[Prospects for predicting the life expectancy of patients with chronic obstructive lung disease for refining indicators for lung transplantation]. / Vozmozhnosti prognozirovaniia prodolzhitel'nosti zhizni bol'nykh khronicheskoi obstruktivnoi bolezn'iu legkikh s tsel'iu utochnneniia pokazanii k transplantatsii legkikh.

Success of lung transplantation is largely determined by the patients' timely referral for surgery. However, the determinants of survival in patients with chronic obstructive pulmonary disease (COPD), potential lung recipients are to be established. To reveal the determinants of survival in patients with terminal respiratory failure, the data from a follow-up of 59 patients with COPD who met the generally accepted requirements for the recipients of an isolated lung were analyzed. The analysis of some clinical, functional, hemodynamic parameters established that the level of hypoxemia and the value of pulmonary systolic pressure were of the greatest prognostic value. The values of external respiratory function did not affect the patients' survival. Thus, patients with COPD should undergo lung transplantation if they have a pulmonary systolic pressure of over 50 mm Hg, pO2 of under 60 mm Hg, and no benefits from their conservative therapy.

[Pulmonary thromboembolism]. / Tromboémboliia legochnoi arterii.

To improve the available techniques, diagnostic and therapeutical policies were analyzed in patients with angiographically documented pulmonary thromboembolism (PTE). The investigation included 151 patients with suspected PTE. Angiopulmonography from the pulmonary trunk and great branches provided data on the pulmonary vessels. The diagnosis of PTE was verified in 138 patients: acute massive and submassive types in 44 patients, mild and chronic PTE in 22 and 72 patients, respectively. Fibrinolytic therapy was performed in 34 patients with acute PTE, the others were treated with heparin. In the massive and submassive PTE group, the Miller index was 23.7 +/- 0.86 scores, pulmonary systolic pressure was 56.2 +/- 2.7 mm Hg. The mortality rates were 29.5%, the Miller residual index was 9.9 +/- 1.1 scores. In the mild PTE group, the Miller index averaged 5.2 +/- 0.88 scores, pulmonary pressure was in the upper normal range. All patients with this type recovered after treatment, the residual index was 1.4 +/- 0.5 scores. Fibrinolysis is the method of choice in the treatment of massive pulmonary embolism: however, the administration of large-dose heparin may be rather effective. Heparin therapy ensures blood flow recovery in mild PTE. The severity of pulmonary circulatory and hemodynamic disorders and the time of therapy initiation determine the efficiency of treatment in acute PTE.

[Endovascular embolization of arteriovenous fistulas of the lungs (a review of the literature and our own data)]. / Endovaskuliarnaia émbolizatsiia arteriovenoznykh fistul legkikh (obzor literatury i sobstvennye dannye).

The authors analyze the literature data and their own experience in endovascular closure of arteriovenous lung fistulas: 20 fistulas were closed in 12 patients, in whom transcutaneous catheterization of the pulmonary artery was performed. Large-frame angiopulmonography made it possible to reveal 10 common arteriovenous lung fistulas (7 single and 3 multiple ones). Afterwards the diagnostic procedure was turned into a therapeutic one. Several types of spirals, spongogel fragments, pieces of felt and pools with wool were used as embolizing materials. All these measures resulted in hermetic closure of the arteries and a complete stop of pathological right-left shunting of the blood at the lung level and positive dynamics of blood gaseous indices.

[Endovascular embolization of arteriovenous lung fistulas (review of literature and own results)]. / Endovaskuliarnaia émbolizatsiia arteriovenoznykh fistul lëgkikh (obzor literatury i sobstvennye dannye).

The authors analyze the literature data on and their own experience in endovascular closure of arteriovenous lung fistulas: 20 fistulas were closed in 12 patients, in whom transcutaneous catheterization of the pulmonary artery was performed. Large-frame angiopulmonography made it possible to reveal 10 common arteriovenous lung fistulas (7 single and 3 multiple ones). Afterwards the diagnostic procedure was turned into a therapeutic one. Several types of spirals, spongogel fragments, pieces of felt and pools with wool were used as embolizing materials. All these measures resulted in hermetic closure of the arteries and a complete stop of pathological right-left shunting of the blood at the lung level and positive dynamics of blood gaseous indices.

[Correlation of arterial pressure in the forearm with blood pressure in the ascending aorta]. / O korreliatsii arterial'nogo davleniia na pleche s davleniem krovi v voskhodiashchei aorte.

Forearm blood pressures obtained by auscultation were compared with the data of pressure recording in the ascending aorta during diagnostic catheterization in 243 patients with coronary heart disease, arterial hypertension and some malformations of the heart. With indirect measurement, systolic blood pressure was shown to be sufficiently reliable and to characterize systolic pressure in the ascending aorta with assurance, the pressure in the aorta being slightly less (some 10%) in approximately half the cases. The regression equation for systolic pressure in the ascending aorta against forearm pressure is as follows: Y = 0.96X - 1. Measurement of diastolic pressure in the ascending aorta yields less accuracy, so it is advisable to use two regression equations: (1) Y = 0.98X - 1 for a diastolic pressure of 80 mm Hg or less and (2) Y = 0.85X + 2 for a pressure of greater than 80 mm Hg. Thus, ascending aorta pressure values required for invasive hemodynamic studies may be satisfactorily calculated from the data of blood pressure auscultative measurement.

[Current status of the problem of chronic cor pulmonale]. / Sostoianie problemy khronicheskogo legochnogo serdtsa.

Studies of great number of patients with chronic nonspecific pulmonary disease suggest that high levels of pulmonary hypertension are only observed in cases of pulmonary-arterial thromboembolism and primary pulmonary hypertension. In other pulmonary diseases, the significance of pulmonary hypertension seems to be overestimated, as blood pressure in the pulmonary circulation network has values, indicative of the absence of gross morphologic changes of the vascular bed of the lungs. The available indirect methods for the diagnosis of pulmonary hypertension in chronic nonspecific pulmonary disease patients with rather small blood pressure in the pulmonary circulation network are shown to be of little value. Large functional reserves of the right cardiac ventricle which make it possible to cope with a sudden pressure overstrain (to say nothing of the slowly augmenting one) are pointed out. It follows therefore that either as yet unknown factors contribute to the pathogenesis of chronic pulmonary heart decompensation, or there is virtually no decompensation, while the demonstrated clinical symptoms of systemic circulatory congestion are of extracardiac origin. Various aspects of the assessment of the role of pulmonary hypertension and clinical symptoms of decompensated pulmonary heart will be discussed in the next communication.

[An automated evaluation of cineangiograms of patients with interatrial septal defects]. / Avtomatizirovannaia otsenka kinoangiogramm u bol'nykh s defektami mezhpredserdnoi peregorodki.

Curves of contrast medium dilution based on cineangiograms of patients with congenital heart disease, allow the calculation of a relative shunt value, the assessment of topographic anatomical features of an interatrial septal defect, and the detection of phasic manifestations of change in a contrast medium concentration.

[Characteristics of the course of pulmonary hypertension in patients with chronic obstructive bronchitis (2)]. / Osobennosti techeniia legochnoi gipertenzii u bol'nykh khronicheskim obstruktivnym bronkhitom (soobshchenie 2-e).

The state of pulmonary circulation in patients with chronic bronchitis depends on the presence of obstruction, its progression, development of pulmonary hypertension, cor pulmonale and its decompensation. The authors recommend to administer nitrates of prolonged action to such patients.