[Opportunity of operative traumatism decrease in patients with complicated tricuspid valve defect].

This study examined the results of surgical trivalve of 44 patients with trivalve heart defect. In all the patients the heart defect was combined with two and more complicating factors: advanced III-degree calcinosis of the valves, cardiomegaly, cardiac fibrillation, left atrium thrombosis, high pulmonary hypertension. In 20 patients the operative intervention on the heart was repeated.

[The possibilities for the transcranial monitoring of the blood flow in the circle of Willis arteries during operations on the brachiocephalic arteries and in heart operations].

The paper gives the results of arterial blood flow monitoring in the circle of Willis via transcranial Doppler during 81 reparative operations on brachiocephalic arteries (including carotid endarterectomy from the internal carotid artery in 32 patients). Transcranial monitoring of blood flow supports the fact that there is a collateral reflow along the cerebral arteries during removal of the common carotid artery and that there is a relationship between the status of great arteries and arteries of Willis' circle. The paper also summaries the results of a comprehensive ultrasound study of 9 patients who have undergone reparative and plastic operations on the cardiac valves during extracorporeal circulation and general hypothermia.

[Catheter balloon valvuloplasty: new possibilities in the surgical treatment of mitral stenosis].

A total of 170 catheter balloon valvuloplastic (CBV) operations for rheumatic mitral stenosis were carried out in patients aged 19 to 68, 30 of these in pregnant women, at A. V. Vishnevsky Institute of Surgery, Russian Academi of Medical Scients, from 1988 to 1994.

[A method for preventing an air embolism in repeat operations on the heart with artificial circulation without cardiolysis].

An effective method has been developed for prevention of air embolism in cardiopulmonary bypass surgery on the open heart without heart isolation from intergrown tissues. The method consists in filling and washing heart cavities with carbon dioxide before removing the clamps from the aorta. This method does not involve routine prophylactic measures such as heart dislocation and puncture of left-ventricular apex, heart ventricles massage to remove air, etc.

[Catheter-balloon valvuloplasty in mitral valve stenosis (selection of the method of procedure, immediate results and the criteria of patient selection].

Catheter-balloon valvuloplasty (CBV) was carried out in 80 patients with rheumatic mitral stenosis, whose ages ranged from 22 to 68 years. Seventeen of these patients were operated on for mitral valve restenosis; I-II degree calcinosis of the mitral valve was revealed in 18 patients; seven women underwent surgery in the 24th-32nd week of pregnancy. After applying various methods (19 cases) the authors used in the last series of operations (61 cases) the Silin-Sukhov method using an original dilatation catheter with a balloon measuring in diameter up to 34 mm, which allowed pressure of up to 8 atm.

[The diagnosis and surgical procedure in calcified subtotal thrombosis of the left atrium in rheumatic heart defects].

The authors share their experience with surgical treatment of 5 patients. The methods of thrombectomy from the left auricle used in their work as well as prophylactics of recurrent thrombosis are thought to improve results of treatment of rheumatic heart disease.

[A method of removing air from the cavities of the heart and great vessels during surgery with extracorporeal circulation].

A strictly successive method for removing air from the heart cavities and great vessels after the intracardiac stage of the operation was elaborated from study of the experience of foreign heart surgeons and experience in the use of various measures for the control of air embolism at the Vishnevsky Institute of Surgery, AMS USSR. The techniques of puncture of the heart cavities and vessels and their massage for complete evacuation of the air is described. These manipulations are combined with thorough decompression of the atria and ventricles to relieve the load suffered by them after cardioplegia.

[Use of therapeutic plasmapheresis in heart surgery patients with hepatic insufficiency].

Therapeutic plasmapheresis is a highly effective method in the preparation of patients with hepatic insufficiency for operation on the heart under conditions of extracorporeal circulation. It leads to reduction of the bilirubin level and normalization of the main values of hepatic function. The positive effect of therapeutic plasmapheresis is less manifest in acute hepatorenal insufficiency developing after operation with extracorporeal circulation.

[The dynamics of cardiac dimensions following mitral valve prosthesis in patients with rheumatic heart disease complicated by cardiomegaly and subjected to repeated surgery].

A total of 36 patients with cardiac output above 1000 ml per 1 m2 of body surface underwent repeated operations. As to the endurance of physical loading 10 patients corresponded to the III and 26 patients to the IV functional classes according to the Classification of the New York Association of Cardiologists. In the postoperative period 18 patients with the 1st degree of heart enlargement showed a decrease in the size of the heart.

[Diagnosis of aortic valve calcinosis with a view to the surgical treatment of aortic valve disease].

Combined roentgenologic/echocardiographic diagnosis of aortic valve calcinosis was made in 135 patients operated on for a rheumatic aortic heart disease. Four degrees of aortic valve calcinosis were identified: 1) isolated fine points of calcinosis, as revealed by echolocation and specific treatment of the removed valves; 2) small-focal calcinosis as revealed roentgenologically in 79.2% of cases and by echolocation, in 93%; 3) large-focal, and 4) wide-spread calcinosis, the latter two being detectable both roentgenologically and echocardiographically in all cases.

[Relationship between the oscillatory contractions and myocardial tonus in patients with heart defects].

Interplay between contraction oscillations and the tone that is seen during rhythmic stimulation was studied in atrial trabeculae of patients with heart diseases. It was disclosed that in 50% of myocardial preparations from patients with rheumatic heart diseases, an increase in the tone (incomplete relaxation) and oscillations appeared at a frequency of 0.2 HZ.

[Effect of cooling on rhythmo-inotropic relations in pathologically altered myocardium].

Fragments of the right atrium auricle from patients with congenital and acquired heart diseases were used to study the effect of the Tyrode solution temperature over the 60-minute cessation of electrical stimulation of the preparations on the recovery of the amplitude of rhythmic contractions after the pause. The lack of stimulation within 34 to 24 degrees C does not lower the contraction amplitude after warming of the preparations and renewal of rhythmic stimulation. The hypothermal pause at a temperature of 10-14 degrees C leads to the development of contractures and suppresses the myocardial contractility.