[Endarterectomy from the distal arterial bed in prosthetics of the aorta and iliac arteries].

The work presents an experience with surgical treatment of 32 patients with critical ischemia of the lower extremities developed against the background of two-levels occlusive lesion of the arterial bed of the lower extremities. All the patients had atherosclerosis. Occlusion of the abdominal part of the aorta was the cause of reconstruction of the aorta and iliac arteries in 15 patients, occlusion of the iliac artery - in 14 patients, aneurysm of the abdominal aorta - in 3 patients. In all the patients the proximal lesion was associated with occlusion of the femoral arteries. In addition to proximal reconstruction, retrograde endarterectomy was made with a special instrument from the femoral arteries through the arteriotomy opening intended for distal anastomosis of a synthetic prosthesis. Complete revascularisation of the arterial bed of the lower extremities was obtained in all the patients. There were no lethal outcomes.

[Prolonged endarterectomy in distal forms of arterial diseases of the lower extremities]. / Protiazhnaia endarterektomiia pri distal'nykh formakh porazheniia arterii nizhnikh konechnostei.

Six-year experience of surgical treatment of patients with critical lower limb ischemia due to a distal form of arterial lesion is presented. Surgical treatment was performed in extended occlusive lesion from inguinal fold to arteries of the calf and foot, and inadequate "ways of outflow". The king of arterial lesion did not permit the surgeon to perform typical bypass surgery or arterialisation of venous system with a traditional scheme. All the patients were candidates for amputation. For salvage of extremity 36 patients underwent prolonged semi-closed endarterectomy using special instrument which was supplemented with temporary arterio-venous fistula or popliteal-distal auto-venous bypass. In short-term period after surgery critical ischemia was eliminated in 25 (69%) patients. The rest of the patients underwent amputations. 5 years later cumulative safety of the extremities was 95% among patients with good short-term results. These variants of revascularizing surgery may be regarded as alternative to amputations in patients with critical limb ischemia due to distal lesions of lower limbs arteries.

[Functional heterogeneity of the atrial myocardium in patients with congenital and acquired heart defects]. / Funktsional'naia geterogennost' miokarda predserdii bol'nykh s vrozhdennymi i priobretennymi porokami serdtsa.

In experiments on atrium trabeculae the heterogeneity of myocardium contractile activity in patients operated on for inborn or acquired heart defects was studied. Contractile activity was assessed in isometric regime of muscle drugs work. The degree of functional heterogeneity was reported to differ in myocardium biopsies from patients with inborn or acquired heart defects. The difference was expressed in susceptibility to stimulating action or electrical impulses and in the degree of the change of myocardium contractile activity. The study of human myocardium functional heterogeneity is likely to present a new approach to increase efficacy of the work of pathologically changed heart muscle.