[Experience with the organization of a pathological anatomy laboratory in a heart surgery center]. / Opyt organizatsii laboratornoi patologicheskoi anatomii kardiokhirurgicheskogo tsentra.

Some specific features should be taken into consideration when organizing the laboratory of pathology in the cardiosurgical centre: 1) the heart should be opened according to the modified van Pragh method; 2) heart fixation in the Brodie's liquid allowing to retain its almost natural colour, consistency, volume and shape; 3) coronary arteries filling with lead carbonate and gelatin; 4) combination of methods of both pathology and surgical anatomy; 5) investigation of the brain in the vacuum in all clinical cases of the brain coma for the diagnosis of brain artery air embolism; 6) anatomical examination of the heart conductive system; 7) formation of the automatized pathology archives; 8) transmission electron microscopy of the intraoperative heart biopsies; 9) a new method of a quantitative assessment of the lung hypertension by the investigation of lung biopsies in patients with congenital heart malformation to make a conclusion on the feasibility of operation; 10) macroscopical heart analysis at the first stage of morphological investigation.

[What is anomalous departure of the aorta and pulmonary artery from the right ventricle?]. / Chto takoe otkhozhdenie aorty i legochnoi arterii ot pravogo zheludochka.

Available literature data on terminological and anatomical definition of congenital combined valvular disease--anomalous right ventricular origin of the aorta and pulmonary artery--are reviewed. Not a single report analysed permitted an objective precise structural outline of the disease. The causes of this situation are elicited. The review of the 8 Soviet and 55 foreign original sources shows that the question of pathognomonicity of the anomaly anatomical signs remains disputable.

[Architectonic characteristics of the heart ventricles in a perimembranous defect of the interventricular septum]. / Osobennosti arkhitektoniki zheludochkov serdtsa pri okolopereponchatom defekte mezhzheludochkovoi peregorodki.

The results of quantitative morphological macro-, micro-, and ultrastructural (myocardial biopsies) studies of the ventricles with perimembranous septal defect in 135 infants under the age of one year have been compared. In newborns there appeared ventricular myocardial hyperplasia and low absolute and relative values of all the myocardial parameters versus normal control. At the age of 3 months the parameters were similar to or above the control ones exceeding them considerably by the age of 10-12 months. The comparison of the parameters of the septal parts showed predominant abnormality of the sinus part indicating that the perimembranous ventricular septal defect entity is a sinus one.

[Characteristic features of the pathological anatomy and involvement of the myocardium in anomalous branching of the left coronary artery from the pulmonary trunk (Clinico-anatomical comparisons)]. / Kharakternye osobennosti patologicheskoi anatomii i porazheniia miokarda pri anomal'nom otkhozhdenii levoi koronarnoi arterii ot legochnogo stvola (Kliniko-anatomicheskie sopostavleniia).

Pathologic, clinical and anatomical correlations are presented for left ventricular affection in abnormal origin of the left coronary artery from the pulmonary trunk. It was revealed that there is a complex of critical factors essential for survival of patients and clinical pattern of the defect including the degree of manifestation of intercoronary collateral circulation, specificity of myocardial left ventricular ischemic impairment and that of mitral structure. Clinical and anatomical comparisons are drawn between the degree of affection of the left ventricular myocardium and its functional capacity.

[Anatomical types of the conduction system in congenital heart defects]. / Anatomicheskie tipy provodiashchei sistemy pri vrozhdennykh porokakh serdtsa.

A correlation is demonstrated between the fully formed conduction system and the anatomical type of the so-called normal and abnormal heart. Changes in the anatomy of the conduction system in congenital heart diseases are interpreted as a consequence of respective changes in the anatomy of the heart. New principles are formulated for the classification of congenital heart diseases on the basis of the anatomical types of the conduction system. They permit simultaneous systematization of types of ventricular septal defects and complex congenital heart diseases with ventricular septal defects.

[Laser angioplasty: effect of laser energy on human coronary arteries]. / Lazernaia angioplastika: éffekt vozdeistviia lazernoi énergii na koronarnye arterii cheloveka.

An experimental study of rationed action of laser emission energy (LEE) on human coronary arteries (autopsy specimens) identified major aspects of LEE interaction with biological tissues of atherosclerotically-affected vessels under "dry" and "wet" conditions. An impulse laser with a 1.06 micron wave-length was used as the LEE source. The results suggest that controlled LEE action on atherosclerotically-affected vessels for recanalization purposes (laser angioplasty) may prove a promising approach to the treatment of cardiovascular occlusions.

[Evaluation of the status of the myocardium during surgical correction of congenital heart defects by simultaneous study of ultrastructure and macroergic phosphates (in biopsies of the human heart)]. / Otsenka sostoianiia miokarda bol'nykh pri khirurgicheskoi korrektsii vrozhdennykh porokov serdtsa putem odnovremennogo issledovaniia ul'trastruktury i makroérgicheskikh fosfatov (po biopsiiam serdtsa cheloveka).

During surgical correction of Fallot's tetrad the authors discovered the decrease of macroergic phosphate concentration and moderately marked signs of cardiomyocytic ultrastructural changes, such as mitochondrial injuries, decrease of glycogen levels, insignificant intracellular edema, no increase of membrane penetration. Changes of endothelial cells were absent. In children not over 1 year old under myocardial protection with hypothermic perfusion (at low volume rates) some decrease of macroergic phosphates occurred, as well as a moderate decrease of the mitochondrial index, glycogen content decrease, there was no intracellular edema. The discovered structural changes are minimal and reversible. A close correlation was found between the electron microscopic data and the character of myocardial energetic metabolism, the biochemical changes preceding the ultrastructural ones. Comparison of morpho- and biochemical changes in the myocardium of the majority of patients with impaired myocardial function confirmed the existence of a complex relationship between them.

[Ultrastructural diagnosis of changes in the human myocardium during protection of the heart with cardioplegic solutions]. / Ul'trastrukturnaia diagnostika izmenenii miokarda cheloveka pri zashchite serdtsa kardioplegicheskimi rastvorami.

Results of qualitative and quantitative assessment of myocardial changes are presented based on examinations of 180 cardiobiopsy specimens taken from 58 patients with acquired heart diseases during open-heart surgery. For quantitative assessment of intracellular organelle changes a 6-score scale has been developed by means of which the time course of injury to the major cellular components was studied: before aortal clamping, at the height of ischemia, and during reperfusion. Basing on the integral assessment of structural changes it is possible to assess the severity of myocardial damage; such approach is valuable in the assessment of the efficacy of cardioplegic solutions in the clinical practice.

[Analysis of hospital mortality of patients with congenital heart defects in the 1st year of life]. / Analiz gospital'noi letal'nosti pri vrozhdennykh porokakh serdtsa u bol'nykh 1-go goda zhizni.

Causes of mortality were analysed in a group of 122 patients with congenital heart disease in their first year of life following conservative management, closed surgery and operations under assisted circulation. Fatal outcomes were predetermined by a severe congenital defect in 18.2% of the patients, while in the remaining cases they could basically have been prevented by means of a timely primary diagnosis and referral to a specialized clinical institution, accurate topical diagnosis, correct assessment of the severity of the patients' condition and improved post-operative intensive care.

[Automated pathologicoanatomic archives in a heart surgery center]. / Avtomatizirovannyi patologoanatomicheskii arkhiv v kardiokhirurgicheskom tsentre.

The dialog informational system "Automatized pathology archives" is presented which allows an accumulation of data, search when requested regardless of the complexity of request and analysis of complications and causes of the cardiosurgical patients death in a selected set of documents. The system contains data about patients dying in the institute since 1956. The advantages of the dialog working regimen are stressed that permits a physician-investigator not having specific experience to use directly the data bank and system program. Some examples of the use of this system are given.

[Pathological anatomy of post-infarction mitral valve insufficiency]. / Patologicheskaia anatomiia postinfarktnoi mitral'noi nedostatochnosti.

Failure of the bicuspid valve is one of the most frequent (20-25%) and grave complications of myocardial infarction. The causes of mitral failure occurring at different times following myocardial infarction are established. It is shown that the severity of coronary arteries lesions in postinfarction mitral failure is chiefly due to the occlusion of the two or three coronary arteries and to the segmental stenosis of more than 75% of the lumen of the main heart arteries. Postinfarction mitral failure caused by dysfunction of the papillary muscles may be provoked by acute infarction of the papillary muscles, rupture of the papillary muscle body, large-focal papillary muscle cardiosclerosis, by dilation of the left ventricular cavity and fibrous ring resulting in disturbance of space interrelationships between the tendinous filaments and valves.

[Erythrocyte morphology in anemia after artificial circulation (based on scanning electron microscopic data)]. / Morfologiia éritrotsitov pri anemii posle iskusstvennogo krovoobrashcheniia (po dannym skaniruiushchei élektronnoi mikroskopii).

Erythrocyte stereo-ultrastructure of 58 patients operated under the conditions of extracorporeal circulation was studied by scanning electron microscopy. It is established that after the operation with extracorporeal circulation the hemoglobin level is always decreasing, 3 mg% on the average; hemoglobin decrease up to 10 mg% and less was considered as anemia, this occurring according to the approximate calculations, in 10-11% of cases. The causes of anemia in an early postoperative period are as follows: mechanical trauma of erythrocytes in the system of extracorporeal circulation; disturbance of the osmotic balance; alteration of the erythrocyte membrane plasticity due to the change of its enzyme-lipid component. Anemia in the late postoperative period is due to the purulent inflammatory processes. Morphological substrate of anemia is represented by the iron-deficient, target-like, two-pit erythrocytes, spherocytes, lacerated erythrocytes and other forms.

[Role of lung biopsy in a heart surgery center (a new method for the quantitative assessment of pulmonary hypertension by biopsy of the lung of patients with congenital heart defects)]. / Rol' biopsii legkogo v kardiokhirurgicheskom tsentre (novyi metod kolichestvennoi otsenki legochnoi gipertenzii v biopsii legkogo u bol'nykh vrozhdennymi porokami serdtsa).

Forty-three lung biopsies taken from 42 patients with various congenital heart malformations with high pulmonary hypertension (aged from 8 months to 34 years) were studied by morphological and morphometric methods. Changes in the pulmonary vessels were evaluated according to Heat-Edwards' classification and morphometric classification of Rabinovitch , et al. The morphometric data give some additional information on the growth and development of peripheral vessels, the degree of hypertrophy of tunica media muscularis, a decrease in the size of arteries. The demonstration of considerable reduction in the number of peripheral arteries by morphometry constitutes a serious prognostic sign of further progression of sclerotic changes in the pulmonary vessels even in the early correction of the heart malformation.

[The role of biopsy of the human myocardium in cardiological and cardiosurgical centers]. / Rol' biopsii miokarda u cheloveka v kardiologicheskom i kardiokhirurgicheskom tsentrakh.

Endomyocardial puncture biopsy is practicable for elucidating etiology (nosology), differential diagnosis, the determination of activity of rheumatism or nonspecific myocarditis, the assessment of treatment efficiency and prognosis of outcome. Incision intraoperative biopsy should be used to evaluate the efficiency of myocardial protection and the specifics of metabolism and function of the myocardial cell. Open incision intraoperative myocardial biopsy is more informative than the endomyocardial puncture biopsy as it provides a heart specimen where all layers are represented, so that the number of negative results attributable to the mosaic pattern of myocardial abnormality is reduced.

[Comparative characteristics of gas and mechanical endarterectomy based on light and scanning electron microscopy]. / Sravnitel'naia kharakteristika gazovoi i mekhanicheskoi éndarterektomii po dannym svetovoi i skaniruiushchei elektronnoi mikroskopii.

A portion of a coronary artery removed at mechanical or gas endarterectomy shows the intima, internal elastic membrane and part of the media. After gas endarterectomy, the vascular "mould" is cone-shaped and pointed, resembling the main arterial trunk with lateral branches, whereas its surface is smooth. After mechanical endarterectomy, the main trunk "mould" may have no lateral branches, while its surface is rough. Electron microscopic scanning shows collagen and elastic fibres of the vascular wall to remain intact following gas endarterectomy, while after mechanical procedure they are torn and "stick out" on the surface, this observation providing anatomical evidence for the advantage of the gas technique over the mechanical one. Following endarterectomy, the vessel retains part of the media, outer elastic membrane and adventitia, whereas the vascular lumen closes due to dystonia of folding vascular wall.

[Evaluation of the efficacy of human heart protection during cardioplegia]. / Otsenka éffektivnosti zashchity miokarda cheloveka pri kardioplegii.

Materials from 546 intraoperative incision biopsies from 253 patients were studied in order to assess the effectiveness of myocardium protection during operations on the open heart. No significant ultrastructural, metabolic or functional changes develop in the myocardium upon pinching of the aorta and ischemia for 10 min, therefore myocardium protection is unnecessary. In ischemia for up to 40 min ultrastructural changes in cardiomyocytes are reversible therefore deep hypothermia proved to be sufficient for myocardium protection. When the aorta is pinched for up to 60 min under conditions of cold cardioplegia, ultrastructural changes in cardiomyocytes may be reversible but they depend upon the initial condition of the heart muscle and precise accomplishment of all the requirements of this type of myocardial protection. Cryopharmacological cardioplegia allows one to shut down the heart from the circulation safely for 120 min which has been confirmed by the results of electron microscopic and histochemical studies and the results of clinical examinations of the patients. Incisional intraoperative biopsy allows the judgement of the effectiveness of myocardium protection during asystole due to the pinched aorta, of the initial changes of the myocardium, i. e. the preoperative background, of the subtle features of metabolism and function of the myocardial cell to be made. The open incisional intraoperative biopsy of the myocardium is more informative than the puncture endomyocardial one.