Three clinical methods of circulatory assistance.

Three clinical methods of circulatory assistance are described: intraaortic balloon counterpulsation, left ventricular bypass using a roller pump, and the artificial ventricle. All three methods have hemodynamic effectiveness. The first method is indicated in cases of widespread cardiosclerosis and pronounced coronary insufficiency and may be contraindicated in pathology of the valvular apparatus. The second method demonstrated a temporary positive effect in patients in whom it was not possible to discontinue artificial circulation. The artificial ventricle is useful in treating patients with cardiogenic shock following cardiac surgery.

[Surgery of complicated aneurysms of the abdominal aorta]. / Khirurgiia oslozhnennykh anerizm abdominal'noi aorty.

Results of the surgical treatment of 107 patients with a complicated aneurysm of the abdominal aorta are presented. The general lethality for the period from 1966 to 1984 was 49,5%. In the recent years the postoperative lethality in patients with ruptured aneurysms has been reduced from 79,4% to 47,2%, in patients with threatening ruptures from 41,6% to 16%. The positive changes were due to a number of factors: less amount of prehospital diagnostic errors; earlier admission to the hospital, better urgent diagnosis of the abnormality by up-to-date non-invasive methods of examination (ultrasonic scanning, computer tomography, radionuclide angiography); using balloon catheters obturating the aorta above the ruptured aneurysm for temporary preoperative arrest of bleeding; selection of a less traumatic method of operation of the aneurysm resection without dissection of the aorta with intra-aortal prosthesis specific under conditions of the HBO-operating room; better resuscitation and anesthesiologic aid for this critical category of patients.

[Our experience with the surgical treatment of renovascular hypertension]. / Nash opyt khirurgicheskogo lecheniia vazorenal'noi gipertenzii.

The experience with 785 operations performed for the period from 1962 to 1983 on 697 patients is presented. The advantage of direct reconstructive operations over restorative interventions with the employment of explantation materials is proved. In the remote period after operation positive results were noted in 85% of patients with fibrose-muscular dysplasia of renal arteries and in 70% of patients with non-specific aorto-arteritis.

[Surgical treatment of recurrent renovascular hypertension]. / Khirurgicheskoe lechenie retsidiva vazorenal'noi gipertenzii.

The article analyzes the results of surgery for a recurrence of vasorenal hypertension developing as a result of an impaired major blood flow in the operated on renal artery. The main causes of the blood flow impairment in the immediate postoperational period included an expansion of indications for the primary reconstructive operation or technical drawbacks during the operation itself whilst in the long-term post-operational period the progression of the underlying disease was the principal culprit. Repeated operations on the renal arteries were performed in 19 patients, and in 28 patients surgery consisted of secondary nephrectomy. Good and satisfactory results after repeated reconstructive operations on the renal arteries were obtained in 73.3% of the cases. The operation of choice in repeated interventions is the autovenous prosthesis of the renal artery.

[Iatrogenic injuries of the major vessels]. / Iatrogennye povrezhdeniia magistral'nykh sosudov.

Jatrogenic injuries of the major vessels during performing intravascular instrumental examinations and different operative procedures are known to be dangerous and severe complications and make 22,4% of the total number of patients with traumatic injuries of the vessels. The early reconstructive operation is considered to be a basis of the surgical tactics for this pathology facilitating the re-establishment of the major blood flow in 78,4% of patients. The total lethality made up 7,2%. Better result of the operative treatment of jatrogenic injuries of major vessels is dependent on early diagnosis and timely aid.

[Stellectomy in patients with ischemic heart disease and only slightly changed coronary arteries]. / Operatsiia stelléktomii u bol'nykh ishemicheskoi bolezn'iu serdtsa pri maloizmenennykh koronarnykh arteriiakh.

A group of coronary patients were identified who coronarographically showed no or only minor lesions of main coronary arteries (hemodynamically insignificant stenosis of up to 50% of vascular lumen). The results of stellectomy performed in 71 such patients are reported. To achieve good surgical results, primary focus should be on accurate diagnosis of coronary disease using specialized techniques: coronary arterial scanning to assess myocardial microcirculation, and the measurement of lactic acid arterial-venous difference under atrial electrostimulation to assess metabolic manifestations of myocardial ischemia. With adequate selection of patients, precise determination of indications and adherence to the surgical procedure described, early post-operative results were good in 94.37% and late results in 73.22% of the patients.

[Surgery of extracranial aneurysms of the carotid and vertebral arteries]. / Khirurgiia ékstrakranial'nykh anevrizm sonnykh i pozvonochnykh arterii.

An analysis of the literature and personal observations of 27 patients with extracranial aneurysms of the arteries enabled the authors to determine clinical symptoms, methods of diagnosis and surgical treatment of the disease. Resection of the aneurysm with suturing the artery defect is recommended as optimal techniques of the operation for posttraumatic aneurysms, resection with the end-to-end anastomosis being proposed for a true aneurysm of the aorta arch branches.