[Aortocoronary shunting or mammary-coronary anastomosis?]. / Aorto-koronarnoe shuntirovanie ili mammaro-koronarnyi anastomoz?

On the basis of the personal experience and literature the authors came to a conclusion that there must be no alternative: the aorto-coronary shunting or mammary-coronary anastomosis since each operation has its positive and negative features as well as indications and contraindications. However, in their opinion, the aorto-coronary shunting should be chosen for patients with the ischemic heart disease since this operation is simpler and more rational, has low postoperative mortality and good remote results.

[Possibilities of emergency coronary surgery in acute myocardial ischemia (clinico-experimental study)]. / Vozmozhnosti ekstrennoi koronarnoi khirurgii pri ostroi ishemii miokarda (clinico-eksperimental'noe issledovanie).

The work is based on the analysis of data on 20 patients with acute myocardial infarction who underwent emergency operations for aorticocoronary shunting and on the findings of 50 dog experiments. Comparison of experimental and clinical data showed that the extrapolation of experimental parameters to a sick person should be undertaken with caution and with a greater probability for groups of patients suffering from myocarial infarction for the first time and with no chronic ischemic heart disease. A time period of six hours from the moment symptoms of myocardial infarction develop is the optimum term for emergency aorticocoronary shunting. A successful operation, however, is also possible at later periods, 15 to 18 hours form the time myocardial infarction develops.

[Diagnosis and treatment of neck chemodectoma]. / Diagnostika i lechenie khemodektom shei.

The work is based on the analysis of clinical data of 10 patients with chemodectoma of the neck, 8 of them being subjected to surgery. The diagnosis in 8 operated patients was confirmed histologically, 2 non-operated patients had angiographic manifestations. It is emphasized that carotid angiography plays an important role in establishing the diagnosis and differential diagnosis of benign and malignant chemodectoma. There were noted no mortality and postoperative complications. The oncological aspects of surgery for chemodectoma are also discussed.

[Preinfarct stenocardia and acute myocardial infarct from the viewpoint of modern coronary surgery]. / Predynfarktnaia stenokardiia i ostryi infarkt miokarda s pozitsii sovremennoi koronarnoi khirurgii

The results of aorto-coronary shunting in 36 patients with preinfarction angina and of urgent direct myocardial revascularization in 17 patients with acute myocardial infarction are presented. The surgical mortality comprised 28% in the group of patients with preinfarction angina. Twenty-two patients were followed-up for 8 months to 4 years. Good results were obtained in 9 patients, satisfactory--in 7, unsatisfactory--in 4. One patient died of cardiac insufficiency 1 1/2 year after surgery. The diagnosis of preinfarction angina is a direct indication for urgent coronary angiography and aorto-coronary shunting in case suitable coronary arteries are available for anastomosing. The indications for urgent revascularization of the myocardium in cases of infarction included the inefficacy of drug therapy within 2-3 hours of its onset, an unarrested pulmonary oedema and cardiogenic shock in cases of localized proximal occlusion of the coronaries revealed by elective or urgent coronary angiography. Four patients were operated on in the state of cardiogenic shock (one of them after reversing the state of clinical death), and two patients were operated on with pulmonary oedema. All these patients (with the exception of the one with pulmonary oedema) recovered. Four patients died. The follow-up covered a period of 9 months to 3 years. Good results were obtained in 4 patients, satisfactory--in 3, unsatisfactory--in 4. No late mortality cases were observed. The obtained results permit to analyse the preinfarction angina and acute myocardial infarction from the standpoint of modern coronary surgery.

[Emergency direct revascularization of the myocardium in acute infarct]. / Neotlozhnaia priamaia revaskuliarizatsiia miokarda pri ostrom infarkte

A new surgical conception of urgent direct revascularization of the myocardium in acute infarction is discussed and substantiated. Clinical observations and results of 13 urgent operations for aorto-coronary shunting in 10 patients with acute myocardial infarction are analysed (double aorto-coronary shunting was performed in 3 cases). Indications to urgent revascularization of the myocardium in infarction were as follows: no effect of drug therapy during 2--3 hours since its onset, a failure to eliminate pulmonary edema and cardiogenic shock in a localized proximal occlusion of the coronary artery, revealed during a planned or urgent coronarography. Three patients were operated upon in the state of cardiogenic shock (one after reanimation), two with pulmonary edema. All these patients (excluding one with pulmonary edema) have made a good recovery. Three patients died. Good immediate and late results obtained evidence the advantage of this policy. The problems of most optimum terms for urgent revascularization of the myocardium are discussed.

[Intraoperative hemodynamics in patients with pre-infarct stenocardia and acute myocardial infarct]. / Intraoperatsionnaia gemodinemika u bol'nykh s pred'infarktnoi stenokardiei i ostrym infarktom miokarda

Intraoperative haemodynamics was studied in 31 patients with pre-infarction angina pectoris and in 3 patients with acute myocardial infarction. Twelve of them (3 with myocardial infarction) were subjected to a graphic examination of 12 haemodynamic parameters. Aorto-coronary bypass procedures using autovenous grafts were demonstrated to improve the contractile function of the left-ventricular myocardium in this group of patients, as manifested in a decrease of the binite diastolic pressure, increase of the cardiac index and stroke volume in the aorta. Tracing the intraoperative haemodynamics helps in determining the immediate postoperative prognosis and in choosing the optimum regimens of drug therapy. The determination of the volume blood flow in the bypass with the help of a flowmeter is a compulsory procedure, since it permits an objective assessment of the adequacy of the conducted revascularization of the myocardium.