[Minor stenosis of carotid arteries: differential approach in diagnosis and surgical treatment]. / Malye stenozy sonnykh arterii: differentsial'nyi podkhod v diagnostike i khirurgicheskom lechenii.

The results of treatment of 161 patients with atherosclerotic small degree stenoses of carotid arteries (up to 50% of diameter) were analyzed. From them 67 patients underwent operations for chronic cerebro-vascular failure and 11 patients--for acute cerebro-vascular failure. 31 patients, who had contraindications for surgery or refused it, plasmapheresis procedures were carried on, 52 patients with asymptomatic carotid arteries' disease underwent conservative treatment. On the base of the results of examination and late results of treatment it is shown valid to recommend carotid endarterectomy as a prophylactic measure in acute cerebrovascular failure in asymptomatic patients who have morphologically unstable plaques of carotid arteries. If there are general contraindications for carotid endarterectomy, with the aim of prophylaxis of cerebrovascular failure the procedures of plasmapheresis for alteration of morphologic structure of plaques are advisable.

[Recommendations for implanting cardiac pacemakers in bradycardia]. / Rekomendatsii dlia implantatsii élektrokardiostimuliatorov pri bradikardiiakh.

The paper gives recommendations for cardiologists and cardiac surgeons who are engaged in working out indications, choice of the type and mode of cardiac pacing. Based on the understanding of the great importance of nomenclature documents concerning the development of indications for pacemakers implantation, the Working Group of the Expert Committee, Ministry of Health of the Russian Federation and Russian Academy of Medical Sciences, for implantable antiarrhythmic devices and electrophysiology has developed recommendations on pacemaker implantation in acquired atrioventricular (AV) block, in AV-block after myocardial infarction, chronic bi- and tri-fascicular block, sinoatrial nodal dysfunction, hypersensitive carotid sinus syndrome, neurovascular syndromes, as well as in childhood bradyarrhythmias. In developing the recommendations, the authors have used their own 25-year experience in implanting pacemakers and the recommendations proposed by the Working Group of the American College of Cardiologists and the American Association of Cardiologists in 1984 and 1991 for implanting pacemakers in bradyarrhythmias. The proposed recommendations define indications and contraindications for implantation of up-to-date pacemaker models and determine the behaviour policy of a specialist in selecting patients with bradyarrhythmias for the optimal pacing mode, which suggests a compulsory certification of the centers engaged in implanting pacemakers in bradyarrhythmias.

[Surgical treatment of paroxysmal cardiac arrhythmias with extracorporeal circulation and deep hypothermic protection]. / Khirurgicheskoe lechenie proksizmal'nykh narushenii ritma serdtsa v usloviiakh iskusstvennogo krovoobrashcheniia i uglublennoi gipotermicheskoi zashchity.

The paper analyzes the results of surgical management of the Wolff-Parkinson-White syndrome in 29 patients. Evidence is provided that it is not necessary to perform an intracardiac electrophysiological study in all patients in the preoperative period. A method for pacing mapping is proposed, which is advisable to be used in conduction block by the accessory pathway during an operation. Surgical policy is also discussed in the paper in relation to the site of accessory pathway. The paper provides the results of surgical management of cardiac fibrillation in patients with the Wolff-Parkinson-White syndrome in deep hypothermic protection.

[The inotropic reactions of the human heart muscle in ischemic heart disease]. / Inotropnye reaktsii serdechnoi myshtsy cheloveka pri ishemicheskoi bolezni serdtsa.

The investigation were performed on trabeculae extracted from right auricle of IHD patients aged 40-55 years during aortocoronary bypass. In transitory increase of stimulation frequency from 0.5 up to 1 Hz, a significant decrease of developed tension (Tmax), of the rate of its increase (T'max) and decrease (T'min) by 37% on the average were observed. On the contrary, stimulation frequency decrease up to 0.1 Hz caused, Tmax, T'min and T'max increase, by 20 + 4, 16 + 3 and 13 + 4 respectively (p < 0.05). The effect of hypercalcium (4 mM Ca2+) solution led to Tmax increase by 324%, T'max--by 254% and T'min by 383%, meanwhile the T'min/T'max ratio being initially equal to 0.3, increased to 0.4. Adrenalin caused not only the same Tmax increase (by 322%) as did Ca2+ but the same response of the rate parameters (T'min/T'max, 0.4--fold). The decrease of stimulation frequency to 0.1 Hz associated with Ca2+ or adrenalin effects resulted in additional increase of contractile activity. It was concluded that the contractile apparatus of myocardium in IHD patients retained sufficient functional reverse, accompanied by changes in the regulation of Ca(2+)-transporting systems.

[Functional heterogeneity of the atrial myocardium in patients with congenital and acquired heart defects]. / Funktsional'naia geterogennost' miokarda predserdii bol'nykh s vrozhdennymi i priobretennymi porokami serdtsa.

In experiments on atrium trabeculae the heterogeneity of myocardium contractile activity in patients operated on for inborn or acquired heart defects was studied. Contractile activity was assessed in isometric regime of muscle drugs work. The degree of functional heterogeneity was reported to differ in myocardium biopsies from patients with inborn or acquired heart defects. The difference was expressed in susceptibility to stimulating action or electrical impulses and in the degree of the change of myocardium contractile activity. The study of human myocardium functional heterogeneity is likely to present a new approach to increase efficacy of the work of pathologically changed heart muscle.

[Vasotonometry in the episcleral arteries in the diagnosis of stenotic lesions of the extracranial sections of the carotid arteries]. / Vazotonometriia v épiskleral'nykh arteriiakh v diagnostike stenoziruiushchikh porazhenii ékstrakranial'nykh otdelov sonnykh arterii.

The object of the work was evaluation of the method of vasotonometry (VTM) in the episcleral arteries in recognizing stenoses of the extracranial part of the internal carotid artery (ICA). The examination was conducted by means of a specially designed vasotonometer in patients suffering from ischemic type cerebral circulatory disorders. The authors examined 98 patients and 20 healthy volunteers. The parameters of the diagnostic sensitivity of the method in various degrees and forms of the stenotic lesions of the ICA were determined. The correct diagnosis of a hemodynamically significant ICA stenosis was established in 85% of patients. The results of the examination were confirmed by angiography and operation.

[Cerebral blood flow after carotid-subclavian shunting]. / Mozgovyi krovotok u bol'nykh posle operatsii sonno-podkliuchichnogo shuntirovaniia.

The radioisotope and rheography methods were used to study the cerebral blood flow in 12 patients in the late-term periods after formation of a carotid-subclavian shunt in occlusion of the initial segments of subclavian arteries. It is shown that an intact donor common carotid artery ensures adequate supply of blood to the brain and upper extremity.

[Effectiveness of the methods of electric cardiac stimulation and low-energy cardioversion-defibrillation in the prevention and treatment of ventricular tachycardia and ventricular fibrillation]. / Effektivnost' metodov élektrokardiostimuliatsii, nizko- énergeticheskoi kardioversii-defibrilliatsii v preduprezhdenii i lechenii zheludochkovykh takhikardii i fibrilliatsii zheludochkov.

The efficiency of treatment of ventricular tachycardias and fibrillation in cardiologic and cardiac surgical practice was examined in 154 patients by employing new unique means and facilities for automatic cardioversion-defibrillation of the heart. A comparative analysis was made of the efficiency of prevention of ventricular fibrillation and arrest of ventricular tachycardias by using various electric cardiac stimulation. The investigations indicated ventricular arrhythmia deaths might be significantly reduced by applying various methods of electric pulse therapy. The differential use of ++anti-tachycardia cardiac pacing and automatic low-energy cardioversion-defibrillation decreases the number of complications and enhances the efficiency of therapy in this contingent of patients.

[First experiences with the effect of low-energy electric impulse on the atrioventricular junction in various types of paroxysmal supraventricular tachycardia]. / Pervyi opyt nizkoénergeticheskogo élektroimpu'lsnogo vozdeistviia na atrioventrikuliarnoe soedinenie serdtsa pri nekotorykh paroksizma'lnykh nadzheludochkovykh takhikardiiakh.

Efficient treatment of paroxysmal supraventricular reciprocal tachycardias (nodal and orthodromal) was studied in 29 patients by applying low-energy discharges (mean 2.3 +/- 0.1 kV) to the area of the atrioventricular junction. Late results of the treatment were assessed 7-22 months later. Cessation of tachycardia paroxysms was observed in 10 patients, their lower frequency (by more than 50%) was seen in 14 cases. The value of discharge energy, their numbers, relations between potential amplitudes produced by atria and His' bundle, feasibility of paroxysm induction, presence or absence of bundle-branch block were not prognostic criteria for efficiency of this mode of therapy in the present investigation. In the authors' opinion, the method is promising in the treatment of atrioventricular nodal and orthodromal paroxysmal tachycardias.

[Late complications of VVI electric stimulation in patients with sick sinus syndrome]. / Oslozhneniia élektrostimuliatsii v rezhime VVI u bol'nykh s sindromomslabosti sinusovogo uzla v otdalennom periode.

Forty-nine patients, including 38 with documented bradysystolic sick-sinus syndrome (type I) and 11 with bradytachycardiac sick-sinus syndrome (type II) were studied. Follow-up of 24 patients with VVI stimulation (34 +/- 4 months) and 7 patients with AAI stimulation (23 +/- 1.2 months) demonstrated that VVI stimulation was associated with retrograde ventriculo-atrial conduction in 71% of patients, causing paroxysms of atrial fibrillation (5 patients, 4 of those having type I sick-sinus syndrome). Six patients developed permanent atrial fibrillation (including 5 with type I sick-sinus syndrome). Retrograde conduction slowed down the pulse rate because of ineffective ventricular response in 6 patients. Nine patients with retrograde conduction developed circulatory insufficiency.

[Clinical use and late results of transvenous endocardial destruction of the atrioventricular junction by the bipolar method]. / Klinicheskii opyt i otdalennye rezul'taty transvenoznoi éndokardial'noi destruktsii atrioventrikuliarnogo soedineniia serdtsa bipoliarnym sposobom.

Transvenous endocardial destruction of the AV junction, using an original bipolar technique, was carried out in 32 patients with supraventricular tachyarrhythmias, resistant to medication. The procedure was effective in 29 (91%) of 32 patients. Stable and complete AV block was achieved in 23 of 30 patients, with subsequent implantation of a pacemaker, while in 4 patients, clinical improvement was achieved with intact AV conductivity. Two patients with re-entry tachycardia of the AV junction were subjected to low-energy contusion of the AV junction, and the results were good. Major hemodynamic and myocardial contractility parameters were basically unchanged at long-term follow-up; spontaneous heart rate was significantly decreased in patients with implanted pacemakers, and some of those developed pacemaker dependence.

[Function of the heart conduction system in patients with progressive muscular dystrophy]. / Sostoianie provodiashchei sistemy serdtsa u bol'nykh s progressiruiushchei myshechnoi distrofiei.

Intracardiac electrophysiologic studies were carried out in 9 patients with progressive muscular dystrophy. Diagnostic stimulation of the heart demonstrated no sinus mode dysfunction. The intra-atrial conduction time increased to 72 +/- 7.1 ms (p less than 0.05), and the interatrial conduction time, to 97 +/- 12.5 ms (p greater than 0.05) in response to shortened testing stimulus delay in 3 patients. All 9 patients showed great variation in the duration of effective refractory atrial and atrioventricular periods (97.0 +/- 12.5 ms). The H-V interval increased from 43.9 +/- 4.3 to 73.9 +/- 7.6 ms (p less than 0.01) in response to shortened delay in 7 of 9 patients. Atrial pre-excitation resulted in a block of the right and left limbs of the His bundle in 5 of 7 patients. Third-degree atrioventricular block was recorded by continuous ECG monitoring in 7 patient. It is suggested that an apparent or latent intraventricular conductivity disorder may be present in most cases of progressive muscular dystrophy.