[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.

[Long-term results of mitral valve prosthetics depending on the prosthesis model (ball, disk)]. / Otdalennye rezul'taty protezirovaniia mitral'nogo klapana v zavisimosti ot modeli proteza (sharovoi, diskovyi).

The authors conducted a comparative analysis of patients of 2 groups--with a MK4 model ball prosthesis and an folding disc prosthesis. It was found that the number of late-term (repeated) thromboembolic complications was significantly less in patients with a disc prosthesis (3.95 cases per 100 patient-years) and 4.28 cases among patients with a ball prostheses. No fatal outcomes associated with thromboembolism occurred among patients with a disc prosthesis, the lethality among those with a ball prosthesis was 27.5%. The advantages of a disc prosthesis in indices of physical activity and increased survival were also established.

[Analysis of results of surgical treatment of patients with infectious endocarditis]. / Analiz rezul'tatov khirurgicheskogo lechenia bol'nykh s infectsionnym éndokarditom.

The results of surgical treatment of 180 patients were studied according to the character of infectious endocarditis (primary--PIE and secondary--SIE), the functional class (FC) in the preoperative period, and the patients' immune status. The survival of patients with PIE (with hospital mortality taken into account) was somewhat higher than that of patients with SIE. Survival in the late-term periods was significantly higher in patients with PIE. There were no fatal outcomes among patients with PIE of FC III, mortality among patients with SIE was 7.7%; mortality in FC IV was, respectively, 10 and 21.6%; the mortality rate among patients with PIE and SIE of FC V was 43.5 and 57.5%, respectively. The late-term results were good in 85.5 and satisfactory in 14.5% of patients. Twenty-one (16%) patients died. Cardiac failure and recurrent sepsis were the main causes of fatal outcomes. The preoperative immunological parameters (the concentration of ceruloplasmin, blood serum IgG and IgM, the activity of lymphocyte mitochondrial enzymes and the neutrophil test) reflect the activity of infectious endocarditis and have an effect on the development of postoperative complications and on the mortality.

[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.

[Electrophysiologic effects of serotonin on atrioventricular conduction in dogs]. / Elektrofiziologicheskoe deistvie serotonina na atrioventrikuliarnuiu provodimost' u sobak.

In 12 anaesthetized dogs acute effects of serotonin on the atrioventricular conduction system were studied by obtaining intracardiac electrograms. The significant increase in the heart rate and decrease in aortic pressure elicited by an intravenous infusion of 50 mg/kg.min serotonin for 30 minutes were comparable to those observed in previous investigations. Our data indicate a serotonin induced acceleration of the sinus node pacemaker and atrioventricular conduction by direct and indirect mechanisms.

[Causes of decreased stability of good survival results and the incidence of complications in patients with multiple heart valve prostheses]. / Prichiny snizheniia stabil'nosti khoroshikh rezul'tatov vyzhivaemosti i chastota oslozhnenii u bol'nykh s mnogoklapannym protezirovaniem serdtsa.

The results of six-year follow-up of 368 patients after multiple prosthetic valve implantation (mitral and aortic prostheses in 173, mitral and tricuspid prostheses in 129, three prostheses in 36, mitral and aortic prostheses with tricuspid annuloplasty in 30) are reviewed. The mean functional class was 4.05 prior to the operation, and eventually declined to 2.1, being indicative of increased physical activity of the patients. Good results were stabilized in 61% of cases. Major causes of insufficient stability of good results were specific complications and progressive attendant heart diseases. There were no specific complications in 51% of the patients. The survival rate was 39.2%, including the intraoperative mortality rate. Long-term survival rate was 59.3%. Myocardial insufficiency, mostly occurring in patients with aortic prostheses and preoperative functional class 4 or 5, was one of the leading causes of reduced long-term survival. Therefore, patients should undergo surgery when in functional class 3, and those with aortic defects, while they are in functional class 2.

[Effect of progressive arteriosclerosis on late results of the reconstruction of the aorta and peripheral arteries]. / Vliianie progressirovaniia ateroskleroza na otdalennye rezul'taty rekonstruktsii aorty i perifericheskikh arterii.

The results of repeat angiographies, conducted for late impairments of the reconstructed artery, were reviewed in 912 patients after reconstructive operations on the abdominal aorta and its main branches. Progress of atherosclerosis in intact arteries was the cause of impairment in 65.9% of cases. Contribution of diabetes mellitus, tobacco smoking and arterial hypertension is discussed.

[Diagnosis and outcome of dysfunction of mechanical prostheses of the heart valves (analysis of 143 cases)]. / Diagnostika i iskhody narushenii funktsii mekhanicheskikh protezov klapanov serdtsa (analiz 143 nabliudenii).

Diagnosis of dysfunction of heart valve prostheses has been reviewed in 143 patients over 17 years of follow-up. Sixty-eight paravalvular fistulas, 69 thromboses and 6 prosthetic ball or disk changes have been detected. Sepsis was the cause of prosthetic dysfunction in 61 (42.7%) patients. Diagnosis was difficult to make in cases of thrombosis in the area of the ventricular ring of the mitral prosthesis, thrombosis of the aortic prosthesis and ball changes. Because of similar phonocardiographic features, thrombosis of the obturative part of mitral prosthesis should be differentiated from thrombosis of the atrial part of the prosthesis and paravalvular fistula. The absence of diastolic murmur and prevailing symptoms of right ventricular insufficiency are distinctive features of obturator thrombosis rather than atrial thrombosis of the prosthesis. Thrombosis of the aortic prosthesis or a ball change should be suspected, if the ratio of the opening to closing tone amplitude drops below 0.5 and intermittent protodiastolic murmur emerges. Clinical phonocardiographic studies are capable of detecting prosthetic dysfunction in most cases.

[Late results of aortocoronary shunting in ischemic heart disease patients in relation to the severity of the coronary lesion and degree of myocardial revascularization]. / Otdalennye rezul'taty aortokoronarnogo shuntirovaniia u bol'nykh ishemicheskoi bolezn'iu serdtsa v zavisimosti ot tiazhesti porazheniia koronarnykh arterii i stepeni revaskuliarizatsii miokarda.

Long-term results of aortocoronary shunting are reviewed in 219 coronary patients with reference to the severity of coronary arterial damage and myocardial revascularization. Functional class of angina pectoris declined 2.5-fold postoperatively and was 1.6 +/- 0.14 at long-term follow-up. The success rate reached 74%. Survival rate was 87.3%, including hospital mortality, and long-term survival was 92.1%. Acute coronary insufficiency was the principal cause of compromised success and survival rates. The operation was particularly effective in patients with first- or second-degree total coronary arterial lesion and true complete myocardial revascularization.

[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.