[Effect of aortic clamping on hemodynamics at reconstruction of the thoracoabdominal aorta]. / Vliianie perezhatiia aorty na gemodinamiku pri rekonstruktsii grudnoi i briushnoi aorty.

This paper describes an experience with monitoring and computerized follow up of the hemodynamic status in 60 patients at and right after reconstruction of the thoracoabdominal aorta. In addition to the routine control, measurements were made of the pressure in the large vessels and cavities of the heart, duration of each heart contraction and CI. The following parameters were computed automatically: the status of the ventricles for each heart contraction, resistance of the greater end pulmonary circulation, elasticity of the arterial, venous, pulmonary arterial and pulmonary venous reservoirs, also for each cardiac cycle. At the generally accepted monitoring the hemodynamic responses to the surgeon's manipulations on the aorta appear smoothed or are not visualized at all. The control of each heart contraction reveals the responses to application of the clamp and its removal from the aorta, with their hemodynamic significance being not questionable. Aortic clamping and clamp removal from the aorta are associated with the generalized response of the regulatory systems of the body. The slow and thoroughly controlled aortic clamping and graded, controlled blood flow restoration due to clamp removal as well as the use of sodium nitroprusside (trimetafan or isofluran are preferable) allow to avoid an abrupt stroke load of the left ventricle of the heart and, respectively, the generalized response of the regulatory systems of the body.

[Methods of plastic surgery of the renal arteries in children with vasorenal hypertension]. / Metody plastiki pochechnykh arterii u detei s vazorenal'noi gipertenziei.

The work deals with the management of vasorenal hypertension in children and adolescents. The Bakulev Institute of Cardiovascular Surgery had 185 children with arterial hypertension from 1965 to 1990. Their ages ranged from 12 months to 17 years. The vasorenal genesis of hypertension was caused by fibromuscular dysplasia (FMD) of the renal arteries in 61 patients, unspecific aortoarteritis (UAA) in 39, hypoplasia of the abdominal aorta, kidneys, and renal arteries in 22 patients, supernumerary renal arteries were found in 7 patients. A total of 119 operations were carried out on 106 patients. Operations and one-stage revascularization of the kidneys and alimentary organs were performed on 22 patients, isolated reconstruction of the renal arteries on 51 patients. Among 99 patients with stenoses and aneurysms of the renal arteries 13 were treated by nephrectomy (11.3%). The postoperative mortality was 0.9%. A hypotensive effect was not produced in the immediate postoperative period in 5 patients with UAA (4.6%) and in one patient with, FMD (0.9%). Six operations were performed in late-term periods after the first operative interventions: 2 for aneurysm of autovenous grafts, 2 for restenosis of the renal arteries, and 2 for stenosis of the aorta distal to the primary site of reconstruction in UAA. Three patients died in the late-term periods. The stability of good operative results was highest in congenital hypoplasia of the aorta--100%. A favorable effect of the operation persists in 89.6% of patients with FMD of the renal arteries. The stability of the effect is lowest (75%) in UAA.

[New aspects of the surgical treatment of aortic coarctation]. / Nekotorye novye aspekty khirurgicheskogo lecheniia koarktatsii aorty.

The article substantiates the urgency of the problem and shows the results of surgical treatment of coarctation of the aorta in 103 patients who were operated on in the recent 5 years. The operation of choice was resection of the coarctation with the formation of an end-to-end anastomosis (90.3% of operations). Establishment of the anastomosis by methods developed at the department makes it possible to achieve good results and avoid complications in the immediate and late-term postoperative periods. An anomalous arterial branch, a reduced branch of the 5th aortic arch called Abbott's artery, was ligated in 40% of cases. No fatal outcomes occurred in the last 5 years in surgical treatment of coarctation of the aorta.

[Surgical treatment of nonspecific aorto-arteritis]. / Khirurgicheskoe lechenie nespetsificheskogo aorto-arterita.

The authors analyse experience with 273 operations carried out in 273 patients; 107 operations were conducted on the branches of the aortic arch, 136 were performed for the "middle aorta syndrome", and 30 operations were performed in affections of the terminal aorta and the iliac arteries. Experience is also shown in operative treatment of 32 patients with coexistent affections of the "middle aorta" and the branches of the aortic arch, the surgical tactics and the sequence of operations in this type of pathology are discussed. Problems dealing with the classification of nonspecific aorto-aortitis (NAA) are discussed, and the authors' classification of the variants of the vascular manifestations of the process is suggested. The authors draw attention to the need for preoperative management of patients with UAA for correcting the activity of the inflammatory process. Hemosorption and immunocorrective therapy are suggested for this purpose. Means for improving the results of surgical treatment of patients with UAA are suggested. The total mortality was 13%.

[Effect of lumbar sympathectomy on late results of reconstructive operations on the abdominal aorta and arteries of the lower extremities]. / Vliianie poiasnichnoi simpatéktomii na otdalennye rezul'taty rekonstruktivnykh operatsii na briushnoi chasti aorty i arteriiakh nizhnikh konechnostei.

The use of reconstructive operation in combination with lumbar sympathectomy for the treatment of obliterative lesion of the vessels of the aortoiliofemoral segment permits to reduce the incidence of development of the early postoperative vascular thrombosis and late reocclusion. A good patency of vascular transplants after combined operation was noted in 62% of cases, after isolated reconstruction--in 38%.

[A new method of surgical treatment of recurrent aortic coarctation (aorto-aortic shunting from the ascending to the descending thoracic aorta)]. / Novyi metod khirurgicheskogo lecheniia rekoarktatsii aorty (aorto-aortal'noe shuntirovanie ot voskhodiashchei k niskhodiashchei grudnoi aorte).

The authors discuss the immediate results of 44 reconstructive operations performed for a second time on the descending thoracic aorta for complications of operative interventions conducted earlier for coarctation of the aorta. The high operative risk is connected with difficulties of rethoracotomy and the need to compress the thoracic aorta for a lengthy period of time. Operation for aorto-aortic shunting through right thoracotomy made it possible to avoid these difficulties. The immediate results of all 9 such operations were good.

[Surgical treatment of post-anastomosis aneurysm developed after reconstructive operations on the thoracic aorta]. / Khirurgicheskoe lechenie anevrizm anastomozov, voznikshikh posle rekonstruktivnykh operatsii na grudnoi aorte.

Twenty-three patients were examined and operated on for aneurysms of anastomoses which formed after reconstructive operations on the thoracic aorta for its coarctation (15), kinking of the arch of the aorta (4), traumatic aneurysms (2), nonspecific aortoarteritis (1) and dissecting aneurysm (1). The involved segment had to be repaired with a prosthesis in all operations carried out for the second time. In 30% of patients the course was complicated (aortopulmonary fistulas, false aneurysm with dissection of the descending thoracic aorta). Mortality was 57% in a complicated course and 6.3% in uncomplicated cases. The results of the operation were good in 18 patients.

[Dissecting aneurysms of the descending thoracic and abdominal aorta (current classification and surgical tactics)]. / Rasslaivaiushchie anevrizmy niskhodiashchei grudnoi i briushnoi aorty (sovremennaia klassifikatsiia i khirurgicheskaia taktika).

Results of clinical studies and surgical treatment of patients with dissecting aneurysms of the descending thoracic and abdominal aorta are discussed. A new modification of the clinicoanatomical classification of this aortic disease is proposed with the emphasis on the possibility of (1) retrograde extension of the pathological process into the aortic arch with primary intimal rupture in the descending thoracic segment, and (2) multifocal aortic lesion, a combination of dissecting aneurysm and true discrete aneurysm of the unaffected aortic portion. The possibility of performing various types of one-stage and stage-by-stage reconstruction of the descending aorta depending on the degree and extension of dissection is shown.

[Surgical treatment of high occlusion of the abdominal aorta associated with lesions of coronary, renal and visceral arteries]. / Khirurgicheskoe lechenie vysokoi okkliuzii briushnoi chasti aorty, sochetaiushcheisia s porazheniem venechnyk, pochechnykh i vistseral'nykh arterii.

The results of surgical treatment of 158 patients with high occlusion of the abdominal aorta associated with lesion of the coronary, renal and visceral arteries are presented. The technique of aorto-femoral shunting from the descending aorta with isolated plasty of its branches in patients with concomitant severe coronary disease, permitting to reduce the incidence of complications and lethality, is suggested.