[Intraventricular blood flows and myocardial contractility in impairments of coronary circulation]. / Vnutrizheludochkovye potoki krovi i sokrashchenie miokarda pri narusheniiakh koronarnogo krovoobrashcheniia.

We examined a total of 106 patients with ischaemic heart disease (mean age - 59±7 years) and 30 apparently healthy people (mean age - 36±4 years). Myocardial revascularization was performed with the help of stenting and coronary artery bypass grafting. The patients with ischaemic heart disease were divided into 2 groups: Group 1 with postinfarction cardiosclerosis and Group 2 without Q-forming myocardial infarction. Echocardiography was performed using the Vivid E9 machine prior to operation, intraoperatively, and 10-14 after the intervention. We registered the end-systolic volume and end-diastolic volume of the left ventricle, ejection fraction, cardiac index. Alterations of velocity were assessed in relation to of the volume of the left ventricle (dVol/dt), length of the ventricle (dL/dt) in systole and diastole, as well as myocardial shift velocity in 3 endocardial regions - basal (V1), middle (V2), apical portions (V3) and interrelationship with intraventricular blood flows. It was determined that myocardial dysfunction leads to impairment of the structure of the flow, change of acceleration, which is accompanied by a decrease in the cardiac productivity. Impairment of segmental contractility of the left ventricle is manifested by a decrease of vectors of myocardial motion velocity by more than 20%. Intraventricular flows in cardiac chambers may serve as predictors of adequacy of correction of coronary pathology.

[Solid lesions of heart valves].

AIM: To analyze clinical-diagnostic and surgical aspects of cardiac valve solid lesions as well as long-term results of surgical treatment. MATERIAL AND METHODS: Clinical, diagnostic and surgical aspects of treatment of 51 patients with tumorous and pseudotumorous lesions of cardiac valves were analyzed. RESULTS AND DISCUSSION: Hospital complications were observed in 17.7% of patients. Mortality rate was 3.9%. 1- and 28-year overall survival was 100% and 94.1% respectively. Quality of life was good, satisfactory and unsatisfactory in 73.5%, 20.4% and 6.1% of cases respectively. CONCLUSION: Timely diagnostics of tumorous and pseudotumorous lesions of cardiac valves is very difficult but possible based on short history, positional dependence of symptoms, embolic events without rhythm disturbances. Additional instrumental methods including TTE, TEE, CT and MRI are necessary to define diagnosis. Intraoperative diagnostics and immediate histological survey are useful to determine volume of surgery in each case. Successful surgical treatment implies urgency, hypothermic perfusion and pharmaco-cold cardioplegia during operation.

[Infective Endocarditis: Problems of Diagnosis and Treatment].

Results of the clinical study involving 458 patients (from 12 to 75 years, mean age 49 +/- 9.3 years) with various forms of infective endocarditis (IE) have been summarized. Integrated echocardiography was the principal non-invasive method of presurgical diagnosis of the disease. Sensitivity of transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) were 96% and 97.9% in patients with primary IE, 59% and 92% in patients with secondary IE and 2.7% and 90% in patients with prosthetic endocarditis, respectively. Results of echocardiography were confirmed during intrasurgical revision and histological study of removed valves. However, we have not found correlation between size, location, shape, mobility of vegetations, and risk of embolic events. Integrated echocardiography contributed to the correct diagnosis and also provided the possibility to determine the necessity of surgery and to schedule it in time. The main goals of surgery in IE heart valves are complete removal/sanitation of infected tissue and restoration or replacement of damaged heart valves. Overall hospital mortality was 8.1%. Mortality among patients operated in the active stage of IE and during remission was 10.5 and 7.1%, respectively. Surgical treatment in the active phase of IE is indicated in patients with factors of high risk, when the possibility of cure with antibiotics is unlikely, as well as in patients with high chances of recovery according to the state of organs and systems.

The diagnosis and surgical treatment of cardiac pseudotumors.

AIM: Investigation of clinical-diagnostic, surgical and morphological features of cardiac pseudotumors. MATERIAL AND METHODS: Acad. B.V. Petrovskiy Russian Research Center for Surgery has experience of surgical treatment of 336 patients with cardiac pseudotumors followed from December 1962 to December 2014. Morphologically verified primary cardiac tumors were diagnosed in 269 (80.1%) patients. In this study it was analyzed the results of survey and treatment of 67 patients with cardiac pseudotumors who were under observation in institution since February 1970 to December 2014. There were 36 men and 31 women aged 2.2-74 years (mean age 34.1±2.1 years). RESULTS: Overall 1- and 24-year survival without hospital mortality according to Kaplan-Meier test was 100 and 94.3% respectively. Patients' life quality in the remote period significantly improved. Good postoperative results were obtained in 62.8% of cases, satisfactory--in 31.4% of patients, unsatisfactory--in 5.8% of survivors. Medical tactics in patients with morphologically unidentified cardiac neoplasms (29.9%) was determined by their small sizes (0.4-1 cm), absence of displaceability followed by risk of embolic syndrome, homogenous echogenicity and clear outlines, absence of hemodynamic disorders and clinical manifestations. CONCLUSION: Analysis showed that timely diagnosis of pseudotumors and morphologically unidentified cardiac neoplasms is very difficult. Successful operations require normothermic or hypothermic perfusion and pharmaco-cold cardioplegia to provide convenient exposure and adequate myocardial protection, prevention of neoplasm fragmentation with following embolism, correction of concomitant valve diseases, congenital heart diseases and coronary heart disease.

[Echocardiography of cardiac cysts].

Experience of ultrasound diagnosis of cardiac cysts of various origin accumulated by the authors during 30 years of practice is described. For the first time in the literature of this country and in foreign literature attention is attracted to a wide spectrum of possible cardiac cysts and there main diagnostic signs are presented. Eleven patients aged 9-55 years were examined. Intraoperative and histological verification of the described pathology was conducted.

[Mental health indices in senior schoolchildren and students].

Mental health indices were studied in a representative sample comprising young persons aged 16 to 25 years. Senior schoolchildren in their early teens were ascertained to have neurotic symptoms more frequently than students at older age. When the manifestations of mental stress were less evident, senior students at the age of 22-25 years were found to have a negative trend of social adaptive indices as their achievement dissatisfaction, frustration, and anxiety for further professional carrier and social security, which leads to interpersonal conflicts, unstable familial relations, alcoholization, and intake of psychoactive substances. The findings of the high prevalence of neurotic disorders among young individuals suggest that it is necessary to implement active psychopreventive measures.

[Function of transplanted heart].

Clinical and functional results of orthotopic cardiac transplantation are analyzed. It is demonstrated that case follow-up with special non-invasive methods (ECG, Holter monitoring, high-resolution ECG, EchoCG, dopler-EchoCG) is mandatory for detection of cardiac transplant function, early diagnosis of chronic rejection crisis, timely and optimal treatment tactics.

[Clinical, diagnostic and surgical aspects of heart space-occupying lesions at children and youths].

Clinical, diagnostic and surgical aspects of primary heart tumors, pseudotumor and morphologically unidentified heart space-occupying lesions were analyzed at 52 childhood and adolescence patients. Difficulty of early diagnosis, more aggressive clinical course in majority cases, and individual approach to the choice of surgical approach has been demonstrated. Principle of oncological determinant has been ensured the success in surgical treatment of patients with non-malignant intracavitary and intramuscular neoplasms, and also with pseudotumor space-occupying lesions. Postoperative lethality was low (2.2%), and there were no true recurrences of disease in long-term period after surgery.

[Echocardiographic assessment of results of single stage mitral and aortic valvuloplasty].

Echocardiographic assessment of results of single stage mitral and aortic valvuloplasty was carried out in 29 patients (mean age 44.1+/-1.2 years) with combined rheumatic mitral and aortic valve disease. Dynamics of most of ultrasound parameters of the heart after double intervention on mitral and aortic valves was positive. Aortic regurgitation was either absent or minimal. Mean pressure gradient across the aortic valve was reduced 50%. Average reduction of transmitral valve pressure gradient was > or = 70%. Average increase of mitral orifice area index was 146%; average decrease of left atrial diameter index was 17%.

[Echocardiography of operated heart. Assessment of results of mitral valvuloplasty].

AIM: To assess results of surgery and to elaborate criteria of noninvasive diagnosis of cardiac function in patients with rheumatic mitral disease after reconstructive interventions on mitral valve. MATERIAL: Patients (n=192, mean age 41.2+/-1.2 years) with pure mitral stenosis (76%) and combined mitral valve disease with prevalent stenosis (24%), and 32 practically healthy people (n=32, mean age 36.6+/-3.5 years, control group). METHODS: Comprised transthoracic mono and two-dimensional echocardiography and doppler echocardiography. Results of intracardiac flow study were compared with data of invasive methods of investigation--intraoperative flowmetry and manometry, cardiac catheterization and intraoperative transesophageal echocardiography. RESULTS AND CONCLUSIONS: The following criteria of hemodynamically effective valvuloplasty were established: lowering of mean mitral valve pressure gradient by 54-65%; absence of regurgitation or lowering of mitral valve regurgitation fraction to < or =6% of total stroke volume. Significant increase of left ventricular stroke volume (by 22-27%), increase of mitral valve area (by 164-222%), decrease of left atrial diameter (mean decrease 17%) were also noted.

[Primary tumors of heart]. / Pervichnye opukholi serdtsa.

The analysis of 36 years' experience in surgical treatment of 162 patients with benign and malignant primary tumors of the heart, verified by morphological examination, is presented. The possibility of their timely and intra vital revealing is noted in cases of clinical alertness which makes possible to suspect this disease and purposefully examine these patients using preferably echocardiography and computed tomography. The scope of the operations and their success depend on morphological characteristics of the tumors and the extent of neoplastic process. However, by now short- and long-term results of surgical treatment evidence, that predominant part of this category of patients is potentially curable, provided that these neoplasms of the heart were revealed at an initial stage.

[Surgical treatment of heart echinococcosis]. / Khirurgicheskoe lechenie ékhinokokkoza serdtsa.

Echinococcosis of the heart is a rare but dangerous for life disease, very difficult for diagnosis. 5 patients with echinococcosis of the heart were examined, 2 were operated. Introduction into clinical practice of complex echocardiography contributed to precise diagnosis. The viability of the parasite was determined after application of the latex-test. Defection of the living echinococcus parasites in the heart was indication for surgery. Removal of the echinococcus from the myocardium of the left ventricle in 1 patient was carried out without artificial circulation and was accompanied by a significant risk, the complete excision of fibrous capsula being impossible. Intraventricular location of the echinococcus cyst in the other patient has required artificial circulation and cardioplegia. Intraventricular cyst was successfully and radically removed after preliminary sterilization by glycerine solution.

[Anatomic orthotopic heart transplantation: the surgical characteristics and the advantages of the method]. / Anatomicheskaia ortotopicheskaia transplantatsiia serdtsa: khirurgicheskie osobennosti i dostoinstva metodiki.

Standard technique of establishment of interatrial anastomoses allows to carry out orthotopic transplantation of the heart quickly and reliably. However the accumulation of collective experience evidences about a number of unavoidable shortcomings of such operation: rhythm disturbances, worsening of hemodynamics in discordant atrial contractions of recipient and donor, atrio-ventricular valve insufficiency, thromboembolism, coronary fistulas. Since 1990 in RRCS 25 operations were carried out with the use of standard technique and we also met with the risk of developing the above complications. In experiment on 30 mongrel dogs the technique of anatomical, truly orthotopic transplantation of the heart with six anastomoses was developed: left pulmonary veins with a common cuff, separate anastomoses of the superior and inferior caval veins, anastomoses of aorta and pulmonary artery. Particular attention was paid to developing of original surgical modes for prophylaxis of stenoses in the area of anastomoses of pulmonary and caval veins. In 1997 the anatomical technique of heart transplantation was successfully introduced by us into clinical practice. Clinical electrophysiological, echocardiographic and functional examinations have confirmed the results of the experiments and have evidenced for substantial advantages of the anatomical technique of orthotopic transplantation of the heart. By reliability the new operation is not inferior to standard method of N. Shumway.

[Comparison of transesophageal and transthoracic echocardiography in cardiac surgical care]. / Sravnitel'naia kharakteristika transtorakal'noi i transézofageal'noiékhokardiografii v kardiokhirurgicheskoi praktike.

This paper analyzes the results of 1093 transesophageal (TEE) and transthoracic echocardiographic (TTE) studies made in patients with various cardiovascular diseases in December 1989 to November 1996. The investigation was undertaken to define indications for TEE. Undoubtedly, TEE has some advantages over TTE in diagnosing abnormalities of the descending aorta, thromboses of the left atrium, small vegetations of cardiac valves, insignificant atrial septal defects and in evaluating excursions and systolic thickening of middle and basal segments of the left ventricular anterior wall. However, detection of thrombosis of the left ventricular apex remains to be priority in TTE. TEE was found to supplement TTE and considerably improves the diagnostic quality in cardiovascular diseases.