[The mechanisms of the adaptation of the cardiovascular system to physical loading in patients with arterial hypertension in the late periods following the hemodynamically adequate correction of aortic coarctation]. / Mekhanizmy adaptatsii serdechno-sosudistoi sistemy k fizicheskoi nagruzke u bol'nykh s arterial'noi gipertoniei v otdalennye sroki posle gemodinamicheski adekvatnoi korrektsii koaktatsii aorty.

Arterial hypertension was detected in 40 (59.7%) of 67 patients operated on for aortic coarctation. The patients' age ranged from 15 to 35 years. The hypertensives whose physical working capacity corresponded to that of healthy persons showed no increase in stroke index and an inadequate rise of cardiac index with preserved left ventricular in tropic function and high specific peripheral resistance developed due to irreversible structural changes in the vascular bed. Hence, an elevation in blood pressure is due to high peripheral resistance. To make recommendations on exercises for patients undergoing aortic coarctation resection bicycle ergometric test should be performed along with studies of hemodynamic parameters.

[Arterial hypertension in the late period after the hemodynamically adequate correction of aortic coarctation]. / Arterial'naia gipertoniia v otdalennye sroki posle gemodinamicheski adekvatnoi korrektsii koarktatsii aorty.

The paper is concerned with a study of arterial hypertension in the long-term periods after the resection of coarctation of aorta in 77 patients aged 6 to 35 years. The complex of the patients' examination included bicycle ergometry. Arterial hypertension was revealed in 59.7% of the patients. In 83.2%, adequate correction was performed, in 16.8%, recoarctation was suspected. The rate of the development of hypertension in the operated under 16 years depends on the grade of the systolic AP increase before the operation. In those operated on in the older age, the rate of arterial hypertension depended on the time elapsed after the operation and the age by the moment of examination. In 50% of arterial hypertension patients, the work fitness corresponds to that in healthy subjects, in 28%, it constitutes 75% of the level seen in healthy subjects, and in 22%, it is low. Indications for operation in persons under 16 years rest on the grade of the arterial pressure increase; in the older age, indications are not dependent on the arterial pressure level.

[Changes in the functional state of patients after radical correction of tetralogy of Fallot]. / Dinamika funktsional'nogo sostoianiia bol'nykh posle radikal'noi korrektsii tetrady Fallo.

The authors studied the changes in the functional condition of patients in the immediate and long-term periods after radical correction of Fallot's tetralogy. The values of the heart pumping and contractile functions at rest and during bicycle ergometer exercise were studied by tetrapolar chest rheography; oxygen consumption was studied by spirometry. Thirty patients were examined in the early postoperative period and then 6 and 12 months after the operation. The values were compared with those in healthy children. It is shown that 12 months after the operation the clinical condition improves, the physical capacity for work increases, and the exercise response is more adequate. Adequacy of the correction of the anomaly is the main determinant of the patients' functional condition by this time.

[Physical rehabilitation using bicycle ergometry training of patients after aortic valve replacement]. / Fizicheskaia reabilitatsiia metodom veloérgometricheskikh trenirovok bol'nykh posle protezirovaniia aortal'nogo klapana.

After prosthetics of the aortal valve 30 patients underwent bicycle ergometry training at the sanatorial stage of rehabilitation. 10 patients who did not undergo bicycle ergometry training made up the control group. The efficacy of bicycle ergometry training was assessed according to the time-course of changes in pump and contractile functions of the heart and oxygen consumption at rest and during bicycle ergometry. Transfer of the patients to a higher functional class, a decrease in the number of threshold reactions, attainment of a higher heart rate and a higher oxygen consumption, capacity for an increase of the stroke index up to the load of 1.0 W/kg and of the level of the myocardial reserve up to 1.5-2.0 W/kg were used as criteria for the effectiveness of bicycle ergometry training. The effectiveness of bicycle ergometry training is also supported by the data obtained on comparison of the findings in the main and control groups.

[Use of spirometry and bicycle ergometry in the assessment of the stability of mitral valve bioprosthesis]. / Ispol'zovanie spiroveloérgometrii dlia otsenki stabil'nosti rezul'tatov bioprotezirovaniia mitral'nogo klapana serdtsa.

Muscular and cardiac performance was assessed a spirometry and bicycle ergometry in two groups of patients aged 25-55 with mitral xenobioprostheses functioning normally. 36 patients were examined 1-3 years following surgery (group I), 23 patients in 3.5-8 years. Functional results were found not inferior in group II. Stable parameters were more characteristic for patients having preoperative functional classes I-III.

[Functional assessment of the state of patients after Fontan's operation]. / Funktsional'naia otsenka sostoianiia bol'nykh posle operatsii Fontena.

A bicycle ergometric test was performed in 27 patients 2.5 months to 5 years after Fontana's operation in order to study their physical working capacity and major parameters for cardiac pump and contractile functions by tetrapolar chest rheography and those for external respiration. In the early periods following the surgery, the patients showed a low physical working capacity with a respective reduction in the pump and contractile functions of the heart. In the late periods, in addition to positive clinical dynamics, there was an improvement of functional parameters for the cardiorespiratory system. The status in the majority of patients was steady-state for more than 2 years after the surgery.

[Functional state of the cardiorespiratory system in healthy children at rest and during the bicycle ergometry test]. / Funktsiia kardiorespiratornoi sistemy u zdorovykh detei v pokoe i pri veloérgometricheskoi nagruzke.

Altogether 25 healthy untrained children aged 9 to 12 years were examined. There were 11 boys and 14 girls. The following parameters were measured at rest and during bicycle ergometry: the heart rate, oxygen consumption, pulmonary ventilation, metabolic units, the ratio of oxygen consumption increment, oxygen pulse, stroke and cardiac indices, index of the Q-Z interval and work fitness. The ECG was recorded as well. During exercise, adequate reaction of the cardiorespiratory system was characterized by linear growth of the heart rate, cardiac index and oxygen consumption together with a proportional shortening of the Q-Z interval. At all levels of exercise the girls manifested more pronounced chronotropic stimulation, leading to the attainment of the submaximal heart rate (1.5 Watt/kg). On chronotropic delay overtension of inotropic function was demonstrable in children exposed to high loads, which was accompanied by restriction of the cardiac index growth.

[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.

[Rehabilitation of patients after heart surgery: experience and problems]. / Reabilitatsiia kardiokhirurgicheskikh bol'nykh: opyt i problemy.

The problem of rehabilitation of cardiac surgical patients is of great humane and socioeconomic significance. Over years, a great scientific and practical experience has gained in rehabilitating patients with acquired and congenital heart diseases after surgical correction. Stages of rehabilitation, a complex of medical, somatic, psychological, and socio-occupational measures are specified. Substantial shortcomings in medical labour examination of operated patients lead to an increase in the number of disabled persons. There is a lag in the study into the problem of patients with coronary heart disease after aortocoronary bypass.

[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.

[Evaluation of the cardiorespiratory system during rehabilitation of patients after prosthesis of the mitral and annuloplasty of the tricuspid valves]. / Otsenka funktsii kardiorespiratornoi sistemy v protsesse reabilitatsii bol'nykh posle protezirovaniia mitral'nogo i annuloplastiki trikuspidal'nogo klapanov.

Twenty-five patients undergoing rehabilitation for 2 to 3 years after surgery were examined. External respiratory parameters were investigated by means of bicycle spiroergometry, and the pump and contractile functions of the heart were assessed using tetrapolar chest rheography. In addition to positive clinical developments and improved functional class, physical working capacity of the patients was found to be increased. External respiratory function was improved accordingly. The efficacy of surgical correction of the defect was evidenced early after surgery by the normalization of minute flow volume and only slightly reduced stroke volume at rest. Hemodynamic support of physical working capacity that increases progressively in the course of rehabilitation is characterized by overstrain of inotropic mechanisms, uneconomically increased minute volume, and insufficiently increased stroke volume, mostly due to the incompetence of the Frank-Starling mechanism associated with tachycardia that is inadequate to the effort.

[Evaluation of the pump and contractile functions of the heart in healthy persons by tetrapolar chest rheography]. / Otsenka nasosnoi i sokratitel'noi funktsii serdtsa u zdorovykh metodom tetrapoliarnoi grudnoi reografii.

The central hemodynamics and myocardial contractility were studied in 40 normal untrained men by tetrapolar chest rheography. The response to exercise was studied and compared in subjects with eu- and hypokinetic circulatory types. It was revealed that marked differences in the SI, CI, SPR recorded at rest lessen with exercise increase and disappear at submaximal and maximal levels of exercise at the expense of a higher rate of changes in these parameters in subjects with the hypokinetic circulatory type. The energy and tension adequacy of both types of normal circulation under exercise has been proved. The linear increase in the index of myocardial contractility (Formula: see text) has been shown to be dependent on the exercise rate and to be in a good agreement with an increase in the MV (r = 0.82), which is highly informative.

[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.