[Possibilities and perspectives of Holter monitoring in assessing the adequacy of cardioplegia in "open" heart surgery].
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Biomedical subjects
Publications and source records attributed to F Z Abdullaev.
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The results of intracardiac examination of 37 patients with anomalous origin of the left coronary artery from the pulmonary trunk were studied. On the basis of anatomo-angiographic++ comparisons the authors point out the characteristic features of coronary circulation and affection of the left ventricular myocardium which determine the clinical manifestations of its dysfunction. The functional condition of the left ventricle was appraised depending on the character of development of the intercoronary collaterals.
The clinical significance of 201Tl myocardial perfusion scintigraphy was studied in 7 patients with abnormal branch of the left coronary artery from the pulmonary trunk and in 1 patient with that of the anterior interventricular artery from the pulmonary trunk. Radiological criteria for the defect were established on the basis of comparative analysis of the data of myocardial scintigraphy with those of electrocardiographic, coronary angiography and anatomic examinations. It was shown that it was feasible to make a differential diagnosis between abnormal left coronary artery branch and dilated cardiomyopathy and that the technique was of value for comparative assessment of the efficacy of various types of surgical treatment for abnormal left coronary artery ramus from the pulmonary trunk.
A complex ultrasound examination makes it possible to tentatively differentiate a coronary fistula and recommend to perform coronary angiography. The tentative diagnosis of coronary fistula can be made on the basis of a set of the following sings: location of aneurysmally enlarged ostium and proximal segment of a coronary artery along with an intact contralateral one; recording of abnormal turbulent systolic and diastolic blood flow in the aneurysmally enlarged coronary artery. The location of coronary distal segments and the site of the coronaryfistular shunt are a complicated problem that awaits further exploration.
Electrocardiographic characteristics of abnormal left coronary arterial branching (ALCAB) from the pulmonary trunk were examined in 36 patients, aged 2 months to 39 years. Signs of marked left-ventricular and left-atrial overstrain were typical for all ages. There were signs of past left ventricular myocardial infarction in 88.8% of patients, the cicatricial changes being anterolateral in 65.6%, which is typical for the defect. The follow-up of ECG pattern over 1 month to 8 years after the defect was first detected demonstrated that coronary circulation deteriorated in 64.3% of cases.
Pathologic, clinical and anatomical correlations are presented for left ventricular affection in abnormal origin of the left coronary artery from the pulmonary trunk. It was revealed that there is a complex of critical factors essential for survival of patients and clinical pattern of the defect including the degree of manifestation of intercoronary collateral circulation, specificity of myocardial left ventricular ischemic impairment and that of mitral structure. Clinical and anatomical comparisons are drawn between the degree of affection of the left ventricular myocardium and its functional capacity.
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ECG changes were analysed in 31 patients with congenital coronary arterial fistulas with reference to the site of coronary arterial lesion and the level and magnitude of blood discharge. Two hemodynamic factors, conditioning ECG changes, were identified as typical for coronary arterial fistulas: 1) volume strain on cardiac compartments making up the fistula receptacle chamber; 2) perfusion deficiency in the distal segment of the affected coronary artery. Fistulas with large-volume shunts may be accompanied by both ischemic changes in the affected-artery basin and regional perfusion disorders in adjacent basins, the latter being due to "stealing" of the adjoining coronary trunk or the type of coronary blood supply.
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The degree of hypertrophy of the right ventricle is proportionate to the size of the systolic pressure gradient between the right ventricle and pulmonary artery prior to operation. The involution of hypertrophy is dependent on the type of stenosis, age of the patient and the term of surgery.
A special circulating installation for topical hypothermia of the myocardium is proposed. An advantage of the installation is the possibility of the permanent controlled irrigation of the whole surface of the heart, especially of the posterior surface represented mainly by the left ventricle mass with the ice-cold solution.