[Aorto-esophago-bronchial and aorto-pulmonary fistulas in a patient with aortic aneurysm].

Aorto-esophageal and aorto-bronchial fistulas are rare and life-threatening diseases if emergency treatment is absent. The most of publications devoted to this problem are case reports describing successful treatment of patients with aorto-esophageal and aorto-bronchial fistulas by using of endovascular or open transthoracic surgery. However, we did not find reports of several aortic fistulas in a patient after previous aortic stenting.

[Cardiopulmonary bypass and circulatory support in Petrovsky Russian Research Center for Surgery].

Since initial application of cardiopulmonary bypass (1960) and circulatory support (1977) unique methods of extracorporeal circulation have been developed at Petrovsky Russian Research Center for Surgery. Some of them were introduced for the first time in the country (USSR and then in the Russian Federation). It was possible due to creative team of Boris Vasilyevich Petrovsky, whose potential was aimed at expanding the indications for surgical treatment of cardiac, aortic, liver, lung and kidney diseases under artificial circulation and then circulatory support.

[Cardiopulmonary bypass in thoracic surgery].

Aim: To analyze advisability of cardiopulmonary bypass in thoracic surgery.

Material And Methods: We estimated early and long-term results of CPB-assisted thoracic interventions in 31 patients with malignant and benign thoracic diseases and invasion into vital mediastinal structures or with concomitant cardiovascular pathology.

Results: Acceptable rates of mortality and morbidity confirm safety of CPB in thoracic surgery while satisfactory long-term outcomes are arguments in favor of this direction of thoracic oncology.

[ASSESSMENT OF LIVER FUNCTION WITH TRANSESOPHAGEAL ECHOCARDIOGRAPHY HEART SURGERY WITH CARDIOPULMONARY BYPASS].

Aim Of The Study: evaluation of arterial and venous liver circulation during cardiopulmonary bypass (CPB) using the method of transesophageal echocardiography (TEE).

Materials And Methods: 62 patients undergoing reconstructive cardiac surgery with CPB were analyzed. During all the stages of treatment we performed monitoring of mean arterial pressure, heart rate and central venous pressure.

[GAS MICROEMBOLISM DURING EXTRACORPOREAL CIRCULATION].

Introduction: Over the past 20 years, there are many studies, where great attention is paid to the gas and material embolism as the cause of cognitive impairment in patients undergoing surgery with cardiopulmonary bypass.

Purpose: To identify the filter capacity of 4 extracorporeal circuits for removing gaseous microemboli in various interventions on the heart and aorta.

Material And Methods: Work carried out on 60 patients operated on acquired heart and aorta under cardiopulmonary bypass.

[ANAESTHETIC MANAGEMENT OF RECONSTRUCTIVE SURGERY ON THE AORTIC ARCH: THE NUANCES OF ORGAN PROTECTION].

Unlabelled: Aortic arch reconstruction is one of the most difficult surgical procedures. Therefore the aims of our study were: to choose appropriate flow rate for antegrade cerebral perfusion and assess its adequacy in relation to cerebral metabolic demands; to evaluate safety of temperature settings during the surgery; to assess the effectiveness of chosen protocol for brain and visceral organ protection during aortic arch reconstruction surgery. Our study included 67 patients.

[Surgical treatment of giant aneurysms of ascending parts and arch of the aorta in condition of deep hypothermia and circulatory arrest with artificial assisted circulation].

Sternotomy in giant (10 cm and more in diameter) aneurysms is highly dangerous due to possibility of injury of aneurysmatic wall with fatal bleeding. That is why sternotomy in condition of artificial circulation (AC) and cooling of patients to 29-30 degrees C are preferred. Two cases of successful surgical treatment of critical patients with giant aneurysms of ascending parts and arch of the aorta in condition of femoro-femoral AC, hypothermia (20 degrees C) and circulatory arrest are presented.

[Transplantation of the right hepatic lobe from an alive relative donor].

The use of relative donors in the transplantation of the liver has shown a good performance as an alternative line in its orthotopical grafting. Shortage of donor organs actively stimulates the development of relative transplantation. The main problem of relative hepatic transplantation is the limited capacity of obtaining a required mass of a hepatic graft for obese recipients.

[Hypothermal perfusion: protection or damage?].

Ninety six patients were examined during operations on the open heart and great vessels: 25 perfusions were performed at a temperature of 30-32 degrees C; 41 perfusions at 26-29 degrees C; 10 at 23-26 degrees C; 20 at 12-14 degrees C. It was found that with superficial hypothermia and moderate PaO2, blood myoglobin (MG) release was minimal and the count and activity of platelets were optimal. The degree of myoglobinemia increased as PaO2 rose.

[Perfusion management in liver transplantation].

Veno-venous bypass (VVB) with a Biopump centrifugal pump (Biomedicus, USA) was used in 36 patients with liver diseases during orthotopic transplantation of the liver. Volume rate of perfusion (VR), systolic, diastolic, and mean arterial pressure (AP), and central venous pressure (CVP) were monitored. VR during liver-free period was 850-1350 (1064.

[Causes of myoglobinemia in surgery with artificial circulation].

Release of myoglobin (Mg) into the plasma and increase of its concentration during perfusion are a result of muscle cell injury during artificial circulation. High values of oxygen tension and hypothermia during cardiosurgery are sources of active oxygen forms damaging the biomembranes. We investigated release of Mg into the blood and relationship of this parameter with oxygen tension and depth of cooling.

Platelet monoamine oxidase activity during surgical intervention under condition of hypothermic perfusion.

Platelet and plasma monoamine oxidase activity was determined at early stages of hypothermic perfusion and circulatory arrest. Monoamine oxidase activity decreased more drastically and restored more slowly against the background of deep (14 degrees C) compared to moderate hypothermia (26-29 degrees C). The decrease in platelet monoamine oxidase activity was accompanied by its increase in the plasma, which attests to mechanical (in tubes) and toxic damage to platelets.

[The effect of the perfusion parameters on the functional characteristics of the thrombocytes].

Platelet and plasma monoamine oxidase (MAO) activity was evaluated in two groups of patients at different stages of surgery (before perfusion, at the depth of cooling, height of warming, and 1 h and 24 h after perfusion). Group 1 consisted of 26 patients with acquired heart diseases operated on under artificial circulation and hypothermia (26-29 degrees C), group 2 consisted of 13 patients subjected to reconstructive operations on the aorta under artificial circulation with deep hypothermia (14 degrees C) and circulatory arrest for 50 min. The activity of platelet MAO was decreased in group 1 (by more than 50% during cooling and by 68% during warming and 1 h after perfusion); 24 h after surgery MAO activity increased, but did not reach the initial value.

[The left atrial-femoral bypass in operations on the descending aorta].

Fifteen patients were operated on for aortic aneurysms and were fitted with prostheses of the thoracoabdominal portion of the aorta in March 1997-February 1999. The operations were performed under conditions of a left atrial-femoral bypass with a centrifuge pump with a working heart. The patients were divided into 2 groups.

[Orthotopic liver transplantation].

Orthotopic liver transplantation is the only method of choice for many severe liver diseases with poor prognosis. The development of liver transplantation programmes is based on medical science achievements and high technology in surgery, anesthesiology and perfusiology. The experience of the Surgery Research Center, Russian Academy of Medical Sciences, made it possible to obtain positive results of liver transplantation and posttransplantation management.

[Role of academic B.V. Petrovskiĭ in the development of extracorporeal circulation].

The paper shows the role of Academician B.V. Petrovsky and his scientific school in the development of extracorporeal circulation, as well as his ties with S.

[Orthotopic liver transplantation: surgery research center's experience].

From 1990 to 1996, 178 patients with severe diffuse and advanced focal liver diseases with grave prognosis were observed for indications to orthotopic liver transplantation (OLT). According to the revealed indications and contraindications, 95 patients were enrolled for the procedure. Eighteen patients underwent 19 OLTs, including 1 urgent retransplantation and 3 living related graftings.

[Comparative assessment of temperature of the myocardium during its protection by 2 methods in aortocoronary bypass].

Eighty-eight patients operated on for coronary heart disease were examined. Continuous irrigation of pericardial cavity with circulating cold solution in combination with antegrade cardioplegia was used in 53 patients, antegrade cardioplegia with external cooling of the heart by icy mass in the rest 35. Intensive external cooling provided a stable temperature of the myocardium during clamping of the aorta.

[First experience in normo-thermal artificial circulation with constant warm blood cardioplegia].

Normo-thermal artificial circulation (NAC) with constant thermal blood cardioplegia (CTBC) was carried out for the first time in Russia in 12 coronary patients subjected to surgical revascularization of the myocardium. Artificial circulation device with the vesical type oxygenator was used for NAC. For CTBC, systems for delivery of the cardioplegic solution and blood from the oxygenator in 1:4 ratio were used.

[The protection of the myocardium with a circulating cold solution during aortocoronary bypass operations].

Forty-three patients operated on under conditions of aortocoronary bypass were examined. In 29 of them continuous circulation of cold solution in pericardial cavity was combined with antegrade cardioplegia. In 14 routine technique of external myocardial cooling with snow and antegrade crystalloid cardioplegia was employed.

[Changes in the content of microelements--copper, zinc and iron--in the blood of patients following cardiopulmonary bypass].

Changes in the blood content of trace elements (E)--copper, zinc and iron--have been studied in 10 patients with ischemic heart disease subjected to cardiopulmonary bypass surgery. It has been shown that blood TE concentrations decreased considerably during surgery. Variability in blood TE levels could be accounted for by hemodilution caused by the administration of colloids and crystalloids that contained no TE under study.

[Our initial experience of protecting the myocardium by irrigating the pericardial cavity with a circulating cold solution during operations with artificial circulation].

In 21 patients with coronary heart disease, a procedure of protecting the myocardium was used during cardiac surgeries via irrigation of the pericardial cavity with circulating cold solution in combination with cardioplegia into the aortic root. The application of the procedure maintained stable myocardial temperature from 10.26 +/- 1.

[Orthotopic liver transplantation (first clinical experience)].

The article deals with the results of work conducted according to the orthotopic liver transplantation (OLT) program from January 1990 to January 1992. To select the patients for OLT, 54 persons (24 males and 30 females aged from 12 to 55 years) with diffuse (34) and focal (20) diseases of the liver were examined. OLT was indicated for 19 patients who were registered in the waiting list.