[A response to the correction of congenital heart diseases in infants of the first year of life under extracorporeal circulation].

Examination of 36 infants of the first year of life, who had been operated on under extracorporeal circulation, revealed the activation of the monocytic cellular pool. This reaction was accompanied by an increase in the content of activated HLA-DR-positive cells. Limitation of the monocytic test via apoptotic mechanisms was inadequate. The control children undergoing cardiac surgery without extracorporeal circulation showed the same trend in the number of monocytic cells, which counts in favor of the fact that surgical injury is just a trigger of their activation. Extracorporeal circulation prolongs these changes to 3-4 postoperative days.

Ultrastructure of myocardial capillary endothelium in children with congenital heart disease.

Cardiosurgical stress initiates endothelial injury of the colliquation necrosis type (without activating coagulation necrosis) in coronary capillaries of infants aged under 1 year. The dark cells exhibited high tolerance to operation stress in the presence of labile ultrastructural response of endothelial cells of the main and light types. The percentage of dark cells does not change during surgical intervention, which is a sign predicting a favorable course of the postoperative period.

[The study of cerebral oxygenation and central hemodynamics in patients with ischemic heart disease at rest and during physical effort.]. / Issledovaniia tserebral'noi oksigenatsii i tsentral'noi gemodinamiki u bol'nykh ishemicheskoi bolezn'iu serdtsa v pokoe i pri fizicheskoi nagruzke.

Cerebral oxygenation (rSO(2)) in the region of sagittal sinus and main hemodynamic parameters were measured in 112 patients with ischemic heart disease and class II-III angina. Four groups of patients were distinguished according to degree of rSO(2) lowering. Hemodynamics and oxygen transport function of the blood were proportionally related to degree of rSO(2) lowering. Normal rSO(2) (>70%) and degree lower (70-61%) was associated with predicted (desirable) cerebral blood flow. Lower rSO(2) values (60-50%) were accompanied with increased oxygen utilization (by 20-25%). Critical rSO(2) lowering (below 50%) was associated with>/=75% rise of oxygen utilization what was indicative of decreased brain blood flow and cerebral ischemia.

Experimental studies on the endothelium ultrastructure of heart capillaries under moderate (28-30 degrees) and deep (22-24 degrees) hypothermia without perfusion.

Ultrastructural changes in endothelial cells (EC) of myocardial capillaries were studied in 24 dogs which underwent hypothermia without perfusion. Biopsy specimens for electron microscopy were taken from the left ventricle of each dog in the control group, during anesthesia (prior to active cooling), and at the end of moderate (28-30 degrees ) and deep (22-24 degrees ) artificial body cooling. The following morphological types of the EC were identified both in the control group and in all test groups: those with moderately dense cytoplasm, light, dark, and irreversibly damaged cells. Dark cells showed increased numbers of plasmalemmal vesicles and appeared to be more transport-specialized as opposed to other types. In all stages of the experiment the amount of dark cells continuously increased (to 23.80, 34.62, and 47.17%, respectively). On cooling to 28-30 degrees, subcellular manifestation of reduced synthetic activity of organelles (nucleus, Golgi complex, and rough endoplasmic reticulum) was observed in all types of the EC. These changes persisted, or even increased, at the end of deep hypothermia. The transport activity of the EC changed differently in three experimental groups in all cell types. Micropinocytotic activity increased under spontaneous mild hypothermia (34-35 degrees ) during anesthesia and tended to decrease with subsequent artificial lowering of the temperature to 22-24 degrees. These ultrastructural changes seem to make up an integral part of the process of capillary endothelium adaptation to body surface cooling, and they might contribute to the development of tolerance to subsequent ischemic exposure during cardiac arrest.

[Characteristics of carbohydrate metabolism regulation during correction of congenital heart defects and hypothermic protection without perfusion]. / Osobennosti reguliatsii metabolizma uglevodov pri korrektsii vrozhdennykh porokov serdtsa v usloviiakh besperfuzionnoi gipotermicheskoi zashchity.

Carbohydrate metabolism and insulin status have been studied in 89 patients with congenital heart valve defects operated on in conditions of profound perfusion-free hypothermic protection. It has been established that anesthesia, hypothermia, and surgical trauma are accompanied by hyperinsulinemia, which had nothing to do with the introduction of exogenic hormone. Insulin effect is attenuated and insulin resistance develops, which leads to a drop not only in glucose consumption but also in the consumption of glycolysis products. Single insulin injection during induction to anesthesia at a dose of 0.5 U/kg was insufficient for normalization of carbohydrate homeostasis. Glycolysis activation with a considerable increase in blood pyruvate level has been observed, which decreases lactate/pyruvate coefficient informative value at different stages of surgical treatment of heart valve defects.

[Prevention of cerebral occlusive venous hypertension during operations on the "dry" heart]. / Profilaktika okkliuzionnoi venoznoi gipertenzii golovnogo mozga pri operatsiiakh na "sukhom" serdtse.

A method of cava-caval draining is described. Under study was the dynamics of changes of pressure in the vena cava superior in 22 patients with congenital heart diseases operated upon under conditions of nonperfusion deeper (25-25 degrees C) hypo-thermal defense of organism. It was established that after putting cava-caval drainage the pressure in the vena cava superior decreased from 15.7 +/- 0.8 mm Hg to 4.57 +/- 0.53 mm Hg with a simultaneous formation of blood depot in the system of vena cava inferior. The data obtained are thought to show that the method is a reliable method of prophylactics of occlusive venous hypertension of the brain in operations on the "dry" heart.