[Ischemic heart disease complicated by heart failure: possibilities of surgical treatment].

Aim of the study was to assess remote results of surgical reconstruction of the left ventricle (LV) in patients with ischemic heart disease (IHD) and chronic heart failure (CHF). During 1996-2010 136 patients with IHD complicated by CHD were subjected to surgery. The patients were divided into 2 groups: with LV aneurism (group 1, n=70) and with ischemic cardiomyopathy (group 2, n=66). In all patients we performed coronary bypass surgery and Dor LV reconstruction. Moderate and high degree mitral regurgitation was corrected. Hospital mortality was 5.4% in group 2. There were no inhospital deaths in group 1. In all survivors we noted reduction of LV dimensions and sphericity of LV cavity, increase of LV ejection fraction. Ten year survival was 78 and 56,5% in groups 1 and 2, respectively. In 10 years after surgery 80.2 and 68% of patients, respectively, had no signs of high NYHA class (III-IV) CHF. Thus surgical intervention on all components of intracardiac pathology in patients with IHD with CHF allowed to achieve satisfactory long term results.

[Permanent cardiac pacing in vasovagal syncope and carotid sinus syndrome].

Vasovagal syncope and carotid sinus syndrome are common conditions in young and elderly people, respectively, mostly with benign prognosis. Nevertheless, severe or "malignant" syncopal attacks in some patients may be associated with life-threatening injury. Unfortunately, up to now almost all drug trials have failed to demonstrate any benefit in preventing syncope and interventional approach (pacemaker) may be appropriate. This article contains literature review and discussion of indications for pacing in vasovagal syncope and carotid sinus syndrome.

[Distributions of polymorphisms of genes of some components of hemostasis in patients with ischemic heart disease].

We have studied structure of polymorphisms of genes of blood clotting factors II, V, VII, platelet membrane glycoprotein IIIa (GPIIIa) and enzyme methylenetetrahydrofolate reductase (MTHFR) in patients with ischemic heart disease (IHD). In this cohort of patients most prevalent are polymorphism PLAA1/A2 of GPIIIa gene and 677T/T polymorphism of MTHFR gene. Inconsistency of existing evidence on effect of R/Q genotype of FVII gene on early development of IHD and myocardial infarction (MI) is underlined, and data on the absence of protective effect of Q allele on early development of MI are presented. Activating effect of PLAA1/A2 polymorphism of GPIIIa gene and 677T/T polymorphism of MTHFR gene on morphofunctional state of platelets is proved.

[Concerning study of life quality in patients with postinfarction cardiosclerosis].

Myocardial infarction, which often occurs as a result of emotional stress, represents a severe somatic disease. This disease creates a substantial stress which would affect the quality of patient's life. Other factors like age, gender and education level affect psychological condition of the patients who had previously suffered from myocardial infarction. Thorough examination of interrelation between life quality, severity of disease and accompanying pathology would help to identify distinctive pattern of the disease clinical course, which in turn would serve as a contributing factor to optimize medical treatment and rehabilitation of the patients that fall into this category.

[Localization of accessory atrioventricular pathways in patients with manifest premature ventricular excitation syndrome by three-dimensional vector electrocardiography].

Distribution of excitation via ventricular myocardium in patients with accessory atrioventricular pathways (AAVP) was studied using three-dimensional vector ECG. Analysis of the ECGs obtained during the study formed new views on the excitation process in the myocardium in the presence of AAVP, and made it possible to formulate vector ECG (VECG) criteria of AAVP localization. In 30 cases out of 33 it was possible to correctly localize AAVP. Information obtained as a result of VECG analysis made it possible to localize AAVP preoperatively within the limits of 1/14th atrioventricular sulcus with 97.1% accuracy, which is substantially higher than the accuracy of conventional electrocardiographic algorithms. Thus, the study found that in some cases three-dimensional vector ECG allows for substantial increase in the validity of AAVP localization, while in others it is the only sensitive non-invasive method of topical diagnostics of manifest premature ventricular excitation syndrome. Knowledge of the character of intervector interaction during ventricular electric systole makes it possible to predict the character of changes in the trajectory of QRS vector loop in any AAVP localization, i.e. to model the vector loop.

[Features of forming oxidative stress in blood of postinfarct cardiosclerosis patients during aortocoronary bypass]. / Osobennosti formirovaniia okislitel'nogo stressa v krovi bol'nykh postinfarktnym kardiosklerozom pri operatsiiakh aortookoronarnogo shuntirovaniia.

Patients with postinfarction cardiosclerosis in association with angina (NYHA class III) during coronary artery bypass grafting usually develop oxidative stress in erythrocytes which is characterized by enhanced free radical oxidation and depression of antioxidative enzymes. This process is of especially great importance and lasts longer in patients with the reperfusion syndrome. The consequences of this process could be revealed as derangement of the functional and structural state of erythrocytes, "rheological crises", further depression of the postischemic myocardium, rhythm and coronary flow disturbances. The results obtained show the effective prophylactics and antioxidant treatment of the oxidative stress syndrome to be necessary.

[Surgical treatment of infective endocarditis of the right sections of the heart]. / Khirurgicheskoe lechenie infektsionnogo éndokardita pravykh otdelov serdtsa.

The authors present results of surgical treatment of infective endocarditis of the right chambers of the heart in 22 patients subjected to 23 operations. Primary endocarditis was diagnosed in 14 patients, secondary endocarditis in 8 patients. Four patients died. In 12 patients the operations were performed during the active phase of the process. Positive bacterial hemoculture was detected in 11 patients. The operations were performed on the open heart. For correction of valve lesions artificial heart valves were used either with special antimicrobial cuffs ("Silzone") or cuffs impregnated with silver ions ("St. Inda Med.") or treated with a solution of Rifampicin during operation.

[Immediate results of reconstructive surgery in end-stage dilated cardiomyopathy]. / Neposredstvennye rezul'taty rekonstruktivnoi khirurgii terminal'noi stadii dilatatsionnoi kardiomiopatii.

First experiences with multistage surgical reconstruction of the left ventricle, heart valves and coronary arteries in patients with the end stage dilated cardiomyopathy are summarized. During the last three years operations have been made on 21 patients aged from 24 to 63, eight patients having idiopathic cardiomyopathy and 13 ischemic cardiomyopathy. They had markedly disturbed hemodynamics, ejection fraction of the left ventricle less than 30% and its diastolic diameter more than 70 mm. Most of the patients were candidates for heart transplantation. The Batista and Dor operations were made in combination with plastic operations on the mitral and tricuspid valves. In patients with ischemic heart disease myocardial revascularization was also performed. Four patients died after operation from arrhythmia and heart failure, the others' state had improved with less sizes of the heart and 10-12% greater ejection fraction. A conclusion was made that such operations were expedient.

[Gastrointestinal complications after aortocoronary bypass]. / Zheludochno-kishechnye oslozhneniia posle aortokoronarnogo shuntirovaniia.

Under analysis are gastrointestinal complications (hemorrhage, perforation of the duodenum, acute pancreatitis) which were observed in 10 of 177 patients after aortocoronary bypass. Risk factors of these complications, their specific diagnosis, treatment and prophylactics are discussed.

[Initial experience with the surgical treatment of hypertrophic cardiopathy using an apico-aortic valved conduit]. / Pervyi opyt khirurgicheskogo lecheniia gipertroficheskoi kardiopatii s ispol'zovaniem klapansoderzhashchego apiko-aortal'nogo konduita.

Long-term results (up to 3 years) of operative treatment of first patients with complex obstruction of the left ventricle outflow tract (hypertrophic cardiomyopathy--10 patients, congenital subaortic tunnel stenosis--1 patient) with the help of apico-aortic valved conduit are presented. There was no intrahospital lethality. Two patients died in late terms after operation who had been operated upon for the III degree of circulation insufficiency. Complications associated with using the valved conduit were not noted. All the patients operated upon did not need medicamentous therapy (indirect anticoagulants excluded), seven of them had the 1st functional class NYHA by the moment of examination, two had the 2nd functional class. Continuous observations have revealed a marked tendency to normalization of the hemo- and cardiodynamic parameters.

[Surgical treatment of heart myxomas]. / Khirurgicheskoe lechenie miksom serdtsa.

Nine persons were operated on in the Samara Interregional Cardiosurgical Center for left atrial myxoma in 1986-1991. Two-dimensional echocardiography was the major technique in making a correct diagnosis. The tumor was found in one patient intraoperatively. An operative access was made through the right atrium and atrial septum. The tumor was excised at the wide margin of the underlying myocardium. The postoperative period in all patients was smooth.

[10-year experience with correction of supraventricular tachycardia]. / Desiatiletnii opyt korrektsii nadzheludochkovykh takhiaritmii.

The results of a 10-year experience in surgical treatment of supraventricular tachyarrhythmias in 258 patients are analysed. Invasive and noninvasive methods of electrophysiological studies with the predominant use of Soviet-produced apparatuses were employed in establishing the diagnosis. Surgery of arrhythmias included catheter destruction, cryosurgery on a working heart, but the prevailing methods were various types of destruction of anomalous conducting paths under conditions of extracorporeal circulation. The authors suggest a method for dosed electrocoagulation of paranodal tissues in atrioventricular nodal tachycardias. The results of the operation were positive in over 90% of cases. Three fatal outcomes in operations with extracorporeal circulation occurred during the first years of accumulation of experience in the method. It is concluded that the operation is highly effective in severe tachyarrhythmias.

[A new method for the plastic repair of the aorta in coarctation]. / Novyi sposob plastiki aorty pri ee koarktatsii.

Thirty-six patients underwent operation in the Samara Cardiosurgical Centre in the period from 1987 to 1991. Their ages ranged from 18 months to 28 years, 32 of them were under 16 years of age. The operation was carried out through a lateral approach in third or fourth intercostal space. After mobilization of the aorta the constricted part was resected together with the orifice of the ductus arteriosus at a distance of 2-3 mm from the constricting membrane without removal of areas of conic constrictions of the remaining ends of the vessels. Longitudinal incisions were made in the aortic walls perpendicular to one another and the edges of the flaps were shaped to form triangles. An anastomosis was then formed with continuous sutures. The average time of compression of the aorta was 27 +/- 2.5 min. There were no fatal outcomes. Among the complications were bleeding which called for rethoracotomy in 2 patients, and suppuration of the wound in 3 patients. Thirty-two persons were discharged from the clinic with normal arterial pressure, in 4 patients the pressure reduced as compared to the preoperative level. The long-term results were studied in 29 patients in follow-up periods of 6 months to 4 years. Twenty-five of them had no complaints, residual hypertension was encountered in 4 patients but without signs of recoarctation. Thus, with the use of the described method the possibility for forming a direct anastomosis in cases in which a prosthesis had to be formed applied is greater, and in operations on children it became possible to increase the lumen of the anastomosis with growth of a child.