[VIABILITY OF MYOCAROIUM AS RISK FACTOR FOR MORTALITY IN EARLY AND LATE PERIOD AFTER BYPASS SURGERY OF CORONARY ARTERIES IN PATIENTS WITH CORONARY HEART DISEASE AND SEVERE LEFT VENTRICULAR DYSFUNCTION].

In coronary heart disease and low ejection fraction of the left ventricle (LV) in patients after coronary artery bypass surgery tend mortality and complication rate higher than preserved LV systolic function. Significant preoperative predictors of early mortality and remote in these patients, and the incidence of complications in the early postoperative period were reveald.

[Expediency of application of miniinvasive access in prosthesis of aortal valve].

The literature data, concerning expediency of miniinvasive access in aortal valve prosthesis for its failures of various etiologies, are analyzed. Advantages and failures, occurring while its application, are discussed. Own clinical observation of successful conduction of operative intervention for aortal valve failure, using miniinvasive access, is adduced.

[Atherosclerosis of ascending aorta as a risk factor for neurological complications occurrence in surgical treatment of the ischemic heart disease].

Own experience of the ischemic heart disease (IHD) surgical treatment, combined with the ascending aorta (AA) atherosclerosis, was analyzed. Basing on results of surgical treatment for IHD there were noted mostly informative methods of diagnosis of the AA atherosclerotic affection severity and optimal approaches to surgical treatment of such patients.

[Experience of two-valve prosthesis in patients with combined aorto-mitral heart disease].

One of the main orientations of cardiosurgery is a surgical treatment of combined aortomitral valvular disease and often in combination with mitral valve insufficiency. The article presents the authors's surgical experience on treatment of patients with combined aortomitral valvular disease. Analysis of frequency and patern of complications during hospital stage of treatment and its remote results are given by authors in the article.

[Is there any alternative for the heart transplantation in patients with cardiac insufficiency of terminal stage?].

The heart transplantation constitutes the method of choice in the treatment of patients, suffering heart insufficiency, tolerant to medicinal therapy. Nevertheless, the donor's organs deficiency problem makes it necessary to search for methods of surgical treatment, which are alternative to transplantation and which would secure the patients life span prolongation as well as the quality of life improvement. New approach in surgical treatment of patients, suffering severe cardiac insufficiency have proposed Brazilian surgeon R. Batista. Experience of surgical treatment of 37 patients with dilatational cardiomyopathy and severe cardiac insufficiency (functional class III-IV, NYHA) is presented. In these patients surgical remodelling of left ventricle was done together with local myocardium plasty between papillary muscles base of mitral and tricuspid valves. Fair immediate and late results are noted.

[Efficacy of endovascular prophylaxis of pulmonary thromboembolism].

The improvement of the treatment results and efficacy of the endovascular prophylaxis methods in patients at risk for pulmonary thromboembolism (PTHE) occurrence constitute the aim of the investigation. The work is based on retrospective analysis of the treatment results of 114 patients, to whom cava filter (CF) was implanted for the PTHE accidents prophylaxis. During hospital period after the CF implantation the PTHE reattacks were revealed in 4 patients, the CF embolism and thrombosis--in 10, the ascending thrombosis--in 8, the CF dislocation and migration--in 8. Late results of the CF implantation were studied in 54 patients in terms from 1 to 10 years. In 3 of them the symptomless perforation of vena cava inferior (VCI) wall was diagnosed with nonsignificant CF diversion, distal migration of CF with adequate preservation of antiembolic function--in 1, the thrombosis had occurred in 5 patients. The CF implantation into VCI is an effective method of endovascular prophylaxis of fatal PTHE. The high efficacy of CF "Osot" was evidenced, witnessing the expediency of its clinical application.

[Morphological changes in the lungs and characteristics of thromboemboli in patients with thromboembolism of the pulmonary artery].

Basing on results of pathologoanatomical investigations, performed in 26 cases, the lungs changes in pulmonary thromboembolism were analyzed. It was shown, that an acute thromboembolism of a. pulmonalis main branches did not cause an acute necrosis of pulmonary alveolar tissue, but induces progressive diffuse changes of their microcircular bed, concomitant with pulmonary hypertension. In cases of chronical pulmonary thromboembolism the diffuse vascular sclerosis of the nonaffected lung and the alveolar tissue emphysema are formed, and in such cases the signs of pulmonary hypertension showing hypertrophy of the muscular vessels middle layer as well as their intima hyperplasia are revealed. This determines the expediency of earlier start of thrombolytic therapy conduction as well as surgical intervention in an acute pulmonary thromboembolism.

[Characteristics of hemodynamics and the oxygen balance during operation for massive pulmonary artery thromboembolism with artificial blood circulation].

The experience of artificial blood circulation application in 45 patients during surgical intervention performance for the pulmonary artery thromboembolism and vena cava inferior thrombosis was summarized. Peculiarities of the artificial blood circulation preparation and conduction were depicted and characteristic of the hemodynamics and oxygen metabolism indexes on various stages of operative treatment was presented. Analysis of results of treatment in patients after the operation was conducted. The efficacy of the operative treatment conduction was shown.

[Changes in the coagulational hemostasis system in venous thromboembolism].

The work is based on the results of examination of 51 patients, suffering various clinical variants of venous thromboembolism. There were adduced such indexes of the coagulational hemostasis systems, as the coagulation activation, anticoagulant and fibrinolytic. It was established, that disorders in the coagulational hemostasis system may be manifested by increase in activity of the coagulation activation system or by decrease in activity of anticoagulant or fibrinolytic system. The disorders in the coagulational hemostasis system causes the pulmonary thromboembolism occurrence.

[The tricuspid valve plasty in the surgical treatment of chronic pulmonary thromboembolism].

Chronic pulmonary thromboembolism causes persistent rising of pressure in the pulmonary artery system. Durable existing of hypertension promotes the right ventricle dilatation together with tricuspid valve insufficiency occurrence, dramatizing the disease clinical course and prognosis. There were considered the surgical methods of the tricuspid cardiac valve insufficiency correction. The performance of the tricuspid valve plasty according to De Vega and using supporting ring of Carpentiere was proposed, basing on experience of surgical treatment of chronic pulmonary thromboembolism and postthrombotic pulmonary hypertension.

[Surgical treatment of chronic post-thromboembolic pulmonary hypertension]. / Khirurhichne likuvannia khronichnoï posttromboembolichnoï lehenevoï hipertenziï.

Results of surgical treatment of 9 patients with postembolic chronic pulmonary hypertension, to whom thrombendarterectomy of the pulmonary artery branches was performed, using artificial blood circulation method, were studied up. Indications for conduction of operative treatment, including the heart--lungs complex transplantation, were made more precise. The ways of improvement of the surgical treatment results in patients, suffering this complication, were outlined.

[Cardiac valve prosthesis in patients with infective endocarditis and chronic renal insufficiency in terminal stage on a programmable hemodialysis]. / Protezirovanie klapanov serdtsa u bol'nykh infektsionnym éndokarditom i khronicheskoi pochechnoi nedostatochnost'iu v terminal'noi stadii, kotorym provodiat programmnyi gemodializ.

Mechanical cardiac valve implantation was performed in 3 patients with infective endocarditis, sepsis, chronical renal insufficiency of terminal stage, to whom the programmed dialysis was conducted. The operation was performed for vital indications. All the patients after the operation are alive, their treatment was continued, using programmed hemodialysis, effect of operation is good. The success of treatment of infective endocarditis in patients with chronical renal insufficiency of terminal stage depends on timely radical elimination of the infection foci in endocardium, the intracardial and systemic hemodynamics normalization, application of etiotropic antibacterial therapy, an adequate programmed hemodialysis.

[Application of auto-pericardium for closure of the pulmonary artery defect]. / Primenenie autoperikarda dlia zakrytiia defekta arterii.

In 7 patients with the pulmonary artery thromboembolism the integrity of the pulmonary artery its branches were restored using the patch made of autopericardium sewing in. The author recommend to use the methods for the pulmonary artery restoration in operative intervention performed on her.