[Does nitroglycerin show the properties of a selective venodilator?].

The central hemodynamic effect of continuous intravenous nitroglycerin infusion at an increasing rate (0.01-0.1 microg x kg(-1) x min(-1)) was evaluated by noninvasive (tetrapolar rheography) and invasive (pulmonary arterial catheterization) techniques. The study included 10 healthy volunteers and 30 patients having usual indications for nitroglycerin infusion. The findings suggest that when even infused at low rates, nitroglycerin canses mainly arteriolar vasodilatation, which appears as increased stroke volume due to the predominance of diminished postload over lowered preload. It is obvious that the notion of nitroglycerin as a selective venodilator should be revised.

[Hemodynamic features during coronary bypass surgery on the working heart].

Changes in hemodynamics and blood oxygen transport function were studied during coronary bypass surgery (CBS) on the working heart under anesthesia with propofol and fentanyl. In patients operated on the working heart, the course of the basic stage of an operation was characterized by a moderate reduction in cardiac index and stroke volume due to the cardiac changes and immobilization, which resulted in cardiac compression and venous return deterioration. These impairments did not lead to worse oxygen-transportfunction and they were completely eliminated in the rehabilitative period. Analyzing the results of studies of troponin-T and creatinine kinase-MB showed that the procedure of coronary bypass surgery without using EKK had a less damaging effect on the myocardium. Analyzing the course of an early postoperative period indicated that the use of perfusionless technology substantially reduced needs for inotropic support, the time of artificial ventilation, and the length of stay at an intensive care unit.

[Thrombectomy as a method of surgical treatment of thrombosis of a mechanical prosthesis of the heart valve (a description of three cases)]. / Trombéktomiia kak metod khirurgicheskogo lecheniia tromboza mekhanicheskogo proteza klapana serdtsa (opisanie trekh sluchaev).

The article presents three clinical observations of successful thrombectomies in patients with thromboses of modern bicuspid prostheses of the heart (MEDINZH-2, Carbo Medics) which was 21.4% of all operations (14) for acute thrombosis of the artificial heart valve. It should be taken into consideration that such kind of operation is possible when there are easily removed small loose thrombus, good fixation of the prosthesis and a complete endothelization of the cuff.

[A comparative assessment of the myocardium protection by methods of blood and crystalloid cardioplegia in patients with high risk of coronary bypass grafting operation]. / Sravnitel'naia otsenka zashchity miokarda metodami krovianoi i kristalloidnoi kardioplegii u bol'nykh s vysokim riskom operatsii koronarnogo shuntirovaniia.

A comparative assessment of specific features of the intraoperative and early postoperative periods was made using antegrade blood and crystalloid cardioplegia during coronary artery bypass grafting operation in 100 patients with ischemic heart disease with a fraction of expulsion of the left ventricle of the heart < 0.5. Using the blood cardioplegia has allowed the need in inotropic support to be lowered at the isolated coronary artery bypass from 29.7% to 11.8%, and at a combination with the resection of the left ventricular aneurysm from 66.7% to 36.4% respectively in the control and main groups. The results obtained suggest that the proposed technique of blood cardioplagia has essential advantages over crystalloid cardioplegia in the coronary shunting of patients with a severe and complicated course of ischemic heart disease.

[Immediate results of using the radial artery in direct revascularization of the myocardium]. / Neposredstvennye rezul'taty ispol'zovaniia luchevoi arterii dlia priamoi revaskuliarizatsii miokarda.

The authors discuss results of more than 300 operations of the aorto-coronary bypass using the radial artery as a shunt. An analysis of the initial state of the patients, the intraoperative, early postoperative and intrahospital periods was made. Special attention was given to specific features of the isolating and using the radial artery grafts. Specific complications resulting from the application of them were analyzed and recommendations are given for prophylactics of such complications. The experiences with using the radial arteries allow to recommend it in revascularization of the myocardium. It is one of the ways of improving immediate and long-term results of operations on patients with ischemic heart disease.

[Rare causes of the dysfunction of mechanical bicuspid heart valves]. / Redkie prichiny disfunktsii mekhanicheskikh dvustvorchatykh klapanov serdtsa.

The authors share the observations from their cardiosurgical practice showing that one of the causes of sudden death or of rapid worsening of the state of patients with implanted bicuspid artificial valves might be their dysfunction resulting both from breakage of the hinged mechanisms of the valve with its dislocation and migration and from the disturbed mobility of the valve cusp due to a thrombus formed in the atrium. The observations show that the "ideal" construction of the valve is to be created.

[Excretory function of the kidneys during artificial circulation in patients operated on for acquired heart defects]. / Vydelitel'naia funktsiia pochek vo vremia iskusstvennogo krovo- obrashcheniia u bol'nykh, operirovannykh po povodu priobretennykh porokov serdtsa.

The authors have shown that the suppression of the excretory function of the kidneys during the period of artificial circulation is considerably dependent on the concentration of vasopressin in blood and the associated spasm of renal vessels. The use of morphine as the main medicine for general anesthesia with the dose of 3 mg/kg as compared with the dose 2 mg/kg, gives less level of vasopressin in blood and thus reduces symptoms of antidiuresis in response to the action of strong stressogenic factors.

[Ion-balanced cardioplegic solutions in cardiac surgery]. / Ionosbalansovannye kardioplegicheskie rastvory v khirurgii serdtsa.

A comparative analysis of effectiveness of anti-ischemic defense of the myocardium performed in operations on the heart in 128 patients has shown that use of ion-balanced solutions is preferential since it allows reducing intrahospital lethality related with acute cardiac insufficiency from 13.3% to 6.3%.

[Prolonged peripheral arteriovenous perfusion with a membrane oxygenator]. / Dlitel'naia perifericheskaia veno-arterial'naia perfuziia s membrannym oksigenatorom.

The authors have developed the optimal method of performing prolonged veno-arterial perfusion and studied its influence on the animal organism. In 22 experiments a membrane oxygenator on the national film "Sigma" was used. It has been established that for successful performing of prolonged veno-arterial perfusion it is necessary to strictly maintain the circulating blood volume and take measures to prevent disorders in the microcirculation. The blood trauma in the membrane oxygenator with the "Sigma" film is inimal.

[Dimethylpolysiloxane reinforced film in a membrane oxygenator]. / Dimetilpolisiloksanovaia armirovannaia plenka v membrannom oksigenatore.

With the purpose of diffuse membranous oxygenation of blood the possibility of employing a Soviet-made dimethylpolyxyloxane-reinforced film "Sigma" was investigated. The test-trials were carried out with a membranous oxygenator of the "Sandwich" type. In 15 acute tests on dogs a partial cardio-pulmonary pass-by shunting with oxygenation of the blood after the veno-venous or veno-arterial perfusion was performed. With the mass-exchange area of 1.15 m2 the oxygen transport in different tests varied within a range of 20-50 ml/min and depended upon the arterio-venous difference and the circulation rate. No disruptions in the elimination of carbon dioxide were in evidence. In the course of investigations the "Sigma" material was found to be strong, impermeable to liquids and is not subject to swelling following its long-term use.

[Method of increasing the effectiveness of veno-arterial perfusion]. / O povyshenii effektivnosti veno-arterial'noi perfuzii.

Under study was the efficacy of heart unloading in different variants of asynchronous peripheral veno-arterial perfusion (VAP). In 12 experiments VAP was accomplished in association with the left ventricle decompression. Due to the latter, complete or nearly complete exsanguination of the left ventricle was gained in 11 experiments. In fibrillation of caridac ventricles no lung edema was noted in these cases. The elaborated technic was successfully employed twice in animals being in the state of "cardiogenic shock", induced by myocardiac infarction lasting for a day.