[Catheter therapy of congenital cardiovascular defects].

The authors analyze the experience gained in catheter operations performed at their Department over the recent 28 years. A total of 500 balloon (Rashkind) and 35 knife (Park) atrioseptostomies were performed in critical patients with different "blue" congenital diseases over this period. An immediate hemodynamic effect at the operation table was attained in 95% of patients.

[Transluminal balloon valvuloplasty in the treatment of congenital critical aortic valve stenosis in infants in the 1st year of life].

Balloon valvuloplasty was performed in 14 patients with congenital valvular aortic stenosis. Their age was 28 days to 12 months. All the patients had severe heart failure.

[The treatment of critical valvular stenosis of the pulmonary artery by the balloon valvuloplasty method in patients in the first 3 years of life].

The work generalizes the experience of the Bakulev Institute of Cardiovascular Surgery in balloon valvuloplasty of valvular pulmonary stenosis in 58 children of the first 3 years of life: 8 were 1 to 6 months of age, 10 were 7 to 12 months of age, 18 were 13 to 24 months old, and 22 were 25 to 36 months old. Cyanosis was found in 27 of them. As the result of balloon valvuloplasty, the systolic pressure gradient between the right ventricle and the pulmonary artery reduced from 114.

[Complications of catheter-balloon valvuloplasty (analysis of their causes and the methods of prevention and treatment].

The authors analyse the results of 1,404 operations of catheter-balloon valvuloplasty in stenoses of the pulmonary, aortic, and mitral valves. The experience was accumulated by the leading heart surgeons of the country from 1984 to 1990. The total number of complications was 77 (5.

[The effect of contrast ventriculography of the left ventricle on intracardiac hemodynamics in patients with ischemic heart disease].

The effect of left ventricular (LV) contrast ventriculography (VG) on the state of intracardiac hemodynamics during the administration of a contrast medium and 30-40 sec. after it was investigated in 48 CHD patients. It followed retrograde catheterization of the left ventricle by a parallel use of two catheters that permitted recording intraventricular pressure directly during LV VG.

[Effect of contrast ventriculography of the left ventricle on coronary hemodynamics in patients with ischemic heart disease].

The effect of left ventricular (LV) contrast ventriculography (VG) on the state of intracardiac hemodynamics during the administration of a contrast medium and 30-40 sec. after it was investigated in 48 CHD patients. It followed retrograde catheterization of the left ventricle by a parallel use of two catheters that permitted recording intraventricular pressure directly during LV VG.

[Angiographic signs and pathophysiology of abnormal origin of the left coronary artery from the pulmonary trunk].

The results of intracardiac examination of 37 patients with anomalous origin of the left coronary artery from the pulmonary trunk were studied. On the basis of anatomo-angiographic++ comparisons the authors point out the characteristic features of coronary circulation and affection of the left ventricular myocardium which determine the clinical manifestations of its dysfunction. The functional condition of the left ventricle was appraised depending on the character of development of the intercoronary collaterals.

[Intravascular radiologically-guided surgery in the treatment of congenital heart defects].

The article discusses the experience of the Bakulev Institute of Cardiovascular Surgery, USSR AMS, in catheter endovascular radiologically-guided surgery of some congenital heart diseases in the period from 1967 to 1990. A total of 505 operations were performed at the department of radiologically-guided examination and treatment of the heart and vessels: 307 Rashkind's and 35 Park's operations in total transposition of the great vessels, 110 balloon dilatations in valvular stenosis of the pulmonary trunk and 13 in valvular stenosis of the aorta, 7 embolizations in coronary-cardiac fistulas, 2 balloon dilatations in constrictions of Blalock-Taussig anastomosis, 14 balloon dilatations in peripheral stenoses of the pulmonary arteries, etc. The methodical aspects and the results of endovascular interventions are discussed in detail.

[Transluminal balloon angioplasty of pulmonary arteries after palliative reconstruction of the outflow tract from the right ventricle as a preparatory stage for radical surgery].

The authors describe their experience in the use of transluminal balloon angioplasty (TBA) of the pulmonary arteries (PA) carried out in stenosed segments in the late-term period after operation for palliative reconstruction of the right ventricular outflow tract without closure of a ventricular septal defect (VSD) in 7 patients: in 6 with Fallot's tetrad after previously created systemic-pulmonary anastomoses and in one with PA atresia and VSD. TBA was conducted in 11 stenosed segments of the pulmono-arterial tree. The TBA method is suggested as a procedure for preparing the PA for the final stage of operative treatment.

[Tl-201 perfusion scintigraphy of the myocardium in patients with anomalous origin of the left coronary artery from the pulmonary trunk (clinico-anatomical comparisons)].

The clinical significance of 201Tl myocardial perfusion scintigraphy was studied in 7 patients with abnormal branch of the left coronary artery from the pulmonary trunk and in 1 patient with that of the anterior interventricular artery from the pulmonary trunk. Radiological criteria for the defect were established on the basis of comparative analysis of the data of myocardial scintigraphy with those of electrocardiographic, coronary angiography and anatomic examinations. It was shown that it was feasible to make a differential diagnosis between abnormal left coronary artery branch and dilated cardiomyopathy and that the technique was of value for comparative assessment of the efficacy of various types of surgical treatment for abnormal left coronary artery ramus from the pulmonary trunk.

[Comparative hemodynamic characteristics of Soviet-made mechanical heart valve prostheses in the mitral position].

The article deals with hemodynamic evaluation of Soviet-made, and heart valve prostheses in late-term periods after operation for mitral valve replacement. Fourty-six patients were examined: a ball prosthesis was implanted in 21 patients (1st group), as disk prosthesis--in 15 patients (2nd group) and a prosthesis--in 10 patients (3rd group). A good clinical result of the operation was achieved in all patients, they were referred to functional class I and II.

[Angiographic semeiotics and pathophysiology of congenital fistulas of the coronary arteries].

From analysis of the findings of intracardiac examination of 35 patients with congenital fistulas of the coronary arteries the authors discuss the angiographic semeiotics of the anomaly and the mechanism of disorders of coronary circulation. The pathophysiology of the anomaly is determined by the amount of blood shunted through the fistula, the location of the fistula (whether in the proximal or distal segment of the artery), and the perfusion deficit of the distal segment of the involved artery. Fistulas with a large volume of the shunt may be accompanied both with ischemic changes in the basin of the affected coronary artery and with regional disorders of myocardial perfusion in the adjacent basins (intact coronary arteries).

[Left-ventricular relaxation in patients with ischemic heart disease, congestive cardiomyopathy and mitral and aortic valve defects].

Left ventricular relaxation was studied in 105 patients with coronary heart disease (CHD), 42 with mitral and aortic valvular diseases, and 14 with congestive cardiomyopathy. To assess the left ventricular relaxation, the values of dP/dt and T time constants for isovolumic exponential fall in intraventricular pressure were defined in the patients. Depressed left ventricular relaxation was found in the majority of the patients with CHD whatever the status of global and segmental pumping function of the left ventricle.

[Balloon valvuloplasty in congenital aortic stenosis].

The authors discuss their experience with balloon valvuloplasty (BVP) in aortic valvular stenosis (AVS) in 3 patients aged 10 months, 15 and 16 years. BVP was carried out in all of them with exposure of the right subscapular artery. Left ventricular (LV) systolic pressure before BVP was 198 +/- 45 mm Hg on the average, systolic pressure gradient between the LV and the aorta was 102-32 mm Hg.

[Endovascular laser methods in the treatment of arteriosclerotic cardiovascular diseases].

Employment of laser for restoration of adequate blood flow in atherosclerotic vessels is a radically new approach to treatment of cardiovascular diseases of atherosclerotic genesis. Since 1983, wide-scale experimental work has been done at A.N.

[Transluminal balloon valvuloplasty and aortoplasty in the treatment of congenital heart defects].

The authors' experience in endovascular treatment of such congenital heart defects as pulmonary valvular stenosis (PVS), aortic valvular stenosis (AVS), and aortic coarctation (AC) is presented. Transluminal balloon dilatation was performed in 46 patients: in 30 patients with PVS, 11 patients with CA, and 4 patients with AVS, the patients' age ranging from 7 months to 45 years. Transluminal balloon valvuloplasty was performed using 'Schneider-Medintag' catheters (Switzerland).

[Hemodynamic mechanisms of ECG changes in congenital fistulas of the coronary arteries].

ECG changes were analysed in 31 patients with congenital coronary arterial fistulas with reference to the site of coronary arterial lesion and the level and magnitude of blood discharge. Two hemodynamic factors, conditioning ECG changes, were identified as typical for coronary arterial fistulas: 1) volume strain on cardiac compartments making up the fistula receptacle chamber; 2) perfusion deficiency in the distal segment of the affected coronary artery. Fistulas with large-volume shunts may be accompanied by both ischemic changes in the affected-artery basin and regional perfusion disorders in adjacent basins, the latter being due to "stealing" of the adjoining coronary trunk or the type of coronary blood supply.

[Effect of the rheological properties of the blood on the intracardiac hemodynamics in patients with acquired mitral valve defects].

A study of 17 patients with prevailing mitral stenosis and 10 patients with prevailing mitral insufficiency demonstrated a significant aspirin-induced improvement of blood rheologic characteristics in all patients that was accompanied with a heterogeneous shift of intracardiac hemodynamics and left-ventricular myocardial pumping activity. For instance, in patients with prevailing mitral stenosis, an improvement of blood rheologic properties is accompanied with a drop in mitral pressure gradient and a decrease in total pulmonary resistance and total peripheral resistance resulting in increased pumping capacity of the heart (increased minute volume, systolic index and stroke index). In patients with prevailing mitral insufficiency, the improvement of blood rheologic properties is accompanied by an increase of regurgitation volume, a reduction of effective ejection fraction and a rise in total pulmonary resistance.

[Characteristic features of the pathological anatomy and involvement of the myocardium in anomalous branching of the left coronary artery from the pulmonary trunk (Clinico-anatomical comparisons)].

Pathologic, clinical and anatomical correlations are presented for left ventricular affection in abnormal origin of the left coronary artery from the pulmonary trunk. It was revealed that there is a complex of critical factors essential for survival of patients and clinical pattern of the defect including the degree of manifestation of intercoronary collateral circulation, specificity of myocardial left ventricular ischemic impairment and that of mitral structure. Clinical and anatomical comparisons are drawn between the degree of affection of the left ventricular myocardium and its functional capacity.

[Initial experience with transluminal laser recanalization in patients with stenosing arteriosclerosis of the lower extremities].

Early experience with transluminal application of low-intensity laser beam (632 nm) to treat atherosclerotic vascular occlusions in 23 patients with combined disorders (Leriche's syndrome and coronary heart disease) is summed up. The beam was carried to the site of occlusion through special laser catheters developed at the A. N.