Grudnaia khirurgiia (Moscow, Russia)最新文献

The variants of distribution of the coronary arteries were studied on 41 specimens of the heart with Fallot's tetralogy. The typical topography of the coronary arteries in this cardiac defect is characterized by counterclockwise rotation of the coronary sinuses, dominant system of the right coronary artery with a large infundibular branch, and right type of heart blood supply. There were 6 variants of anomalies of the coronary arteries. The most characteristic of Fallot's tetralogy were: a single coronary artery, origin of the large infundibular artery by an independent orifice, and anomalous origin of the anterior interventricular branch from the right coronary artery. The peculiarities of radical correction of the tetralogy in atypical distribution of the coronary arteries were discussed on the basis of analysis of 27 operations conducted with the use of non-traditional methods of correction.

The condition of pulmonary circulation in children of the first year of life with complete transposition of the great vessels (CTGV) and interventricular septal defect (IVSD) was evaluated by comparing the complex of hemodynamic and angiometric values obtained in catheterization of the heart cavities and angiocardiography. All patients were divided into two hemodynamic groups according to the blood flow in the lungs: group 1 - with the ratio of pulmonary to systemic circulation (PC/SC) greater than 1; group 2 - with the PC/SC ratio less than 1. In group 1 patients the ratio of effective pulmonary circulation (EC) to PC is always less than the ratio of EC to SC both in normal and in increased total pulmonary resistance (TPR); in group 2 patients, in contrast, EC/PC greater than EC/SC when TPR is above 10 mu/m2. The evaluation of the degree of pulmonary hypertension in infants with CTGV and IVSD should therefore be based not only on the absolute values of PC, EC, and TPR but also on such differential-diagnostic signs as the PC/SC, EC/SC, and EC/PC ratios.

The authors analysed 171 patients with ischemic heart disease (IHD) and life-threatening and non-threatening arrhythmias before and after surgical treatment. The control group was composed of 34 patients with IHD (of a similar severity of the principle disease) but without arrhythmias. Life-threatening arrhythmias of the third arrhythmic group persisted even after effective revascularization of the myocardium and resection of the aneurysm. To reveal the zones of elective instability in this group of patients preoperative electrophysiological examination must be conducted with programmed stimulation of the heart for subsequent simultaneous correction of coronary circulation and the conducting system of the heart. Inoperable patients suffering from IHD with threatening arrhythmias (according to coronary pathology) are considered, in the absence of contraindications on the part of the viscera, to be potential recipients for heart transplantation. Patients with IHD and non-threatening arrhythmias should be kept under observation and given corrective drug therapy. The question concerning their operative treatment is decided upon according to the standard indications for IHD.

The number of operated on patients who are referred to a commission for expert medical assessment of working capacity is growing at present. Correct expert assessment of the working capacity allows the results of surgery to be reliably consolidated and promotes restoration of working ability. The duration and severity of working ability. The duration and severity of the pulmonary abscess, the method of surgical treatment, the lapse of time after the operation, the course of the restorative processes, complications and concomitant diseases, the degree or respiratory and circulatory insufficiency, the patients' age, profession, and the conditions and character of work are taken into account during examination. Timely and complete treatment and rational choice of occupation are important factors in the prevention of invalidism and enable most patients (86.8%) to resume work in full volume or with limitations as specified by the commission.

The article analyses the results of surgical correction of tri-valvular heart diseases in 132 patients who were operated on between January, 1973 and March, 1986. Total hospital mortality was 20.4%. Among the last 72 operations conducted from January, 1980 hospital mortality amounted to 14.0% (10 patients died). The results of the operations were approximately the same in the different methods of correction: 105 patients were studied in late follow-up periods (from 6 months to 14 years). With consideration for the hospital losses, by the 7th year of follow-up the survival after prosthetic replacement of 3 valves was 61.8%, after replacement of the mitral and aortic and valvuloplasty of the tricuspid valve--60.6 degrees. The stability of good results was 59.6 and 58.1%, respectively. Among and analogous group of patients who received drug treatment survival by the 7th year was 28.1%, which is evidence of the obvious advantages of the surgical method of treatment. The results were best in patients subjected to plastic operations on two and three valves.

Hyperbaric oxygenation leads to 100% survival of albino rats in development of fatal under normobaric conditions pulmonary edema induced by embolism of the vessels of the lesser circulation by olive oil. The degree of lung hydration and the amount of pleural effusion diminish significantly in this case but hyperemia of the pulmonary tissue persists. Thalamonal produces a moderate protective effect in fat embolism, which is manifested by reduced steeping of the lungs in fluid. Under the condition of hyperbaric oxygenation thalamonal fails to change the degree of edema and reduces slightly blood filling of the lungs in fat embolism. Hyperbaric oxygenation, thalamonal and their combination do not protect the lungs from edema and hyperemia in mechanical embolism of the vessels of the lesser circulation by lycopodium.

The aggregate of disorders of the hemostasis system revealed in patients with cancer of the lung, respiratory insufficiency, and hypoxemia should be evaluated as the presence of chronic disseminated vascular blood clotting. The degree of these disorders requires obligatory use of methods for correction, both before the operation and before the prescription of any special method for the management of cancer of the lung.

Severe cardiac insufficiency resistant to drug therapy developed in the immediate post-perfusion period in 1.5-2% of cardiosurgical patients who underwent operation in the recent 8 years. In view of this, such a method of mechanical sustenance of the weakened heart as left-ventricular bypass (LVB) was suggested. LVB lasting 5.7 hours on average, was carried out in 56 patients in the immediate postperfusion period in adequately corrected heart valvular disease. It was shown that by unloading the left ventricle by means of a roller pump the average arterial pressure can be raised, the average left-ventricular pressure lowered, and the dose of the administered cardiotonics reduced. All this contributes to the restoration of the patient's own adequate circulation. Owing to LVB, cardiac activity was restored in 56% of patients, 41% of patients recovered and were discharged from the hospital. The results bear evidence that LVB is an effective method for sustenance of circulation in cardiosurgical patients.