Results of vascular reconstructions for a associated lesion of the brachiocephalic arteries and paroxysmal disorders of cardiac rhythm.

Annually, about 400,000 new patients with strokes are recorded in Russia. Of these, 80% of patients may develop ischemic brain infarctions. In approximately 30-40% of cases, ischemic lesion of the brain eventuates in lethal outcome; the same number of patients remain heavily disabled and only 15-20% of patients return to the previous level of work fitness. In 30-50% of cases, the development of ischemic stroke and other forms of cerebrovascular insufficiency is caused by stenotic and occlusive lesion of aortic arch branches, being more frequently of atherosclerotic origin. Patients with brachiocephalic artery (BCA) lesion face an important problem of the origin and progression of different forms of cardiac rhythm disorders. In the presence of hemodynamically significant stenotic and occlusive lesion of brain vessels, even transient changes in cardiac rhythm may induce an additional deterioration of cerebral flow. In turn, the origin of arrhythmias in the immediate postoperative period in patients after reconstructions on the BCA is a serious complication which may lead to sudden death. The aim of the present study was to examine the long-term results of the surgical treatment in patients with associated BCA lesion and paroxysmal disorders of cardiac rhythm (PDCR). The treatment results were analyzed in 89 patients aged 35 to 70 years. There were 66 (74.2%) men and 23 (25.8%) women. All the patients had undergone different BCA reconstructions. In the long-term period, this resulted in the lowering of the death rate. Besides, in the long-term period, vascular reconstructions carried out in patients with associated BCA lesion and PDCR not only improved the neurologic status but also favoured the positive course of changes in arrhythmias in 36.4% of patients.

[The characteristics of the anesthesiological support for surgical interventions in patients earlier operated on the heart]. / Osobennosti anesteziologicheskogo obespecheniia khirurgicheskikh vmeshatel'stv u bol'nykh, ranee operirovannykh na serdtse.

The article presents an analysis of the authors' experiences with anesthesiological maintenance of operations on patients after revascularization of the myocardium, implantation of permanent cardiostimulant and heart value prosthesis. Main risk factors responsible for severe complications were found to be congestive heart failure, myocardial infarction which took place 6 months before the operation, certain forms of arrhythmias, unstable stenocardia, pronounced stenosis of the aortic valve, age older than 70 years, diabetes mellitus. The comprehensive preoperative preparing, choice of the adequate methods of anesthesia and maintenance of the up-to-date intraoperative monitoring create the conditions for a less risk of the surgical treatment.