[Surgical treatment of ventricular allorhythmia and non-ischemic tachycardia]. / Khirurgicheskoe lechenie zheludochnykh alloritmii i neishemicheskikh takhikardii.

The paper deals with the problems in the diagnosis and treatment of patients with the most malignant rhythm disturbances, i. e. ventricular arrhythmias. A great emphasis is laid on the so-called "primary" arrhythmias appearing without a manifest cardiac abnormality. The arrhythmias proceed unfavorably and are followed by profound morphofunctional myocardial changes occurring chiefly in the upper portions of the ventricular septum, more frequently on the right. Cryodestruction of arrhythmogenic areas is an effective method for surgical correction of arrhythmias having an unfavorable course.

[General and regional functions of the right ventricle in idiopathic ventricular arrhythmias]. / Obshchaia i regionarnaia funktsii pravogo zheludochka pri idiopaticheskikh zheludochkovykh aritmiiakh.

Various aspects of the diagnosis of idiopathic ventricular arrhythmias, seen in cases where no heart changes can be detected by noninvasive investigation are discussed. Total and regional right-ventricular myocardial activity was assessed in 10 patients with moderate idiopathic right-ventricular arrhythmias. All patients underwent electrophysiologic investigation with endocardial mapping and right ventriculography. In 9 cases, biopsy from unexamined arrhythmogenic zones was taken intraoperatively for histologic studies. Arrhythmogenic foci were located in the right-ventricular outflow department in most cases of idiopathic ventricular arrhythmias. The outflow and inflow right-ventricular departments commonly demonstrated regional myocardial dysfunctions and disordered sequence of contractions of the appropriate myocardial portions during intermediate intervals of the ejection phase.

[Clinico-morphologic aspects of chronic mesotympanitis]. / Kliniko-morfologicheskie aspekty pri khronicheskom mezotimpanite.

The present authors examined 84 patients with chronic mesotympanitis, 72 of which showed pathological lesions of the middle ear mucosa and bone. This was confirmed by X-ray contrasting examination before surgery and histological examination of tissue samples. Histological analysis showed that the level of destructive changes in middle ear cavities depended on the disease duration. Fibrous tissues of varying degree of maturity, cholesteatoma, tympanosclerotic patches, encapsulated fragments of caries bone frequently cause blockade of the aditus which complicates the chronic process in middle ear cavities and should be regarded as an absolute indication for surgical treatment of chronic mesotympanitis.

[Morphology of heterologous aortic bioprostheses intended for clinical use]. / Morfologiia ksenoaortal'nykh bioprotezov, prednaznachennykh dlia klinicheskogo primeneniia.

Results of an experiment on the preservation of bioprostheses prepared from porcine aortal valves are presented. It is described how the structure of the cusps is affected by autolytic processes, by exposure to various concentrations of glutaraldehyde, and by sequential exposure to glutaraldehyde and papain solutions. Xenogeneic aortal complexes must be processed within the first 24 hours after collection since later on they undergo autolysis whereby the fibroblasts are destroyed and collagen fibrils become damaged. Low glutaraldehyde concentrations preserve the structure of these well enough, although concentrations below 0.5% were found to make the ground substance edematous and cause structural damage to the fibroblasts. Papain treatment without glutaraldehyde pretreatment leads to profound changes in the fibrous structures and in the cells, whereas glutaraldehyde fixation followed by papain treatment assures adequate preservation.

[The role of biopsy of the human myocardium in cardiological and cardiosurgical centers]. / Rol' biopsii miokarda u cheloveka v kardiologicheskom i kardiokhirurgicheskom tsentrakh.

Endomyocardial puncture biopsy is practicable for elucidating etiology (nosology), differential diagnosis, the determination of activity of rheumatism or nonspecific myocarditis, the assessment of treatment efficiency and prognosis of outcome. Incision intraoperative biopsy should be used to evaluate the efficiency of myocardial protection and the specifics of metabolism and function of the myocardial cell. Open incision intraoperative myocardial biopsy is more informative than the endomyocardial puncture biopsy as it provides a heart specimen where all layers are represented, so that the number of negative results attributable to the mosaic pattern of myocardial abnormality is reduced.

[Evaluation of the efficacy of human heart protection during cardioplegia]. / Otsenka éffektivnosti zashchity miokarda cheloveka pri kardioplegii.

Materials from 546 intraoperative incision biopsies from 253 patients were studied in order to assess the effectiveness of myocardium protection during operations on the open heart. No significant ultrastructural, metabolic or functional changes develop in the myocardium upon pinching of the aorta and ischemia for 10 min, therefore myocardium protection is unnecessary. In ischemia for up to 40 min ultrastructural changes in cardiomyocytes are reversible therefore deep hypothermia proved to be sufficient for myocardium protection. When the aorta is pinched for up to 60 min under conditions of cold cardioplegia, ultrastructural changes in cardiomyocytes may be reversible but they depend upon the initial condition of the heart muscle and precise accomplishment of all the requirements of this type of myocardial protection. Cryopharmacological cardioplegia allows one to shut down the heart from the circulation safely for 120 min which has been confirmed by the results of electron microscopic and histochemical studies and the results of clinical examinations of the patients. Incisional intraoperative biopsy allows the judgement of the effectiveness of myocardium protection during asystole due to the pinched aorta, of the initial changes of the myocardium, i. e. the preoperative background, of the subtle features of metabolism and function of the myocardial cell to be made. The open incisional intraoperative biopsy of the myocardium is more informative than the puncture endomyocardial one.

[Ultrastructural and histochemical criteria of myocardial hypoxia and a morphological assessment of the various methods for its protection (based on biopsy data of the human heart)]. / Ul'trastrukturnye i gistokhimicheskie kriterii gipoksii miokarda i morfologicheskaia otsenka razlichnykh metodov ego zashchity (po dannym biopsii serdtsa cheloveka).

Short-term ischemia (up to 10 minutes) induced by clamping of the aorta in correction of a ventricular septal defect causes no essential ultrastructural, metabolic or functional changes in the myocardium. In much longer period of ischemia (of up to 40 minutes) during operation for congenital heart diseases, the use of deep hypothermia is effective. Cold cardioplegia is a sufficiently reliable method for myocardial protection when the aorta is clamped for up to 60 minutes in operations for acquired heart diseases. Changes in the structure and metabolism of the myocardium are reparable, their degree depends on the initial condition of the heart muscle and proper fulfilment of the methodical conditions of this type of protection. Pharmacological cardioplegia combined with external cooling of the heart makes it safe to disconnect the heart from circulation for a loger period (up to 120 minutes).

[Metabolic activity of the gastrocnemius muscles in atherosclerotic lesion of the abdominal aorta and arteries of the extremities]. / Metabolicheskaia aktivnost' ikronozhnykh myshts pri ateroskleroticheskom porazhenii briushnoi aorty i arterii konechnostei.

The histochemical investigation of the oxidizing-reducing enzymes in the gastrocnemius muscle was carried out on the material of 42 patients with atherosclerotic lesions of the abdominal aorta and the extremity arteries. The results obtained were compared with the muscle blood flow value and the level of the partial strain of oxygen in the gastrocnemius muscle. A conclusion is made that it is expedient to investigate the level of metabolic activity of muscles of the injured extremity for the estimation of the vitability of muscles which is very important for solving the question about the possible revascularization of the extremity in severe ischemia due to chronic occlusing process in the extremity arteries.