[Changes of parameters of the functional state of the organism and oxidative stress in patients after surgical revascularization at early stage of restorative treatment]. / Izmeneniia pokazatelei funktsional'nogo sostoianiia organizma i oksidativnogo stressa u bol'nykh posle khirurgicheskoi revaskuliarizatsii miokarda na rannei stadii vosstanovitel'nogo lecheniia.

Early complex restorative treatment with individualized aerobic physical exercise in 2-4 weeks after surgical myocardial revascularization significantly increased physical working capacity and cardiorespiratory reserve of the body. Pronounced oxidative stress which had been present after myocardial revascularization decreased under the action of restorative therapy. Most pronounced increases of total physical capacity and cardiorespiratory reserve and lowering of oxidative stress occurred in patients with lowest initial parameters of the functional state of the organism.

[Assessment of the hemodynamic state of ischemic heart disease patients following aortocoronary shunting in relation to indices during surgery]. / Otsenka sostoianiia gemodinamiki u bol'nykh ishemicheskoi bolezn'iu serdtsa posle aortokoronarnogo shuntirovaniia v zavisimosti ot pokazatelei vo vremia operatsii.

Ninety-one coronary patients, aged 30 to 66 years, were investigated following aortocoronary shunting (ACS). The operations made use of assisted circulation (AC) and cold pharmacologic cardioplegia (CP). Three different cardioplegic solutions were used to achieve heart arrest and myocardial protection. Postoperative hemodynamic status was influenced by the duration of AC and CP as well as the composition of the cardioplegic solutions used, the number of shunts applied and the quality of revascularization. Temporary depression of the heart's pump function (within 1-2 months after ACS) was more pronounced in cases of: 1) longer time under AC and CP; 2) the use of a cardioplegic solution with a relatively low potassium content; 3) multiple shunts, and 4) partial revascularization.

[Long-term prognosis of myocardial infarct patients after intracoronary thrombolytic therapy]. / Otdalennyi prognoz u bol'nykh infarktom miokarda posle vnutrikoronarnogo tromboliticheskogo lecheniia.

One hundred and thirty-nine patients with acute myocardial infarction (MI) were followed up for 4 to 48 months after intracoronary thrombolysis. Postinfarction cardiovascular function was better in patients subjected to aortocoronary shunting or transcutaneous transluminal coronary angioplasty after antegrade blood flow recovery by thrombolysis. They had a significantly lower incidence of anginal pains, better working capacity and smaller MI recurrence rates. Effective intracoronary thrombolysis alone, unassisted by the elimination of residual stenosis, failed to produce basic improvement in subjective as well as objective postinfarction condition of the patients who remained at high risk for repeated MI due to a coronary re-occlusion.

[Repeat percutaneous transluminal angioplasty in coronary artery restenosis]. / Povtornaia chreskozhnaia transliuminal'naia angioplastika pri restenozakh koronarnykh arterii.

Early experience with repeat transcutaneous transluminal coronary angioplasty (TTCA) in 9 coronary patients is reviewed. The interval between the first and the repeat TTCA varied between 1 and 12 months averaging 4.9 +/- 4.7 months. Repeat dilatation of the anterior interventricular branch was performed in 7 patients, that of the right coronary artery, in 1, and that of the circumflex artery, in 1. All repeat operations were successful. Changes in the degree of stenosis and the mean arterial blood pressure gradient were actually similar in both dilatations.

[Results of using percutaneous transluminal coronary angioplasty in patients with stable and unstable angina pectoris and acute myocardial infarct]. / Rezul'taty primeneniia chreskozhnoi transliuminal'noi koronarnoi angioplastiki u bol'nykh so stabil'noi i nestabil'noi stenokardiei i ostrym infarktom miokarda.

Transcutaneous transluminal coronary angioplastics (TTCA) was performed in 28 coronary heart disease patients (8 patients had stable and 5 others labile angina, 15 presented acute myocardial infarction, AMI). The patients with AMI received intracoronary thrombolytic treatment prior to TTCA. Successful dilatation was performed in one patient with narrowing of the main trunk of the left coronary artery, in 14 of 21 patients with the stenosis of the anterior interventricular branch and in 5 of 6 patients with the narrowing of the right coronary artery. In three cases TTCA was carried out in the presence of the occluded coronary artery, with two patients benefiting from the operation. In 5 patients with AMI in whom an attempt to dilate the lumen of the coronary artery was unsuccessful, emergency surgery for aorto-coronary shunting was conducted. This operation was also performed in the planned order in 2 angina patients. In 7 patients the failure of TTCA was explained by the impossibility to pass the dilatary sound through the stenosis of the coronary artery and in 1 case by the failure to enter the ostium of the left coronary artery with the guiding catheter.

[Effectiveness of treatment of patients with acute myocardial infarction by intracoronary administration of nitroglycerin and streptokinase]. / Effektivnost' lecheniia bol'nykh ostrym infarktom miokarda vnutrikoronarnym vvedeniem nitroglitserina i streptokinazy.

The intracoronary administration of nitroglycerin and streptokinase was assigned to 95 patients with acute myocardial infarction. In 69 (79.3%) out of the 87 occluded coronary arteries the antegrade blood flow was restored. After the thrombolysis, aortocoronary shunting was performed in 26 patients and transcutaneous transluminal coronary angioplastic surgery in five patients. In 71 patients control angiographic examination was carried out 17-185 days later. It was revealed that in 73.7% of drug-treated patients, the antegrade blood flow was retained for an average of 37 days. Patients with the intact coronary blood flow after the thrombolysis exhibited a positive pattern of the parameters of left ventricular contractile function which was especially expressed following aortocoronary bypassing. In cases of thrombolysis failure or reocclusion, left ventricular contractility had a negative profile.

[Functional state of the cardiovascular system in patients with chronic coronary insufficiency 12 months after direct myocardial revascularization depending on the bypass patency]. / Funktsional'noe sostoianie serdechno-sosudistoi sistemy u bol'nykh s khronicheskoi koronarnoi nedostatochnost'iu cherez 12 mes posle priamoi revaskuliarizatsii miokarda v zavisimosti ot proknodimosti shuntov.

A comparative study of the functional state of the cardiovascular system (CVS) in the presence of chronic heart failure was performed 12 months following direct myocardial revascularization. It involved 49 patients with open aortal coronary bypasses and 20 patients with bypass occlusion. The CVS functional state was assessed by both invasive and noninvasive methods of investigation. The bypass patency was associated with an improvement in the patients' subjective conditions, an increased exercise tolerance and better indices of the left ventricle function. It is inferred that successful revascularization of the myocardium by an aortal coronary bypass produces a considerable therapeutic effect on the CVS functional state in patients with chronic heart failure.

[Indications for surgical treatment in ischemic heart disease and its results]. / Pokazaniia k khirurgicheskomu lecheniiu ishemicheskoi bolezni serdtsa i ego rezul'taty.

Of the 210 patients who underwent direct coronary surgery for stable and unstable angina pectoris and acute myocardial ischemia, 187 were followed up after the operation for 11 months on the average. Operative mortality was 11%. Among the 187 patients, 46.5% were completely relieved of angina, 36.4% showed moderate improvement, and 16.9% had no improvement in their condition. Patients with prior myocardial infarction had a substantially diminished success rate for relief of angina. Postoperative angiography in 125 patients demonstrated high correlation between clinical response and graft patency. It is concluded that direct coronary surgery provides partial or complete relief of angina pectoris in 82.9% of patients, and this response to operative treatment may be directly related to the success of the surgery ensuring patency of the graft, evidence of which is demonstrated by angiography.

Myocardial protection during aortocoronary bypass.

The authors analyze the results of 220 applications of internal cold cardioplegia in 136 patients with ischaemic heart disease, treated surgically by aortocoronary bypass. The operation was performed under neuroleptanalgesia and artificial circulation with hypothermia (27.9 +/- 0.2 degrees C) and haemodilution (24.9 +/- 0.3%). On the basis of clinical examination, electron microscopy of the myocardial ultrastructure, and investigation of the myocardial metabolism (contents of glucose, lactate, pyruvate, free fatty acids, catecholamines, and oxygen in arterial and venous blood flowing out of the myocardium), they come to the conclusion that internal cold cardioplegia efficiently protects the myocardium during aortocoronary bypass and secures favourable conditions for the development of anastomoses between coronary arteries and venous shunts.