[Outcomes of reoperations in dysfunction of mechanical prostheses in relation to the clinical course]. / Iskhody povtornykh operatsii, sviazannykh s disfunktsiei mekhanicheskikh protezov, v zavisimosti ot klinicheskogo techeniia.

Operations were conducted for the second time on 87 patients (98 operations). Reoperations were performed on 75 (76.5%) and closure of the fistula in 23 (23.5%) patients. The outcome of the operation was appraised according to the clinical course: without sepsis and with prosthetic septic endocarditis, respectively, in 57 (65.5%) and 30 (34.5%) cases. It was found that survival was lower among patients with prosthetic septic endocarditis than among those without sepsis, 37.9% and 53%, respectively. The position of the prosthesis determined the time of the development of the complication, both in fistulas and in thromboses. Disturbances in the function of the prosthesis occur mainly in the first postoperative months in patients without sepsis and in the first months and the late-term periods after surgery in patients with prosthetic septic endocarditis.

Quantitative assessment of transient left ventricular asynergy in coronary artery disease.

The purpose of this study was to determine the diagnostic value of quantitative two-dimensional echocardiography during transesophageal atrial pacing in assessing the presence and severity of coronary artery disease. Apical four- and two-chamber views were registered at rest and at different pacing rates. Computerized quantitative evaluation of left ventricle wall motion was performed. On the basis of left ventricle wall motion analysis data of 22 individuals with no coronary pathology, as assessed by angiography and with negative exercise ECG and transesophageal atrial pacing ECG test, nomograms for assessment of wall motion abnormalities and for calculation of asynergy area as a measure of wall motion abnormality extent were obtained. The method revealed new transient wall motion abnormalities during pacing or exacerbation of old ones present at rest in 83 of the 89 patients with angiographically proven coronary artery stenosis greater than or equal to 70% and in 3 of the 32 controls with no changes in their coronary angiograms. Thus, it showed high sensitivity (93%), specificity (91%), predictive value of positive result (96%), predictive value of negative result (83%), and efficiency of the test (93%). These values appeared to be higher than those calculated for transesophageal atrial pacing ECG, recorded simultaneously with echocardiographic images (81, 87, 95, 62, and 83%, respectively) and for exercise ECG test which was performed in 66 coronary patients and in 29 controls (68, 86, 92, 54, and 74%, respectively). The extent of pacing-induced left ventricular regional wall motion abnormalities appeared to be directly correlated to the extent of coronary artery disease.(ABSTRACT TRUNCATED AT 250 WORDS)

[Evaluation of late results of aortocoronary bypass in patients with ischemic heart disease in relation to the bypass function]. / Otsenka otdalennykh rezul'tatov aortokoronarnogo shuntirovaniia u bol'nykh ishemicheskoi bolezn'iu serdtsa v zavisimosti ot funktsional'nogo sostoianiia shuntov.

The authors analyse 82 patients with aggravation of their clinical condition in the late-term periods after aortocoronary shunting. All were subjected to coronaroshuntography 3.6 +/- +/- 0.5 years on the average, after the operation. The main noninvasive criteria of impaired functioning of the shunts were: increase of the degree of angina pectoris (functional class III-IV according to the Canadian classification), diminished tolerance to physical exertion, appearance of "active" myocardial ischemia. Disturbed functioning of the shunts was mainly manifested within the first year, while progression of atherosclerotic changes in the unshunted arteries--in later periods. The main causes of incompetence of the shunts were: small diameter of the shunted arteries, low rate of blood flow in the shunts, and feverish condition of patients lasting for a long time after the operation.

[Hemodynamic effect of a mitral valve prosthesis]. / Gemodinamicheskii éffekt protezirovaniia mitral'nogo klapana.

Hemodynamic findings are analysed in 113 patients with different types of mitral prosthesis. Catheterization of the heart was carried out before the operation and during the late post-operative period. The gradient through the prosthesis was estimated for patients with different types of mitral valve prosthesis during the operation. According to our data, the tilting-disc valve prosthesis MKC-59 and the ball valve prosthesis MKC-25 are associated with the best gradients. Mitral prosthesis improves hemodynamic activity, but does not normalize it. The heart index remains lowered, while the pressure inside the pulmonary capillaries and pulmonary artery remains elevated, as compared to normal levels. Signs of mitral stenosis become more apparent during exercise.

[Diagnosis of acute pulmonary artery embolism]. / Diagnostika ostroi émbolii legochnoi arterii.

The clinical picture and the electrocardiographic and rheopneumographic findings were compared with the data obtained during operation or angiopneumography in 31 patients with embolism of the pulmonary artery. In massive embolism of the pulmonary artery, the dominating clinical symptoms were sudden dyspnea, tachycardia and cyanosis. Collapse and cardiac arrest were encountered in most patients. Moderate embolism is characterized by advancing dyspnea but cyanosis and tachycardia are inconsistant symptoms. The results of electrocardiography and rheopneumography are in correlation with the data obtained in catheterization of the heart, angiopneumography and during embolectomy.

[Diagnosis of paravalvular fistulae after mitral valve prosthesis]. / O diagnostike paraval'vuliarnykh fistul posle protezirovaniia mitral'nogo klapana.

The phonocardiography method is appraised and the correlative dependence of the data yielded by it is compared with the hemodynamic values in the diagnosis of paravalvular fistulas following mitral valve prosthetics in 11 patients. It was revealed that the duration of the interval from the sound of aortic closure to the sound of mitral opening is in close reverse relation (r = -0.61) with the level of the mean pulmonary-capillary pressure: the shorter the interval, the more severe is the disorder of hemodynamics in patients with paravalvular mitral insufficiency and the higher is the mean pulmonary-capillary pressure. Paravalvular fistulas in the 11 patients examined were manifested by the development of a systolic murmur.

[Comparison of the electrocardiographic, clinical and coronarographic data in ischemic heart disease after physical exertion]. / Sopostavlenie elektrokardiograficheskikh, klinicheskikh i koronarograficheskikh dannykh pri Fizvcheskoi nagruzke u bol'nykh ishemicheskoi bolezn'iu serdtsa

A comparison of the clinical data and those of ECG under physical exercises with the results of coronary angiography is presented for 130 patients with the ischaemic heart disease, aged 28 to 68 years; 63 of them had survived myocardial infarction, 63 had angina of effort, 65--angina at rest and angina of effort, 2 presented no complaints. The comparison of the clinical and coronarographic data demonstrated a high correlation in cases of angina; in 85.3% of the patients with typical angina pectoris coronary angiography revealed anatomic changes in the coronaries. Having compared the data to the positive exercise test with the results of coronary angiography, the authors found that 87.9% of the examined patients have--with a positive exercise test--coronary lesions and the S--T segment depression during physicial exercises 1 mm below the iso-electric line, which permits to diagnose anatomic changes in the coronaries. According to the authors, an acute onset of the disease, a brief history (up to 1 year) and a prompt restoration of the ECG following physical exercises are typical rather for local lesions of one coronary branch.