[Early postoperative hyperlactatemia in patients after surgery under extracorporeal circulation].

Metabolic disturbances, such as changes in blood acid-base balance and electrolytic composition; hyperglycemia and hyperlactatemia, are frequent factors that complicate the early postoperative period in patients after cardiac surgery under extracorporeal circulation. The purpose of the study was to estimate the incidence of hyperlactatemia in the early postoperative period and to reveal the predictors of its occurrence. This prospective study was conducted in our center from November 14, 2006, to September 1, 2007. The study covered 270 patients above 15 years of age, who had been operated on for coronary heart disease, acquired heart diseases, and combined lesions of valves and coronary arteries. Hyperlactatemia was observed in a substantial proportion of patients who had been operated on under extracorporeal circulation. Correlation analysis indicated a significant association between the duration of extracorporeal circulation and the magnitude of hyperlactatemia developing in the early postoperative period. Hyperglycemia with a glucose level of > 9 mmol/l is a predictor of the development of hyperglycemia.

[Cardiac autotransplantation in a patient with congestive heart failure].

Congestive heart failure with intact or moderately lowered left ventricular pump function is caused in some patients by mitral regurgitation. Consequences are dilation of the left atrium, pulmonary hypertension, tricuspid regurgitation, thromboembolic complications, rhythm disturbances, elevated risk of sudden death. Efficacy of drug treatment, electroimpulse therapy is little and surgery is the method of choice. One of alternatives is cardiac autotransplantation. A successful experience of application of this technique is presented. Cardiac autotransplantation was carried out in a female patient with moderately lowered left ventricular contractile function, extreme degree of mitral and tricuspid regurgitation, atriomegaly, atrial fibrillation and pronounced signs of congestive heart failure.

[Autotransplantation of the heart as the method of treatment of congestive heart failure].

Congestive heart failure with preserved or moderately lowered left ventricular pump function in some patients is caused by mitral regurgitation. Its consequences are left atrial dilation, pulmonary hypertension, tricuspid regurgitation, thromboembolic complications, disturbances of rhythm with elevated risk of sudden death. As efficacy of drug treatment and electroimpulse therapy is small surgery is the method of choice and one of alternatives - autotransplantation of the heart. Here we present a successful experience of application of this technique in a patient with moderately lowered left ventricular function, extreme degree of mitral and tricuspid regurgitation, atriomegaly, atrial fibrillation, and pronounced manifestations of congestive heart failure.

[A comparative assessment of the myocardium protection by methods of blood and crystalloid cardioplegia in patients with high risk of coronary bypass grafting operation]. / Sravnitel'naia otsenka zashchity miokarda metodami krovianoi i kristalloidnoi kardioplegii u bol'nykh s vysokim riskom operatsii koronarnogo shuntirovaniia.

A comparative assessment of specific features of the intraoperative and early postoperative periods was made using antegrade blood and crystalloid cardioplegia during coronary artery bypass grafting operation in 100 patients with ischemic heart disease with a fraction of expulsion of the left ventricle of the heart < 0.5. Using the blood cardioplegia has allowed the need in inotropic support to be lowered at the isolated coronary artery bypass from 29.7% to 11.8%, and at a combination with the resection of the left ventricular aneurysm from 66.7% to 36.4% respectively in the control and main groups. The results obtained suggest that the proposed technique of blood cardioplagia has essential advantages over crystalloid cardioplegia in the coronary shunting of patients with a severe and complicated course of ischemic heart disease.