[Comparative assessment of hemodynamic parameters in ventricular septal defect, obtained by Doppler echocardiography and catheterization of cardiac cavities]. / Sravnitel'naia otsenka pokazatelei gemodinamiki pri DMZhP, poluchennykh s pomoshch'iu doppleroékhokardiografii i kateterizatsii polosteí serdtsa.

The study was undertaken to assess hemodynamic parameters by Doppler echocardiography in patients with ventricular septal defect (VSD) and pulmonary hypertension. Seventy-two patients aged 5 months to 9 years (mean 2.5 years) who had isolated VSD were examined. The authors conclude that it is possible and necessary to assess hemodynamics in the lesser circulation by using Doppler echocardiography. The method permits monitoring the time course of changes in the right heart, which makes it possible to follow the natural history of disease without applying invasive studies.

[Prosthesis of the aortic valve by a loose allograft]. / Protezirovanie aortal'nogo klapana beskarkasnym allograftom.

A procedure has been developed to prepare live aortic allografts, which consists in taking a valve early after a donor's death, sterilizing it in antibiotics and freezing it to -190 degrees C in the presence of the cryoprotective agent dimethylsulfoxide. The preservation of valve tissue is evidenced by morphological studies. The first 3 operations for aortic valvular diseases were performed. In two cases, the indication for surgery was infectious endocarditis refractory to antibiotic therapy. Postimplantation complications were not seen. The competence of the allograft was confirmed by intraoperative transesophageal echocardiographical study. The patients examined 4 months postoperation developed no signs of aortic incompetence and infectious endocarditis. Thus, the creation of a bank of live valves allows this prosthesis to be implanted with appropriate indications, one of which is active infectious endocarditis of the aortic valve.

Silent myocardial ischemia in patients with essential hypertension.

The aim of this study was to determine the significance of the "coronary factor" in patients with essential hypertension (EH). Electrocardiogram Holter monitoring was performed in 61 patients with EH stage II (according to the World Health Organization criteria). Silent, ie, painless ST-segment depression, was found in 34 patients on whom echocardiography, a treadmill test, and transesophageal pacing were performed. In 21 patients with EH and silent ischemia, the examination included 201Tl stress scintigraphy, coronary angiography, and a platelet aggregation test. In 15 patients, catecholamines and beta-endorphins were obtained in blood samples during silent ischemia. 201Tl scintigraphy showed transient defects of perfusion without clearance abnormalities (group I) and with clearance abnormalities (group II). The patients in group I had more severe left ventricular hypertrophy (LVH) and a significantly higher platelet aggregation response to 0.5 mumol/L adenosine diphosphate; one patient in this group had coronary atherosclerosis. LVH and the platelet aggregation response was less pronounced in the patients in group II, but atherosclerotic lesions of a coronary artery were observed in four patients. In both groups, norepinephrine and beta-endorphin levels were increased during silent episodes of ischemia. The results suggest that there are different pathogenetic mechanisms of coronary insufficiency in patients with EH, a hypertensive heart, and silent ischemia.

[Silent myocardial ischemia in patients with essential hypertension]. / "Nemaia" ishemiia u bol'nykh gipertonicheskoi bolezn'iu.

Holter monitoring was performed in 61 patients with essential hypertension. Painless, silent ST segment depression was found in 34 patients. Exercise myocardial scintigraphy indicated the occurrence of transient perfusion defects without abnormal clearance (Group 1) and those with abnormal clearance (Group 2). The patients from Group 1 showed more severe myocardial hypertrophy, higher platelet aggregation, coronary atherosclerosis was detected in 1 case. The patients from Group 2 exhibited less myocardial hypertrophy, lower platelet aggregation. Coronary atherosclerosis was revealed in 4 cases. The patients from the two groups had elevated plasma norepinephrine levels at the onset of silent myocardial ischemia.

[Annuloplasty of the tricuspid valve with a controllable semi-ring under the control of transesophageal echocardiography]. / Annuloplastika trikuspidal'nogo klapana reguliruemym polukol'tsom pod kontrolem chrespishchevodnoi ékhokardiografii.

The paper analyzes the first clinical experience with a novel procedure of tricuspid annuloplasty with a controllable semiring under the control of transesophageal echocardiography in 6 patients with tricuspid dysfunction and those with mitral and tricuspid valvular diseases. The application of intraoperative transesophageal echocardiography makes it possible to control both the degree of mitral regurgitation and the severity of right atrioventricular stenosis. This echocardiography may serve a method for plastic correction of the tricuspid valve.

[A painless decrease in the ST segment during the 24-hour ECG monitoring of hypertensive patients]. / Bezbolevoe snizhenie segmenta ST pri sutochnom monitorirovanii EKG u bol'nykh gipertonicheskoi bolezn'iu.

The daily Holter ECG monitoring and echocardiography were conducted in 61 men aged on the average 50.5...1.2 years with a diagnosis of stage II essential hypertension. 55.7% of the patients manifested episodes of painless depression of the ST segment. Such parameters as the patients' age, duration and intensity of arterial hypertension, the painful syndrome pattern did not afford revealing persons at high risk for instability of the ST segment of the ECG. Only initial disorders of the repolarization phase of the ECG at rest, so-called ECG with the signs of left ventricle hypertrophy with "strain" were in this respect of prognostic importance. 2/3 of the patients with the left ventricle mass exceeding 200 g manifested episodes of "silent" depression of the ST segment, with those episodes being encountered more frequently in left ventricle hypertrophy with an asymmetry index greater than or equal to 1.5.