[Effect of exogenously administered ATP on heart function and energy status]. / Vliianie ékzogenno vvedennoi ATF na funktsiiu i énergeticheskoe sostoianie serdtsa.

It has been shown that ATP (24.10(-6) M) administered once into the circulating solution improved strength and speed characteristics of aerobically perfused hearts. The increasing demands of the hearts in oxygen and energy substrates were satisfied due to coronary vessels dilatation without harming the energy status of the myocardium. When the functional parameters of the hearts in the test and control groups did not differ, an exogenously administered ATP was included into the energy metabolism and increased considerably ATP and CP tissue levels, the sum of high-energy phosphates and ATP/ADP ratio. Artificial supplementation of tissue energy resources was accompanied by a decrease in energy-dependent end-diastolic pressure and diastolic left ventricular elasticity and by increased extensibility of the heart muscle, which may improve functional parameters.

[Effect of ATP infusion on heart function in the post-perfusion period after aortocoronary bypass surgery in patients with chronic ischemic heart disease]. / Vliianie infuzii ATF na funktsii serdtsa v postperfuzionnom periode pri aortokoronarnom shuntirovanii u bol'nykh khronicheskoi ischemicheskoi bolezn'iu serdtsa.

Using thermodilution technique, 110 patients have been examined during aortocoronary bypass surgery. Cardiac output, pump coefficient, cardiac index, stroke index, mean and edge pulmonary pressure, and other parameters of peripheral hemodynamics have been determined. At the end of the operation upon heart function recovery the test patients were administered intravenously a 1% ATP solution at a dose of 0.05 and 0.025 mg/kg/min. In control patients inotropic drugs were not used, cardiac function recovered spontaneously. A thorough clinical analysis of central hemodynamic data in the control and test groups has been performed. A number of positive effects of intravenous 1% ATP solution in the postperfusion period have been revealed. The data obtained indicate that myocardium protection during heart arrest is insufficient and an additional administration of substrates that form energy and recover adequate coronary flow and oxygen consumption is necessary upon heart function recovery in all the cases. The first results of intravenous ATP administration make it possible to consider the above technique absolutely safe and especially useful for the improvement fo some central hemodynamic parameters.

[The role of fentanyl in protecting the myocardium from ischemic damage]. / Rol fentanila v zashchite miokarda ot ishemicheskikh povrezhdenii.

It has been shown that despite heart hypothermia to 12-15 degrees C the functional parameters under study following 60 min ischemia were considerably lower than their preischemic values. Introduction of fentanyl into the circulating solution enhanced noticeably the protective effect of hypothermia. At all the experimental stages the analgesic led to dose-dependent improvement of heart functions. Its action manifested in attenuation of left ventricular wall tension, a decrease in oxygen consumption and preservation of the coronary flow following ischemia, which enabled the hearts to demonstrate higher contractility and performance.

[Concentration of beta endorphin in blood as a criterion of adequacy of general anesthesia]. / Kontsentratsiia beta-éndorfina v krovi kak kriterii adekvatnosti obshchei anestezii.

Considering beta-endorphin as a sign of tension and adaptation, the changes in its level have been studied during operations and surgery in patients with congenital heart valve defects subjected to cardiopulmonary bypass surgery. The goal of the study was determination of beta-endorphin concentration for the assessment of general anesthesia adequacy. A step-by-step study of beta-endorphin blood concentration, central and peripheral hemodynamics, diuresis, changes in temperature taken in 3 spots, adrenalin, dopamine and noradrenaline blood levels has been performed in 12 patients aged 4 to 17 years. A stable beta-endorphin blood content at all stages of anesthesia and surgery has been established. A correlation has been established between changes in adrenalin and dopamine blood levels, temperature gradient, diuresis intensity and mean BP, on the one hand, and changes in beta-endorphin blood level, on the other hand. Multifactor systemic analysis of the data obtained makes it possible to conclude that beta-endorphin blood level is informative when assessing the adequacy of general anesthesia.

[The effect of exogenously administered ATP on the postischemic restoration of myocardial function]. / Vliianie ékzogenno vvodimoi ATF na postishemichekoe vosstanovlenie funktsii miokarda.

The effect of ATP (24 x 10(-6) M) on the contractility of the isolated hearts has been studied. It has been shown that ATP infusions improved postischemic hemodynamics. The favourable effect of ATP was based on the retention of diastolic properties and compliance of the left ventricle. The percent of postischemic reduction in the force and rate of contractions was analogous to the results in the control group, but the hearts on ATP performed a greater volume of work and demonstrated higher functional reserve.

[Potentialities of ATP in sustaining the function of the myocardium]. / Vozmozhnosti ATF v podderzhanii funktsii miokarda.

The effect of ATP on the functional capacities of the isolated heart has been assessed. It has been shown that the drug at a concentration of 24 x 10(-6) M improves myocardial contractility and increases coronary flow volumetric rate. Favourable ATP effects manifested right after its administration into the circulating solution in improvement of all the physiological parameters, but were unstable. Nevertheless, the presence of ATP in the perfusate ensured high functional reserve and guaranteed stability of the isolated heart performance over 60-min observation period. The paper reviews the prospects of exogenous ATP application in cardiosurgical patients and outlines problems of drug administration techniques, as well as possible difficulties of its clinical use.

[The effect of anesthesia on the neurohumoral regulation system and water-electrolyte balance during aortocoronary bypass]. / Vliianie anestezii na sistemu neirogumoral'noi reguliatsii i vodno-élektrolitnyi obmen vo vremia aortokoronarnogo shuntirovaniia.

Two methods of multicomponent general anesthesia distinct in the analgetic agent used to ensure analgesia have been compared. In group I (6 patients) analgesia was ensured by fentanyl at a dose of 10 micrograms/(kg/min), in group II (7 patients) it was ensured by pyritramide (dipidolor) at a dose of 2 mg/kg for the whole operative period. The study has shown that during aortocoronary bypass surgery in patients with ischemic heart disease analgesia is better ensured by pyritramide than by fentanyl administration. The latter technique of analgesia should be improved, as the current modification causes almost twice as great stress-reaction as the one employing pyritramide.

[Total intravenous general anesthesia during radical correction of tetralogy of Fallot]. / Total'naia vnutrivennaia obshchaia anesteziia pri radikal'noi korrektsii tetrady Fallo.

Three techniques of general intravenous anesthesia were compared, using mathematical parameters of the heart rhythm, hemodynamic and sympathoadrenal system responses, arterial blood Hb saturation with O2 (SaO2) and thermometry. It has been established that anesthesia with dipidolor ensures adequate protection against the operation stress both in patients with tetralogy of Fallot previously subject to interarterial anastomoses and patients with tetralogy of Fallot without anastomoses. Combined fentanyl and ketamine anesthesia ensures an adequate protection against the operation stress only in patients with tetralogy of Fallot without anastomoses. A more marked response of sympathetic autonomous nervous system and hemodynamics in patients with tetralogy of Fallot previously subject to anastomoses is, probably, mediated by a more intensive analgesic sequestration in the lungs in the presence of functioning anastomoses, which attenuates the analgetic effect. Anesthesia in patients with tetralogy of Fallot previously subject to interaortic anastomoses should be performed using higher doses of narcotic analgesics.

[Arterial hypertension of unclear etiology as a complication of anesthesia during heart surgery under conditions of artificial circulation]. / Arterial'naia gipertenziia neiasnoi étiologii kak oslozhnenie anestezii pri operatsiiakh na serdtse v usloviiakh iskusstvennogo krovoobrashcheniia.

The paper deals with causes of arterial hypertension in the early postperfusion and postoperative periods in treating congenital heart disease (CHD) under artificial circulation (AC). The hemodynamics and parameters of the renin-angiotensin-aldosterone system (RAAS) were examined clinically and biochemically in 100 patients. The findings showed that under hypothermic perfusion with nonpulsing blood flow, plasma renin activator and angiotensin converting enzyme became activated to affect the dynamics of mean arterial blood pressure. A method for RAAS blockage under AC has been developed, which includes administration of sodium thiopental and baralgin during AC. The method provides for reliable prevention of RAAS components activation and guarantees the normalization of the mean arterial pressure in the postperfusion and early postoperative periods.