[PATHOPHISIOLOGY OF POSTINFARCTION ANEURYSM OF LEFT VENTRICLE.].

In this article, the definition of a heart attack postinfarction aneurysm of the left ventricle of the heart is given, describe the geometric changes to the left ventricle, proceeding transmural myocardial transferred after a heart attack, they were described the adaptive machinery of the organism on the whole way the anesthesiologist in process of the anesthesia can encounter; and also indicate the presence of a possible sources of pathological threatening the life arrhythmias. At the end of the article is given the evolution of the procedures of correction of the heart attack postinfarction aneurism left ventricle of conducting revascularization myocardial or without it.

Surgical methods of protecting the spinal cord during reconstructive operations on the thoracic and thoracoabdominal portions of the aorta.

Background: Restoration of the spinal blood flow during operations on the thoracoabdominal portion of the aorta is one of the basic and decisive methods of protecting the spinal cord from ischaemia.

Objective: To decrease the incidence rate of spinal complications during interventions on the thoracic and thoracoabdbminal portions of the aorta at the expense of choosing an appropriate option of aortic reconstruction, determined by preoperative diagnosis of peculiarities of blood supply of the spinal cord.

Materials And Methods: From November 2005 to April 2007, a total of 34 patients were operated on at the Department of Arterial Pathology.

[The clinical and diagnostic value of some hemodynamic indices for the assessment of silent ischemia in patients with low myocardial contractility].

During initial anesthesia, central and peripheral hemodynamic parameters were studied in 32 patients operated on for coronary heart disease (CHD). The patients were divided into 3 groups: 1) those with < 35% ejection fraction (EF) with postinfarct left ventricular (LV) aneurysm (PLVA); 2) those with > 35% EF with PLVA; 3) those with > 35% EF without PLVA. All the examinees were assigned as having NYHA functional class III-IV.

[New conditions for evaluating static compliance].

Static compliance (Cst), time course and clinical and diagnostic significance of relationship between Cst and Vinsp were studied in 97 patients with congenital heart diseases aged over 3 years after open-heart surgery for correction of the defect during uneventful immediate postoperative period. Three groups of patients were distinguished: 1) patients operated on for Fallot's tetralogy without a previous aortopulmonary anastomosis (TF-1); 2) patients with Fallot's tetralogy with a previous systemic pulmonary anastomosis (TF-2); 3) patients operated on for atrioventricular septal defects and incomplete atrioventricular communication. Age subgroups of 3-5, 6-8, 9-11, and 12-15 years were singled out in each group.

[Relations between several parameters of respiratory mechanics after radical correction of congenital heart defects].

The results of this study are at variance with highly prevalent opinion that an increase in Vinsp leads to a parallel growth of Cst. A different degree of relationship between Vinsp and Cst was observed in the studied groups (from 0.33 to 0.

[The use of a pressure-support ventilation regimen in the recovery of spontaneous respiration after heart operations].

Pressure-support ventilation (PSV) with supporting pressure (SP) levels 20, 15, 13, 10, and 8 mm H2O was used in 111 patients with congenital heart disease after open-heart surgery during transfer to spontaneous respiration. PSV was associated with a significant decrease of respiratory rate and increase of respiratory volume (RV) at high SP levels. Respiration in the PSV mode permits the patient to control the inspiration flow, duration of inspiration phase, and RV, thus improving the patient-device synchronization.

[The mechanical properties of the lungs in patients with congenital heart defects in the immediate postoperative period].

Static compliance and inspiratory resistance were assessed in 218 patients aged over 3 years after open-heart surgery for correction of congenital heart disease during the immediate postoperative period without complications. Cst in the immediate postoperative period in patients with Fallot's tetralogy, intraventricular septum defect, intraatrial septum defect, and incomplete form of atrioventricular communication was higher than in patients operated on for Fallot's tetralogy with a previous systemic-pulmonary anastomosis and pulmonary artery atresia, whereas Rinsp was virtually the same in all groups. Age-specific differences were noted.

[The cardiac index dynamics of patients after the radical correction of tetralogy of Fallot depending on the level of the pressure-support ventilation (PSV) regimen].

Seventeen patients were examined, reoperated on for correction of Fallot's tetralogy on the open heart after a previous aortopulmonary anastomosis. Pressure support ventilation (PSV) was used in all patients during transfer to spontaneous pressure, making use of different levels of pressure support (20, 15, 13, 10, and 8 mm H2O). Decrease of pressure support from 20-15 mm H2O to 13 mm H2O resulted in a sharp increase of cardiac index.

[Concentration of beta endorphin in blood as a criterion of adequacy of general anesthesia].

Considering beta-endorphin as a sign of tension and adaptation, the changes in its level have been studied during operations and surgery in patients with congenital heart valve defects subjected to cardiopulmonary bypass surgery. The goal of the study was determination of beta-endorphin concentration for the assessment of general anesthesia adequacy. A step-by-step study of beta-endorphin blood concentration, central and peripheral hemodynamics, diuresis, changes in temperature taken in 3 spots, adrenalin, dopamine and noradrenaline blood levels has been performed in 12 patients aged 4 to 17 years.

[Total intravenous general anesthesia during radical correction of tetralogy of Fallot].

Three techniques of general intravenous anesthesia were compared, using mathematical parameters of the heart rhythm, hemodynamic and sympathoadrenal system responses, arterial blood Hb saturation with O2 (SaO2) and thermometry. It has been established that anesthesia with dipidolor ensures adequate protection against the operation stress both in patients with tetralogy of Fallot previously subject to interarterial anastomoses and patients with tetralogy of Fallot without anastomoses. Combined fentanyl and ketamine anesthesia ensures an adequate protection against the operation stress only in patients with tetralogy of Fallot without anastomoses.

[Arterial hypertension of unclear etiology as a complication of anesthesia during heart surgery under conditions of artificial circulation].

The paper deals with causes of arterial hypertension in the early postperfusion and postoperative periods in treating congenital heart disease (CHD) under artificial circulation (AC). The hemodynamics and parameters of the renin-angiotensin-aldosterone system (RAAS) were examined clinically and biochemically in 100 patients. The findings showed that under hypothermic perfusion with nonpulsing blood flow, plasma renin activator and angiotensin converting enzyme became activated to affect the dynamics of mean arterial blood pressure.

[Angiotensin converting enzyme activity in atrial and cubital venous blood].

The relationship between the activities of the blood angiotensin-converting enzyme (ACE) and the site of the blood collection (radial artery, peripheral vein, left atrium) was examined in 15 patients with congenital heart diseases operated on with artificial circulation. No statistically significant differences in ACE activities in the blood from the vein, artery, or left atrium was detectable (p greater than 0.05).

[Principles of intensive therapy in heart surgery of early childhood].

The paper deals with the problems of intensive therapy in cardiac surgery of early childhood. Proceeding from their experience in the treatment of 1036 children aged under 3 years the authors give recommendations as to the measures of intensive therapy both prior to surgery, and in the early postoperative period. The principal differences of pre- and postoperative intensive therapy are determined.