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Biomedical subjects

B V Shabalkin

Publications and source records attributed to B V Shabalkin.

At least 19 recordsLinked to original sources
PubMed2004

[Personality disorders in postoperative period of coronary artery bypass graft surgery].

Personality disorders (PD) are recognized among key maladaptive factors in postoperative period of coronary artery bypass surgery (CABS). However studies on PD among CABS patients are predominantly under psychological approach and information on clinical features is very limited. A present investigation aimed at assessing clinical features and prognostic value of PD in late post operative period of CABS (from 1 to 3 years). Using psychiatric, cardiological and psychological methods, 48 patients (42 male, mean age 61.3 +/- 8.2 years) with diagnosis of PD and favorable cardiological status after CABS have been assessed. PD in post operative period is an important predictor of unfavorable social and occupational outcome of CABS. Three types of clinical course of PD were singled out: 1) hypohondric personality development; 2) "second life" personality development; 3) "denial of illness" reactions. Pronounced maladaptation was observed in type 1, most severe one--in type 2 and minimal maladaptation or its absence--in type 3. These types were differentiated by different repertoires of psychological defense mechanisms (PMD): type 1 was characterized by a limited number of them with a drift to mature mechanisms; PD of type 2 are featured by a narrow and rigid repertoire of defenses with predomination of immature mechanisms and in type 3 a maximum number of PMD with balanced involvement of mature and immature mechanisms was observed.

Adaptation, Psychological↗
PubMed2003

[Minimally invasive coronary grafting without using the artificial bypass blood circulation].

An analysis, the shaping-up and perfection of the surgical treatment of ischemic heart disease (IHD) by using the method of small-invasion grafting of coronary arteries without applying the artificial bypass blood circulation is described. Indications and contraindications for the surgery of coronary grafting on the working heart and with minimal approach are discussed. Advantages of such surgeries boil down to a smaller trauma, a better cosmetic effect, milder pain, a quicker rehabilitation (with a shorter stay in hospital) and cost-efficiency.

Coronary Artery Bypass↗
PubMed2002

[Currently available blood saving methods in a patient at cardiac surgery under extracorporeal circulation].

Different blood saving methods are analyzed in 2000 cardiac surgical patients undergoing coronary and vascular bypass surgery in 1993 to 2000. The basic blood saving methods are as follows: intraoperative autoreinfusion (normovolemic thermodilution), reinfusion of the patient's blood, preoperative autologous plasma donation in combination with aprotinine, aminocapronic acid, etc. An analysis revealed a decrease in homologous blood components intraoperatively. Red blood cell transfusion decreased from 100% in 1993 to 44% in 2000, fresh frozen plasma and platelet transfusions did from 98 to 39% and from 96 to 1%, respectively. Intraoperative homologous blood transfusion could be avoided in 70% of those undergone coronary bypass surgery.

Blood Preservation↗
PubMed1996

[Autoarterial grafts for myocardial revascularization and their morphological assesment in coronary heart disease].

A comparative analysis of arterial grafts used for myocardial revascularization has been done. The morphology of arteries, rate and degree of atherosclerotic process were evaluated. 55 thoracic internal arteries, 52 right gastro-epipiolcal arteries, 34 epigastrical inferior arteries have been tested in cadavers of people with signs of coronary heart disease. Arteria thoracica interna appeared to be a vessel with prevalence of elastic elements, while arteria gastro-epiplocia and arteria epigastrica inferior are predominantly muscle-type. Arteria thoracica interna and arteria epigastrica inferior appeared to be rarely affected with atherosclerosis in people under 60 years of age. Atherosclerotic lesions have been found more often in arteria gastro-epiploica without stenotic lesions. In people over 60 years of age the stenotic lesions in arteria thoracica interna and arteria epigastrica are found much more often than in arteria gastro-epiploica. Arteriography should be done in selecting the proper graft for myocardial revascularization.

Adult↗
PubMed1995

[Topographic-anatomical bases of the use of the inferior epigastric artery in creation of free graft for aortocoronary shunt].

Ten experiments were conducted on nonfixed human cadavers of males and females 50 to 70 years of age. The inferior epigastric artery arises from the medial wall of the external iliac artery 1.0-1.5 cm proximal to the inguinal ligament. Its diameter at the site of its origin varies from 2.5 to 4.0 mm and is 3.25 +/- 0.13 mm on the average. At the level of the umbilical ring the average diameter of the artery is 1.47 +/- 0.03 mm. The total length of the arterial segment which can be used for transplantation varies from 11 to 16.5 cm, being 14.60 +/- 0.48 cm on the average. An approach through an inferomedian incision of the abdominal wall is preferable. The transplant is taken out together with the veins and the surrounding connective tissue. The length and diameter of the inferior epigastric artery are sufficient for using it as an aortocoronary shunt in revascularization of the myocardium in patients with ischemic heart disease.

Aged↗
PubMed1994

The use of high doses of aprotinin to decrease blood loss in aortocoronary by-pass surgery.

There were examined 100 patients who had been operated in extracorporeal circulation for ischemic heart disease. In the 1st group (50 patients), each patient intraoperatively received 6,000,000 KIE of aprotinin; in the 2nd group (50 patients) placebo. Both groups were similar as for the age, duration of extracorporeal circulation, and myocardium anoxia. The total intraoperative blood loss was higher in 2nd group, 638 +/- 5 ml and 952.4 +/- 15.5 ml p < 0.05 correspondingly. The rate of cases without the intraoperative use of donor blood was 42% in group 1 and 18% in group 2. The postoperative blood loss was significantly lower with the use of aprotinin, 392 +/- 6.6 ml and 689.7 +/- 9.6 ml, p < 0.05 correspondingly; and in that the Hb concentration in the drainage blood was higher in group 2: 31.3 +/- 0.5 g and 73.1 +/- 2.2 g, p < 0.05. In group 1 22% of the patients received donor blood in the early postoperative period, and group 2 twice as many -56%. Thus prolonged intraoperative use of large aprotinin dosages in aortocoronary by-pass surgery is an effective means for stabilization of homeostasis, and it allows to reduce intra- and postoperative blood loss and diminishes the requirements in donor blood.

Aprotinin↗
PubMed1992

[Assessment of myocardial function and metabolism in patients during aortocoronary bypass surgery after hypoxia-reoxygenation].

The myocardial function and metabolism were assessed in 12 patients with coronary heart disease intraoperatively during aortocoronary bypass surgery. The antioxidative properties of the blood of the heart were found to become lower along with activated peroxidation after the major stage of an arrested heart operation, that correlated with depressed myocardial function.

Adult↗
PubMed1992

[State of coronary circulation and results of 24-hour ECG monitoring in patients with refractory angina pectoris].

The paper compares the data of selective coronary angiography and 24-hour monitoring in 39 patients with refractory angina pectoris. Transient ST-segment changes were revealed in 79% of the patients, ST-segment depression occurring in 54%, ST-segment elevation in 46%, T-wave inversion in 38%. A combination of ST-T interval changes and occurrence of ventricular premature contraction was found in a third of the examinees. There was no statistically significant correlation between the extent of major coronary lesion and the mean length of ST-segment displacements.

Adult↗
PubMed1992

[Intraoperative myocardiography, a new method of regional myocardial function evaluation during aortocoronary bypass surgery].

Excursions of the myocardium in its revascularization area were recorded in 70 patients with coronary heart disease. Myocardial dyskinesia correlated with low bypass blood flows, myocardial ischemia and infarction in the area of revascularization at any blood flow values. The evaluation of the diagnostic efficacy of myocardiographic symptoms suggested that myocardiography had some advantages. It was concluded that it was essential to include intraoperative myocardiography into the set of methods for examining patients with coronary heart disease during myocardial revascularizations.

Adult↗
PubMed1992

[Myocardial contractility in the early postoperative period after aortocoronary bypass and cardiac aneurysm resection].

Polycardiography was used to examine myocardial contractile parameters: preejection and ejection periods and contractility coefficient in 90 patients with coronary heart disease running without complications postoperatively following aortocoronary bypass and cardiac aneurysm resection. The magnitude and length of lower myocardial contractility were found to be associated with the baseline extent of coronary and cardiosclerosis, the signs of congestive heart failure, the value of ejection fraction, and intraoperative parameters such as the duration of extracorporeal circulation and myocardial ischemia, the number of shunts and their blood flow. Early drug correction of complications and a scientifically substantiated approach to the physical rehabilitation of those operated on may be applied with due account of the changes in myocardial contractility.

Adult↗
PubMed1992

[Arteriosclerosis of the right gastro-omental artery].

The right gastroepiploic artery is most frequently used for direct myocardial revascularization. In this connection, its histological study was performed to reveal the atherosclerosis incidence in persons from different age groups who had apparent signs of coronary atherosclerosis. Twenty one arteries taken from adult cadavers at the age of 35-85 years were examined. The arteries with normal were 28.6%, those with Degree I alterations were 52.4%, those with Degree II alterations were 19%. Degrees III and IV alterations were not detected. Morphological studies indicated that hemodynamically significant right gastroepiploic artery lesions were found in 19% of cases, mainly in subjects above 60 years. The artery may be used in coronary surgery as a shunt with a good prognosis of its performance.

Adult↗
PubMed1991

[Repeated operations in recurrent stenocardia after aortocoronary bypass].

With growth of the number of primary operations and duration of the postoperative period, there was an obvious tendency towards an increase of the absolute number of patients with recurrent angina pectoris. Among 990 patients who were operated on successively during a period of 9 years, 9% had severe Functional Class III-IV angina pectoris, in whom coronary bypass graphy was indicated to determine the possibility of undertaking a reoperation. The examination was conducted in 61 patients with recurrent marked angina pectoris. Impaired patency of the aortocoronary shunts was found to be the main cause of recurrence. At present, reoperations were carried out in 18 patients, 2 years after the first operation, on the average. The authors claim the immediate results of the reoperations to be satisfactory. The hospital mortality was 5.6%.

Angina Pectoris↗
PubMed1991

[Effect of perioperative myocardial infarction on late results of the aortocoronary bypass].

The article deals with the results of examination of 47 patients with a history of perioperative myocardial infarction after aortocoronary shunting and the findings in 358 persons of the control group who were operated on without this complication. The authors studied the dynamics of changes of the patients' functional condition after aortocoronary shunting, complicated by perioperative myocardial infarction in the late-term postoperative period. A comparative study was conducted of the dynamics of changes of the symptomatic status and the incidence of postoperative myocardial infarction among patients with and those without the complication. Its effect on the occurrence of the clinical picture of chronic circulatory insufficiency was also studied. A search was undertaken in this group for risk factors of the development of recurrent angina pectoris, myocardial infarction, and symptomatology of chronic circulatory insufficiency in the late-term postoperative period. The results of the study showed that perioperative myocardial infarction in the late-term postoperative period does not affect the patient's "character" of life. In the late-term postoperative period symptoms of chronic circulatory insufficiency are encountered in patients with perioperative myocardial infarction, as a rule, in a recurrence of angina pectoris and develop significantly more frequently in initial multiple affection of the coronary arteries.

Adult↗
PubMed1991

[Diagnosis of aortocoronary bypass complications].

Thirty-four patients with ischemic heart disease were examined during operation for revascularization of the myocardium. The blood flow in the shunts was measured during the change from extracorporeal to natural circulation. In rise of venous and arterial pressure the blood flow in the shunts increased (positive dynamics) in some patients and decreased (negative dynamics) in others. Positive dynamics were associated with a favourable course of the postoperative period, negative dynamics--with ischemic-type complications. Factors invalidating the myocardium aggravated the initial condition of patients with positive dynamics of the blood flow less than that of patients with negative dynamics. Comparison of dynamic and short-term measurement of the blood flow in the shunts as a diagnostic test for perioperative complications showed the advantage of the dynamic test.

Adult↗
PubMed1990

[The blood coagulation system after autologous blood transfusion following aortocoronary shunt].

Fibrinolysis factors were examined in 112 patients operated on for coronary heart disease. After artificial circulation was over,auto- logous blood + was collected in a cardiotomic reservoir and reinfused to the patient. The collected autologous blood was characterized by a manifest fibrinolytic potential, but already in 18-20 hrs after transfusion these changes were undetectable; no enhanced bleeding was observed after surgery. Use of autologous blood helps reduce the necessary amounts of donor blood.

Adult↗
PubMed1990

[First clinical test of the use of artificial blood circulation with auto-oxygenation].

Thirteen operations for ischemic heart disease were performed in the All-Union Surgery Centre of the AMS USSR using the method of simultaneous left and right heart bypass with oxygenation of the blood in the patient's lungs. This method was found to provide for a better gas exchange in artificial lung ventilation (ALV) with 30 per cent oxygen in the inhaled mixture, and for the reduction in the perfusion blood damage. The biventricular bypass is more complicated technically than the conventional artificial circulation (AC), but it is believed to be more physiological and cost-effective, which allows for considering it an alternative in aortocoronary bypass surgery.

Adult↗