[Opportunity of operative traumatism decrease in patients with complicated tricuspid valve defect]. / Vozmozhnosti snizheniia travmatichnosti operatsii u bol'nykh s oslozhnennymi trekhklapannymi porokami serdtsa.

This study examined the results of surgical trivalve of 44 patients with trivalve heart defect. In all the patients the heart defect was combined with two and more complicating factors: advanced III-degree calcinosis of the valves, cardiomegaly, cardiac fibrillation, left atrium thrombosis, high pulmonary hypertension. In 20 patients the operative intervention on the heart was repeated. The analysis of the results allowed to recommend some surgical techniques which allowed to decrease surgical traumatism in patients with complicated trivalve heart defect. Low traumatism was possible because of incomplete removal of the calcium masses extending on the fibrotic ring and outside, use of two-row counter U-suture on linings for the prosthesis fixing, transdoubleatrial approach without isolation of the heart from the adhesions in dense pericardial obliteration, correction even insignificant trivalve heart defect or relative valve incompetence.

[Catheter balloon valvuloplasty in mitral stenosis (choice of surgical methods and evaluation of its results)]. / Kateternaia ballonnaia valvuloplastika pri mitralnom stenoze (vybor sposoba operatsii i klinicheskaia otsenka eë rezultatov).

Clinico-experimental study was undertaken for the choice of the optimal method for radiosurgical correction of the disease. Catheter balloon valvuloplasty (CBV), suggested by V. A. Silin and V. K. Sukhov with the use of balloon catheters of their design was found to be the most effective and safe method. This method was used to operate on 265 patients with mitral stenosis and various degree of affection of the valvular apparatus and complications in the form of calcinosis of the valve and cardiac fibrillation. Thirteen of the patients were operated on in pregnancy. CBV produced a positive therapeutic effect in more than 95% of patients. Increase of the mitral orifice area by 2.2-3.4 times was attended by a corresponding reduction of the diastolic pressure gradient at the mitral valve and systolic pressure in the pulmonary artery. The increase in the area of the mitral orifice and the positive changes of the hemodynamics values were more marked in patients with severe stenosis. The small number of complications (up to 9.5%) and the low lethality (up to 0.86%) allow the CBV method to be recommended as one of the main methods of surgical correction of mitral stenosis.

[Catheter-balloon valvuloplasty in mitral valve stenosis (selection of the method of procedure, immediate results and the criteria of patient selection]. / Kateternaia bollannaia val'vuloplastika pri mitral'nom stenoze (vybor sposoba operatsii, neposredstvennye rezul'taty, kriterii otbora bol'nykh.

Catheter-balloon valvuloplasty (CBV) was carried out in 80 patients with rheumatic mitral stenosis, whose ages ranged from 22 to 68 years. Seventeen of these patients were operated on for mitral valve restenosis; I-II degree calcinosis of the mitral valve was revealed in 18 patients; seven women underwent surgery in the 24th-32nd week of pregnancy. After applying various methods (19 cases) the authors used in the last series of operations (61 cases) the Silin-Sukhov method using an original dilatation catheter with a balloon measuring in diameter up to 34 mm, which allowed pressure of up to 8 atm. to be produced during a working cycle no longer than 8 sec. As the result of CBV, the area of the mitral orifice was enlarged by no less than twice in all patients, the pressure gradient through the mitral valve and systolic pressure in the pulmonary artery reduced. The total number of complications which called for operative treatment was 3.75%. CBV is a still developing method, but already today it may be considered the method of choice in the treatment of uncomplicated forms of mitral stenosis, in I-II degree calcinosis, and when the risk of the traditional surgical intervention on the heart is increased.

[Treatment of mitral valve stenosis in pregnant women by the method of balloon valvuloplasty]. / Lechenie mitral'nogo stenoza u beremennykh sposobom kateternoi ballonnoi val'vuloplastiki.

Catheter-balloon mitral valvuloplasty was performed in 7 females with rheumatic mitral stenosis on the 19th-32nd week of pregnancy. Four patients were operated on with signs of cardiac insufficiency, two--in a state of pulmonary pre-edema. Edema of the lungs in one patient continued developing on the operating table. The results of the treatment were good in all cases. The area of the mitral orifice increased from 0.9-1.75 to 2.4-3.5 cm2. The pressure gradient between the left atrium and the left ventricle dropped from 25-40 to 2-8 mm Hg. This was attended by the disappearance of the diastolic murmur and the clinical manifestations of stasis in pulmonary circulation in all patients. The development of mitral regurgitation after the operation was not encountered in any of the patients. The period of roentgenoscopy lasted 17.5 min. on the average. Screens were used to protect the fetus from the direct effect of the X-rays. Pregnancy ended in delivery in 6 patients; spontaneous labor at term occurred in 4, cesarean section had to be performed in one patient with placenta previa; one woman gave birth to twins on the 36th week of pregnancy. All the babies were healthy. Catheter-balloon valvulotomy does not yield to closed mitral commissurotomy in efficacy. The fact that it is only mildly injurious and does not need general anesthesia make this intervention preferable for pregnant women suffering from mitral stenosis.

[Complications of catheter-balloon valvuloplasty (analysis of their causes and the methods of prevention and treatment]. / Oslozhneniia kateternoi ballonnoi val'vuloplastiki (analiz prichin, sposoby profilaktiki i lecheniia).

The authors analyse the results of 1,404 operations of catheter-balloon valvuloplasty in stenoses of the pulmonary, aortic, and mitral valves. The experience was accumulated by the leading heart surgeons of the country from 1984 to 1990. The total number of complications was 77 (5.4%), 23 (1.6%) of them were fetal. The least number of complications (1.88%) occurred in catheter-balloon valvuloplasty in pulmonary stenosis, 1% were fetal. Complications in aortic stenosis were encountered in 11.3% of cases, 4.8% were fatal. The greatest number of complications (44) were recorded in mitral stenosis with a relatively low mortality (2.7%). The authors distinguish unspecific complications connected with the use of standard diagnostic catheters and instruments, and specific complications linked with the use of balloon catheters or caused by the course of the disease, and the character of the valve affection. As the result of analysis of the causes of complications, the authors suggest a system for preparation of patients for operation and the principles of its safe accomplishment and describe the order of the acts undertaken by the surgeon for the management of complications. Analysis of complications of catheter-balloon valvuloplasty demonstrates the efficacy and mild injurious character of this method, which makes it possible to rank it among the generally accepted cardiosurgical methods for the correction of heart valvular stenoses.

[Catheterized balloon mitral valvuloplasty in pregnancy]. / Kateternaia ballonnaia mitral'naia val'vuloplastika u beremennykh]

Catheterized balloon mitral valvuloplasty was carried out in two females with rheumatic mitral stenosis on the 28th and 24th weeks of pregnancy. The operation on the first patient was performed at the beginning of the development of pulmonary edema. Treatment produced good results in both cases. The surface of the mitral orifice increased from 1.5 and 1.6 to 3.2 and 3.5 cm2, the pressure gradient between the left atrium and left ventricle reduced from 40 and 30 to 6 and 4 mm Hg. There was attended by disappearance of the diastolic murmur and the clinical manifestations of congestion in pulmonary circulation in both patients. Mitral regurgitation did not occur after the operation. Radioscopy lasted 20 and 33 minutes. Protective screens were used to protect the fetus from direct exposure to X-ray. Pregnancy terminated at full term by spontaneous delivery in both patients. The babies, both girls, are healthy. Catheterized balloon mitral valvuloplasty does not yield to closed mitral commissurotomy in efficacy. The mild character of injury inflicted during the operation and no need for general anesthesia make this intervention most preferable in female patients with mitral stenosis during pregnancy.

[Changes in intracardiac hemodynamics after percutaneous catheter balloon valvuloplasty in different types of valvular stenosis of the pulmonary artery]. / Izmeneniia vnuitriserdechnoi gemodinamiki posle chreskozhnoi kateternoi ballonnoi val'vuloplastiki razlichnykh tipov klapannogo stenoza legochnoi arterii.

Percutaneous catheter balloon valvuloplasty was carried out in 75 patients with valvular pulmonary stenosis (VPS), whose ages ranged from 18 months to 38 years. In 40 of them (53.3%) VPS was complicated by infundibular stenosis of the right ventricle. After percutaneous catheter balloon valvuloplasty 13 patients received out-patient treatment with beta-adrenergic blocking agents in doses of 20 to 120 mg/24 hours. Control examination in periods of 6 months to 2 years after the operation was conducted in 35 patients among whom 10 patients had been given beta-adrenergic blocking agents in the postoperative period. A stable reduction of the right ventricle-pulmonary artery (RV-PA) gradient and positive dynamics of the cardiac volume indices were recorded in 25 patients after correction of isolated VPS and in 6 patients after percutaneous catheter balloon valvuloplasty and treatment with beta-adrenergic blocking agents. The residual RV-PA gradient in 4 patients after treatment with beta-adrenergic blocking agents remained within a range of 30 mm Hg. Percutaneous catheter balloon valvuloplasty is an effective method for the correlation of isolated VPS. Coexistence of VPS with infundibular right-ventricular stenosis is not a contraindication for the use of this method for correcting the anomaly. In such a case the roentgenosurgical intervention should be supplemented by treatment with beta-adrenergic blocking agents in individual doses.

[Clinical and laboratory effect of leukinferon in purulent infections]. / Kliniko-laboratornyi éffekt leikinferona pri gnoinoi infektsii.

Clinical trials of human leukocytic alpha-interferon for injections, leukinferon were performed in 51 patients with different forms of surgical purulent infections. It was shown that leukinferon lowered the terms of normalization of body's temperature, leukocytosis, respiratory neutrophilic outbreak and levels of active T-lymphocytes. The same was observed when leukinferon was used prophylactically in cardiosurgical patients. The effect of leukinferon depended on the level of radical operations on primary purulent foci and severity of the patient's state. Leukinferon had immunomodulatory properties and mainly influenced the system of neutrophilic phagocytes. The action was lymphocyte-mediated. The rapid effect of leukinferon makes it necessary to recommend it for treatment of patients with purulent infections as an agent of urgent immunomodulation.

[Pharmacodynamics of antibiotics in their preventive use in heart surgery with general artificial circulation]. / Farmakodinamika antibiotikov pri ikh profilakticheskom primenenii u bol'nykh, operirovannykh na serdtse v usloviiakh obshchego uskusstvennogo krovoobrashcheniia.

Pharmacodynamics of antibiotics in their prophylactic use was studied in 100 operations with artificial circulation, which were performed in patients with rheumatic heart defects. It was established that at the time of operation and after it, the antibiotic excreted via the kidneys insignificantly++, within the whole period of intracardiac stage of the operation, the myocardium remained without the antibacterial protection, and required the local use of an antibiotic.