[Clinical picture and treatment of mediastinitis after correction of congenital heart diseases in open heart surgery].

Postoperative purulent mediastinitis was observed by the authors in 43 out of 1110 patients. Specific features of the clinical picture and course of this complication are described. The "closed" method of treatment was used in 20 patients.

["Open" surgery of mitral heart diseases complicated by pulmonary hypertension].

Under analysis were the results of 386 operations on the "open" heart made for mitral diseases complicated by pulmonary hypertension of different degrees. Prosthetics of the mitral valve was performed in 251 patients, in 135 patients the so-called "organ-saving" correction of the defect was fulfilled. The decision on the method of the defect correction depends on the anatomical particularities, morphological alterations of the valvular apparatus.

[Surgical treatment of atrial septal defects and associated congenital heart diseases].

The results of radical correction of interatrial septum defects and heart diseases associated with it were analyzed after treatment of 502 patients at the age from 5 to 48 years. In most cases (58.4%) the patients were adults.

[Surgical methods for correcting partial anomalous drainage of the pulmonary veins during artificial circulation].

The authors share their experiences with surgical treatment of 42 patients with different anatomical variants of the partial anomalous drainage of the pulmonary veins. Specific features of the surgical strategy are described depending on the level of confluence of the pulmonary veins, especially if the mouths of the abnormally falling pulmonary veins and the interatrial septum defect are far from each other. Good immediate and nearest results were obtained.

[The echocardiographic indices of patients with tetralogy of Fallot before and after the suturing of subclavian-pulmonary anastomoses].

Echocardiography was made in 69 patients with Fallot's tetrad before and 2 weeks-15 years after forming subclavian-pulmonary anastomosis (SPA). By the anastomosis function the patients were divided into 2 groups. 47 patients with satisfactory function of the anastomosis 3.

[The morphology of the peripheral blood erythrocytes in patients with tetralogy of Fallot before and after its surgical correction].

Quantitative changes in red cells were studied by dark field scanning electron microscopy of native preparations obtained from patients with Fallot's tetralogy of varying severity and duration. Mainly echinocytic transformation of red cells was revealed that directly depended on the disease duration. Morphologic findings have confirmed the efficacy of surgical correction and drug therapy of Fallot's tetralogy.

[Energy substrate metabolism in myocardium in the dynamics of hypothermic perfusion in combined cardioplegia in an experiment].

Experiments on 16 mongrel dogs have indicated that an anesthetic aid during cardiosurgical operations, which involves current multicomponent anesthesia, hypothermal perfusion and cardioplegia, fails to provide a complete protection of the myocardium from ischemia and a balanced uptake of energy substrates in the immediate postperfusion period.

[Biologically active substances during treatment of pulmonary hypertension with ATP infusions immediately after general anesthesia and surgery of hypervolemic congenital heart defects].

In 95 patients with hypervolemic congenital heart valve defects (42 with interventricular and interatrial septal defects, and 53 with patent ductus arteriosus) mixed venous blood levels of serotonin, histamine, adrenalin, noradrenaline, total 11-hydroxycorticosteroids were studied using spectrofluorimetry, cyclic adenosine- and guanosine monophosphate (cAMP and cGMP), prostaglandins E + A and F2 alpha and their interaction were assessed using radioimmunoassay and correlation analysis, respectively. Immediately after general anesthesia and surgical correction of septal defects using cardiopulmonary bypass adrenalin level was increased, while noradrenaline, cAMP, cGMP, prostaglandin E + A levels remained high. Similar pattern was observed in patients after arterial duct ligation.

[Biologically active substances in patients with hypervolemic congenital heart defects undergoing general multicomponent anesthesia].

In 95 patients with hypervolemic congenital heart diseases (42 with interventricular and interatrial septal defects, and 53 with patent ductus arteriosus) mixed venous blood levels of serotonin, histamine, adrenalin, noradrenaline, total 11-hydroxycorticosteroids were studied using spectrofluorimetry, cyclic adenosine- and guanosine-monophosphate (cAMP and cGMP), prostaglandins E+A and F2 alpha and their interaction were assessed using radioimmunoassay and correlation analysis, respectively. Before surgical treatment the patients showed higher (than in the control) concentrations of histamine, adrenalin, noradrenaline, cAMP, and cGMP, prostaglandins E+A. During anesthesia including fentanyl, morphine, diazepam, N2O:O2 in patients with heart valve defects cGMP level was increased and in patients with patent ductus arteriosus cAMP level was increased during analogous anesthesia with morphine replaced by halothane.

[Role of angiocardiography in the diagnosis of anomalous drainage of pulmonary veins].

Analyzes the results of a comprehensive intracardiac examination of 81 patients with abnormal drainage of the pulmonary veins. Angiocardiographic catheterization of the heart cavities helped identify the type of drainage abnormalities and severity of pulmonary hypertension in all the cases. Reliable and indirect angiocardiographic signs in relation to the type of abnormality were singled out.

[Inter-arterial anastomosis in dextral position of the aortic arch in patients with tetralogy of Fallot].

The article discusses the results of formation of inter-arterial anastomoses in 58 (12.7%) patients with a severe form of Fallot's tetralogy in dextra-position of the arch of the aorta. The specific features of the course and diagnosis of dextra-position of the aortic arch in Fallot's tetralogy are analysed, and the significance of radiologic and echocardiographic examination in the choice of the position and type of interarterial anastomoses is determined.

[Reoperations in bradyarrhythmic forms of disorders of heart conductivity].

Under analysis were causes of reoperations in bradyarrhythmic forms of disturbances of conductivity of the heart. 565 operations connected with electrocardiostimulation were performed on 276 patients. Reoperations in patients with the myocardial stimulation were made on 63 patients, with the endocardial stimulation--in 226 patients.

[Repeated arterial anastomoses in surgery of Fallot's tetralogy].

Among 362 patients with the blue form of tetralogy of Fallot treated by arterial anastomoses, 24 (6.6%) developed its thrombosis in 2 to 10 years. All were subjected to repeated subclavian-pulmonary shunting by means of a fluolon-lavsan vascular prosthesis.

[Surgical treatment of total anomalous drainage of the pulmonary veins].

The article discusses the results of radical correction of total anomalous drainage of the pulmonary veins in 5 patients; 4 had the supracardial and 1 patient--the cardial type of the anomaly with drainage of all pulmonary veins into the coronary sinus. Some details of the surgical intervention are described; some findings of the examination in late postoperative periods (2.0 +/- 1.

Energy value of glucose and lactate for the myocardium in patients with mitral stenosis.

In 145 patients with severe mitral stenosis the levels of energy substrates and adenile nucleotides were determined in biopsy samples from the left atrial appendage obtained during mitral commissurotomy. Patients with the latest stage (stage IV according to Bakulev and Damir's classification) of mitral stenosis displayed, in comparison with stage III patients, activation of aerobic oxidation of glucose, lactate and succinate, together with a moderate reduction in myocardial glucose, lactate and pyruvate levels. ATP content and myocardial adenile nucleotide pool did not change with progression of the disease.

A new method of plastic surgery of the right ventricular outflow tract and pulmonary artery in experiment.

A new method of plastic surgery of the right ventricular outflow tract and the pulmonary artery without use of extracorporeal circulation (occlusion of main arteries) was tested in experiments carried out in 28 dogs. The method involves previous suture of a patch to the site selected for plastic surgery and, using an instrument designed by the authors, excision of the necessary part of the ventricular wall and pulmonary artery. The instrument consists of two handles, similar to those of pincers, and working on a pivot, with oval cavities on the inner sides of its elongated grasping jaws.