[Dynamic atriomyoplasty as a method extending F. Fontan's principle in the surgical treatment of complex congenital heart defects (an experimental study)]. / Dinamicheskaia atriomioplastika kak metod, rasshiriaiushchii vozmozhnosti printsipa F. Fontan pri khirurgicheskom lechenii slozhnykh vrozhdennykh porokov serdtsa (éksperimental'noe issledovanie).

The article discusses the data of an original complex experimental research dealing with the study of the possibilities of the method of dynamic cardiomyoplasty in surgical management of complex congenital heart diseases with critical obstructive lesions of the venous atrioventricular valve. An original method for the formation of a peculiar new pumping chamber into the system of pulmonary circulation is described. The hemodynamic efficacy of the operation in the immediate periods after its performance is thoroughly evaluated. Substantiated recommendations are given for the possible use of this method in the clinic in surgical treatment of this difficult contingent of patients.

[Cardiomyoplasty]. / Kardiomioplastika.

The article analyses the current state of the problem of cardiomyoplasty as a new method for the treatment of patients with myocardial cardiac insufficiency. The authors show the experimental and clinical material on the possibility and efficacy of using skeletal muscles for improving myocardial contractility and raising the cardiac index. Experience gained in our country (6 operations) in cardiomyoplasty in patients with severe form of ischemic heart disease is discussed. The authors used an original Soviet produced cardiosynchronized electroneurostimulator "Stiminak" for stimulation of the muscles. Analysis of personal experimental material allows new ways for the development of the problem to be planned.

[The first clinical experience in extended myoventriculoplasty with programmed cardiosynchronized electroneurostimulation]. / Pervyi klinicheskii opyt rasshirennoi mioventrikuloplastiki s programmiruemoi kardiosinkhronizirovannoi élektroneirostimuliatsiei.

The article deals with the description and analysis of the first two operations undertaken for the development of the method and the first clinical use of extended myoventriculoplasty with programmed cardiosynchronized electroneurostimulation. The authors elaborated the items of stage-by-stage training of the skeletal muscle for its adaptation to work in a regimen of the contracting heart, and the techniques of myoventriculoplasty in patients with a complicated form of ischemic heart disease and dilatation cardiomyopathy. Apart from that, the authors approved for the first time in the clinic an original Soviet-made programmed cardiosynchronized electroneurostimulator intended for implantation. The immediate postoperative results were satisfactory.

[Intracardiac hemodynamics in patients with a postinfarct intraventricular septal defect]. / Issledovanie vnutriserdechnoi gemodinamiki u bol'nykh s postinfarktnym defektom mezhzheludochkovoi peregorodki.

Twenty-seven patients with post-infarction defect of the ventricular septum were examined: 27 had sounding of the right portions of the heart, 23 left ventriculography, 22 selective coronary angiography. The decision on the timing of the operation and the extent of surgery should be based on the findings obtained during intracardiac examination. If the grave condition of the patient is caused by a heavy drainage of the blood through the defect of the ventricular septum and by the volumetric overload of the heart then urgent surgery is indicated. On the other hand, if the severity of the patient's state is determined by mostly myocardial contractility disorders then the wait-and-see approach is appropriate. The intracardiac examination is a decisive method of the diagnosis of a post-infarction defect of the ventricular septum and is indicated for all patients with this disease. The extent of the examination is determined by the clinical state of the patient.

[Should patients with post-infarction defect of the interventricular septum be operated on?]. / Nuzhno li operirovat' bol'nykh s postinfarktnym defektom mezhzheludochkovoi peregorodki.

Conservative treatment of patients with postinfarction defect of interventricular septum has proved inefficient. However, the acute stage of infarction and the formation of a perforation is not yet an indication for surgical treatment as plastic surgery is technically impossible in the necrotized area. After the acute stage is over, surgical treatment is necessary to prevent the development, in the chronic stage, of invalidism-bound cardiac failure, which cannot be controlled by conservative means because of continuous left-to-right blood discharge.

[Late results of the surgical treatment of a postinfarct interventricular septal defect]. / Otdalennye rezul'taty khirurgicheskogo lecheniia bol'nykh s postinfarktmym defektom mezhzheludochkovoi peregorodki.

Surgical treatment of patients with post-infarction defect of the interventricular septum is highly effective. Despite the complexity and large volume of operation in this contingent of patients results of the operation are much better than in patients treated conservatively. At late periods after operation fairly high physical activity of patients is observed, which permits return to work to some of them, and to patients of pension age, enables them to do house chores, while the survived nonoperated patients are hardly capable of self-help.

[Simultaneous surgical correction of complicated forms of myocardial infarct--ventricular septal defect and left-ventricular aneurysm]. / Odnomomentnaia khirurgicheskaia korrektsiia oslozhnennykh form infarkta miokarda - defekta mezhzhekudochkovoi peregorodki i anevrizmy levogo zheludochka.

Thirteen patients with postinfarction ventricular septal defect and aneurysm of the left ventricle are discussed. Their ages ranged from 46 to 68 years. Six of them underwent operation in periods ranging from 22 days to 11 months, seven were given drug therapy. Six of these seven died from acute cardiac insufficiency or recurrent myocardial infarction in periods of 8 to 78 days; one patient died in 10 months. Five of the six patients who were operated on were discharged from the clinic in a satisfactory condition, one female patient died in the early postoperative period from acute left-ventricular insufficiency. Late survival (follow-up of 3 years) was 83%. The method for selecting the patients for operative treatment and the necessary volume of the intervention are specified.

[Basic courses of approach to the surgical treatment of postinfarct defects of the interventricular septum]. / Osnovnye puti podkhoda k khirurgicheskomu lecheniiu postinfarktynkh defektov mezhzheludochkovoi peregorodki.

The authors studied 20 patients with postinfarction ventricular septal defects; among them 9 had been operated on and 2 of these patients died. Eleven patients did not undergo operation, 10 of them died. All patients subjected to operation had severe circulatory insufficiency; in 3 the septal defect was of nor more than one month's duration. Patients whose condition was particularly severe were subjected to intubation, catheterization of the heart, left ventriculo- and coronarography, and after the operation has been planned they were operated on on the same day. Some patients who could move about but who also suffered from circulatory insufficiency were operated on according to the planned schedule. In 10 patients who had died without being operated on the anatomy of the defect and the condition of coronary circulation were examined. The authors contend that before undertaking an operation it is necessary to assess the patient's condition and the possibility of operating on him and determine the role of the ventricular septal defect and the hemodynamic disturbances consequent upon the infarction; all cardiac lesions should be corrected during the operation. Besides closure of the defect and resection of an aneurysm 2 patients also underwent operation for aorticocoronary shunt.