum use for prophylaxis of toxic effect of oxygen used for artificial pulmonary ventilation (APV) and oxygenation of blood outside lungs were studied in 27 patients with mitral and aortal valve diseases and ischemic disease before the operation and on its stages. Macroscopically unchanged lung regions were studied before the heart-lung apparatus switching, 40-45 minutes after clamping the artery in conditions of disturbed blood circulation and 10 minutes after hemostation in pulmonary artery. 6 patients were treated with 100% oxygen for 30 minutes before APV finishing while the other 6 previously received alpha-tocopherolum. Disturbance of the structure of the outermost cell membrane in type I alveolocytes and endotheliocytes, widening of basal layers and their fibers and disorders in the osmiophilic lamellar bodies were established to determine the severity of condition of patients with mitral valve diseases.

[A comparative evaluation of the changes in the lungs during open-heart operations using contact and membrane oxygenators]. / Sravnitel'naia otsenka izmenenii v legkikh pri operatsiiakh na otkrytom serdtse s ispol'zovaniem kontaktnykh i membrannykh oksigenatorov.

A comparative investigation of ultrastructural changes in the lungs of 28 cardiosurgical patients operated upon under conditions of bubble and membrane oxygenation of blood has established that the following trends are perspective for lessening the disturbances of the lung ultrastructure in operations on the open heart: shorter time of the first parallel blood flow when using bubble oxygenation, less trauma of the heart during artificial blood circulation due to the improved perfusion system, realization of the conditions of extrapulmonary oxygenation of blood, responsible for the prevention of hypoxic injuries of the lungs.

[Excretory function of the kidneys during artificial circulation in patients operated on for acquired heart defects]. / Vydelitel'naia funktsiia pochek vo vremia iskusstvennogo krovo- obrashcheniia u bol'nykh, operirovannykh po povodu priobretennykh porokov serdtsa.

The authors have shown that the suppression of the excretory function of the kidneys during the period of artificial circulation is considerably dependent on the concentration of vasopressin in blood and the associated spasm of renal vessels. The use of morphine as the main medicine for general anesthesia with the dose of 3 mg/kg as compared with the dose 2 mg/kg, gives less level of vasopressin in blood and thus reduces symptoms of antidiuresis in response to the action of strong stressogenic factors.