[Fibrin glue in cardiovascular surgery]. / Fibrinovyi klei v serdechno-sosudistoi khirurgii.

A variant of fibrin glue has been designed. This glue can be prepared on the basis of cryoprecipitation in departments of blood transfusion (fibrinogen concentration 60-90 g/l). The glue has been used in urgent abdominal and cardiac surgery in particular for facilitation of hemostasis after sternotomy and suturing of the aorta, pulmonary artery and atria.

[Arterial switch operation in reconstructive surgery]. / Perekliuchenie arterii v rekonstruktivnoi khirurgii.

Arterial switch is a relatively novel surgical approach aimed at augmentation of blood flow at the account of less important arterial branches. The method consists in suturing vessels of different diameter end to end and end to side. Arterial switch is used for perfusion of donor organs, kidney in particular. The authors suggested a variant of arterial switch--intrapericardial subclavian to pulmonary arterial anastomosis--in the presence of stenosis of right ventricular outflow tract in tetralogy of Fallot. This anastomosis has several advantages over classical methods of surgical correction of Fallot's tetralogy. Coronary artery bypass surgery using mammary artery grafts is based on arterial switch principle and represents the most effective technique of treatment of coronary artery stenoses. Multiple experimental and clinical methods of arterial switch having been proposed and investigated by the authors since 1955 have found wide application in reconstructive surgery.

[Concept of critical stenosis in cardial surgery]. / O poniatii kriticheskogo stenoza v kardiokhirurgii.

When stenosis of a large artery reaches about 75% of its lumen blood flow distal to obstruction abruptly falls and ceases to play decisive role for the region it supplies. This region survives due to opening of collaterals. This allows to cross-clamp coronary artery for 20-30 minutes and to create distal anastomosis during aorto-coronary venous or mammary coronary artery bypass grafting without artificial circulation. Another example is mitral stenosis. There exists a critical value of an orifice area (1 cm2 or 25% of the lumen) when abrupt decompensation develops. Similar cut off values of inflow (nourishing) vessel stenoses can be demonstrated in other regions of cardiovascular system. Thus conception of a 'critical stenosis' is universal for the arterial part of circulation and finds wide application in clinical practice.

[Management of combined thoracoabdominal wounds]. / Lechebnaia taktika pri sochetannykh torakoabdominal'nykh raneniiakh.

Last years in the country gace rise to the problem of treatment of fire-arm's wounds in civil population. The results of treatment of victims with firearm thoracoabdominal wounds have evidenced unprepareness of surgeons for rendering specialized aid in conditions of "military-urban" surgery. The study performed by the authors has shown that there are substantial and principal differences between many postulates of war-field surgery and "military-urban" surgery. It consists in early hospitalization of victims with combined thoraco-abdominal injuries, prevalence of bullet wounds over fire-mine explosive injuries which have an effect on the extent of surgical intervention, results of treatment and development of complications. The proposed treatment modalities in victims with combined penetrated thoracoabdominal injuries in great measure may contribute to optimization of surgical aid in conditions of "military-urban" surgery.

[Current aspects of hemodynamic compensation and surgical treatment in aortic valve diseases]. / Nekotorye sovremennye aspekty kompensatsii gemodinamiki i khirurgicheskogo lecheniia pri aortal'nykh porokakh serdtsa.

The paper analyzes the data on the examination and surgical treatment of 426 (313 males and 113 females) patients aged from 16 to 60 years with various aortic valvular diseases. Isolated aortic stenosis was detected in 122 (28.6%) patients, isolated aortic failure in 128 (30.0%), and aortic valvular disease concurrent with other valvular diseases in 176 (41.4%) patients. Some problems in the diagnosis of latent myocardial insufficiency and in the compensation of intracardiac hemodynamics, as well as the association of aortic valvular disease, angina pectoris, and coronary heart disease are dealt with. A contribution of risk factors, such as valvular calcification, age, etiology, and their influence on the outcome of surgical treatment are discussed in the paper.

[The possibility of determining the functional status of the hypertrophied myocardium in multiple valvular defects of the heart]. / O vozmozhnosti opredeleniia funktsional'nogo sostoianiia gipertrofirovannogo miokarda pri mnogoklapannykh porokakh serdtsa.

A comprehensive angiocardiographic study with computer-aided data processing were performed in 46 patients (mean age 34.2 years) with multivalvular diseases. Thirty two patients were diagnosed as having mitral and aortic defect, 14 had mitral, aortic and tricuspid defect. Three-valve disease, unlike two-valve disease, showed a "paradoxical" improvement in some parameters, such as end-diastolic volume, end-systolic volume, myocardial mass, ventricular performance rates. An analysis of circular intramyocardial tension, coronary sinus blood oxygen extraction and saturation indicated that myocardial function was less intensive in three-valve disease, suggesting the compensatory pattern of tricuspid valve involvement. However, this "compensation" results in a further decrease in cardiac output and cannot be regarded as a genuine compensation. In multivalvular disease, the integral intramyocardial tension and its ratio to coronary sinus blood oxygen saturation may serve as the only diagnostic criterion for myocardial dysfunction and a predictor in determining the outcome of surgical intervention.

[Use of autologous pericardium in plastic surgery of the right coronary artery in patients with ischemic heart disease]. / Plastika pravoi koronarnoi arterii autoperikardom u bolnykh ishemicheskoi bolezn'iu serdtsa.

The paper describes the procedure developed by the authors for surgical myocardial revascularization in patients with coronary heart disease (CHD) via direct reconstruction of the ostium and all the segments of the right coronary artery by performing direct endarterectomy and subsequent plasty with free autopericardial flaps. The findings indicate that this surgical method is beneficial for CHD patients. In some cases, it may be the method of choice in the surgical treatment of CHD patients.

[Aortocoronary shunting in patients with newly developed stenocardia]. / Aortokoronarnoe shuntirovanie u bol'nykh s vpervye voznikshei stenokardiei.

Aorto-coronary bypass were performed in 10 patients aged from 34 to 55 years 7 to 30 days after the occurrence of angina pectoris for the first time. Coronarography demonstrated stenosis (of more than 75%) of the coronary arteries in all patients. Angina pectoris disappeared and did not recur in postoperative periods of up to 12 months in all cases. Shuntography was carried out 6 weeks after the operation in one patient: the shunt was potent.

[Aortocoronary bypass in progressive stenocardia]. / Aortokoronarnoe shuntirovanie pri progressiruiushchei stenokardii.

The authors evaluate the efficacy of aortocoronary shunting in the treatment of 10 patients with progressive angina pectoris (unstable stenocardia) in follow-up periods of up to 12 months after the operation. In none of the patients did angina pectoris or myocardial infarction develop in the indicated postoperative periods.

[Aortocoronary shunting in unstable and early postinfarction angina pectoris due to lesion of a coronary artery]. / Aortokoronarnoe shuntirovanie pri nestabil'noi i rannei postinfarktnoi stenokardii, osbuslovlennoi porazheniem odnoi koronarnoi arterii.

Aortocoronary shunting was performed in 15 patients with unstable and early postinfarction angina pectoris. Coronarography revealed an isolated lesion of a coronary artery in all the patients. Two years after the operation the patients had no angina pectoris; no myocardial infarctions occurred.

[Formation of pseudoaneurysms at the site of prosthetic surgery of the aorta using a synthetic prosthesis in coarctation]. / Obrazovanie lozhnykh anevrizm v meste protezirovania aorty sinteticheskimi protezami pri koarktatsii.

Two patients who underwent 28 and 20 years ago operation for correction of coarctation of the aorta and its restoration by synthetic dacron prostheses were examined. They had characteristic complaints. Examination by functional and invasive methods revealed changes in the synthetic prostheses which caused the characteristic complaints and elements of the disease. The findings of autopsy were studied in a case of sudden death 25 years after repair of the aorta by a dacron prosthesis in coarctation. Morphological examination revealed essential changes in the synthetic dacron prosthesis which led to complications in the late postoperative period.

[Sutures and anastomoses of the aorta and large arteries]. / Shvy i anastomozy aorty i krupnykh arterii.

The problems of air-tightness of vascular sutures are discussed. The authors suggested and used in the clinic successfully a double-row buried suture of the anterior wall of the aorta, pulmonary trunk, and femoral artery under conditions of using heparin. The incision for forming the proximal anastomosis in correction of coarctation of the aorta is discussed. A circular suture applied to the aorta and pulmonary trunk with a single thread was developed in experiments and performed in the clinic.

[Mitral stenosis and the problem of critical constriction in blood circulation]. / Mitral'nyi stenoz i problema kriticheskogo suzheniia v krovoobrashchenii.

The results of a combined echocardiographic study of 127 patients with mitral stenosis are reviewed. Echocardiographic and hemodynamic parameters are divided into 3 groups with respect to the severity of mitral stenosis. A relationship is demonstrated between mitral opening area and diastolic pressure gradient, as evidenced by dopplerography. The definition of critical mitral stenosis is given. A classification of the severity of mitral stenosis on the basis of two-dimensional echocardiography is offered, that provides indications for surgery.