[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.

[Dynamics of the insulin, somatotropic hormone, glucose and free fatty acid content in the blood during a direct myocardial revascularization operation under neuroleptanalgesia]. / Dinamika soderzhaniia insulina, somatotropnogo gormona, gliukozy i svobodnykh zhirnykh kislot v krovi pri operatsii priamoi revaskuliarizatsii miokarda v usloviiakh neiroleptanal'gezii.

The dynamics of the content of insulin, somatotropic hormone, glucose and the free fatty acids were studied in 32 male patients with ischaemic heart disease subjected to direct revascularization on the myocardium under neuroleptanalgesia and artificial circulation with moderate hypothermia and haemodilution. It is established that during operations on the coronaries under these conditions insulin secretion is not depressed, despite stable increase of the somatotropic hormone in the blood. High concentrations of glucose and insulin in the blood prevent the rise of the free fatty acids.

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.