[Two approaches to correction of disturbed hemostasis in patients with mechanical artificial heart valves at the long-term follow-up]. / Dva podkhoda k korrektsii narushenii gemostaza u bol'nykh s mekhanicheskimi iskusstvennymi klapanami serdtsa v otdalennye sroki nabliudeniia.

The investigation of the hemostasis system performed in 47 patients with mechanical heart valves (MHV) at the terms of (3.50 +/- 0.25) years included 30 men and 17 women. There were 24 cases of aortal MHV and 23 cases of mitral MHV, I-II functional class (NYHA). The patients were given oral anticoagulants: phenylin to 35 patients (0.009 mg/day), varfarin to 12 patients (52.6 mg/a week). The primary examination of the patients has revealed insufficient anticoagulation protection and clinically asymptomatic permanent intravascular coagulation of the third degree (PIC-3), with the signs of activation of thrombocytic and/or coagulation link of hemostasis. It has been found that a complex assessment of the hemostasis system state including the vascular-thrombocytic link is an obligatory condition of the right choice and timely correction of the PIC-3 in patients with MHV. The methods of correction of impaired hemostasis depend on the primary involvement of the vascular-thrombocytic and/or coagulation link of hemostasis. The pathogenetically selected antithrombotic therapy for patients with MHV allows timely arrest of PIC-3 and less risk of the development of thrombosis and thrombo-embolic complications at long-term periods of observation.

[Socioeconomic aspects of the increased volume of cardiosurgical treatment of children with congenital heart defects]. / Sotsial'no-ékonomicheskie aspekty uvelicheniia ob"ema kardiokhirurgicheskoi pomoshchi detiam s vrozhdennymi porokami serdtsa.

The authors made an analysis of social-economical conditions limiting the possibilities of rendering cardiosurgical care to children. Possible ways are mapped out allowing to increase the amount of operations on children with congenital heart diseases.

[Indices of chronic intravascular hemolysis in patients with different prosthetic heart valves in long-term follow-up]. / Pokazateli khronicheskogo vnutrisosudistogo gemoliza u bol'nykh s razlichnymi konstruktsiiami iskusstvennykh klapanov serdtsa v otdalennye sroki nabliudeniia.

An examination of 153 patients with valve replacement was performed at late stages of (6.8 +/- 0.2) years, in 84 patients the mitral valve replacement (MVR) was fulfilled, in 64--the aortic replacement (AVR) and in 5--two valve replacement were performed. Higher indices of hemolysis were noted in patients with AVR, in cases of two valve replacement and in patients with the paravascular fistula. The lowest indices of hemolysis take place in patients with bileaflet prostheses (MEDING/CarboMedics, St. Jude Medical), especially in patients with AVR. The complications of intravascular hemolysis are: cholelithiasis, anemia, hemosiderosis of the kidneys, sideropenia. The timely diagnosis, treatment and prophylactics are necessary to prevent these complications.

[Rare causes of the dysfunction of mechanical bicuspid heart valves]. / Redkie prichiny disfunktsii mekhanicheskikh dvustvorchatykh klapanov serdtsa.

The authors share the observations from their cardiosurgical practice showing that one of the causes of sudden death or of rapid worsening of the state of patients with implanted bicuspid artificial valves might be their dysfunction resulting both from breakage of the hinged mechanisms of the valve with its dislocation and migration and from the disturbed mobility of the valve cusp due to a thrombus formed in the atrium. The observations show that the "ideal" construction of the valve is to be created.

[Aortic valve prosthesis and the plication of a dissecting aneurysm of the ascending aorta in a patient with infectious endocarditis against a background of chronic kidney failure and its management by regular hemodialysis]. / Protezirovanie aortal'nogo klapana i plikatsiia rasslaivaiushchei anevrizmy voskhodiashchei aorty u bol'nogo infektsionnym éndokarditom na fone khronicheskoi pochechnoi nedostatochnosti i provedeniia reguliarnogo gemodializa.

Some literature data are presented on the problem of cardiac surgery in patients with chronic renal insufficiency under regular hemodialysis and on the specificity of performing operations on such patients under conditions of artificial circulation. The authors describe their first experience of a one-step prosthezing of the aortal valve and plication of the dissecting aneurysm of the ascending part of the aorta in the patient receiving the regular hemodialysis during 5 years as well as the positive results of this original operation in dynamics of the first year of observations.

[Chronic cardiac insufficiency at the decompensation stage and the surgical treatment of mitral stenosis]. / Khronicheskaia serdechnaia nedostatochnost' v stadii dekompensatsii v khirurgii revmaticheskogo mitral'nogo stenoza.

A classification of chronic heart failure was made on the material of surgical treatment of 290 patients with rheumatic mitral heart defect with prevailing stenosis. Three stages of chronic heart failure at the decompensation stage were found: I--unstable removable; II--stable removable; III--stable not completely removable. In the Ist stage the authors recommend operations by both closed and open techniques; in the IInd stage closed methods are thought to be preferable (open operations may be used in single cases); in the IIIrd stage only closed methods are possible.

[Experience in the use of the Soviet ultrasonic devices "Ritm" and "Ekran" in cardiosurgical practice]. / Opyt ispol'zovaniia otechestvennykh ul'trazvukovykh priborov "Ritm" i "Ekran" v kardiokhirurgicheskoi klinike.

The study is performed to evaluate opportunities of the echotacho-cardiograph Ritm in detecting the velocify of ventricular wall motions by using the Doppler effect and the echocardioscope Ekran++ that provides display and photography of the heart in the B-mode. In combination with a focusing probe, Ritm is a portable, easy in operation model. When operating with a high frequency recorder it indicates the Doppler signals from different myocardium sites at all stages of the surgical intervention. With the model Ekran++ one can display the heart in real time during surgery as well as evaluate anatomic and dynamic interactions between various cardiac structures that is of great importance in making decisions on surgical tactics and methods.

[Diagnosis and treatment of myxomas of the left atrium]. / Diagnostika i lechenie miksom levogo predserdiia.

Two patients with myxomas of the left atrium stimulating mitral stenosis are described. The observations are analyzed. Recommendations for the diagnosis of left atrium myxomas by the methods of cineangiocardiography and echocardiography are given. The methods of operative treatment include ablation of the tumor under conditions of the artificial blood circulation with dissection of the tumor base within the limits of health tissues.