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Biomedical subjects

V P Kertsman

Publications and source records attributed to V P Kertsman.

At least 19 recordsLinked to original sources
PubMed1992

[Effect of different types of pharmacocryocardioplegia on the occurrence of cardiac rhythm and conduction disturbances in the early postoperative period in patients with ischemic heart disease].

109 patients who underwent operation for formation of an aortocoronary shunt (ACS) were divided into 3 groups according to the method of introducing a cardioplegic solution and reperfusion. Thirty-five patients (group 1) underwent antegrade cardioplegia and direct reperfusion. Thirty-seven (group 2) were subjected to mixed antegrade-retrograde cardioplegia. Group 3 consisted of 37 patients with myocardial protection accomplished by the same method as in group 2, but retrograde perfusion was with warmed oxygenated blood through the right atrium was conducted before removing the clamp from the aorta. The effect of various types of pharmacocryocardioplegia on the appearance of new disorders of rhythm and conductivity in the early postoperative period after ACS formation was analysed. The frequency of sinus tachycardia was less in group 3 (24%) than in groups 1 and 2 (51 and 51%, respectively, p less than 0.05). We obtained no statistically significant differences in the frequency of other types of arrhythmias in these 3 groups. However, the number of transient bundle-branch blocks and disorders of intraventricular conductivity (8.1 and 10.8%, respectively) in group 3 was also less than that in groups 1 and 2 (p less than 0.05) and their regression was faster. We believe that combined anterograde-retrograde cardioplegia applied together with retrograde reperfusion with warmed oxygenated blood is most effective not only in protection of the conduction system of the heart but also in protection of the right- and left-ventricular myocardium.

Arrhythmias, Cardiac↗
PubMed1992

[The causes of cerebral complications in patients with ischemic heart disease following myocardial revascularization operations].

In the period from Jan. 1988 to Jan. 1991 operations for the formation of an aortocoronary shunt were carried out in 437 patients at the Department of Combined Affections of the Coronary and Peripheral Arteries, Bakulev Research Institute. In some cases the operation was combined with resection of a postinfarction aneurysm of the left ventricle. Cerebral complications developed in the postoperative period in 28 (6.4%) patients. Their analysis showed the prevalence of severe forms of consciousness disturbances: coma and comatose states were encountered in 85.7% of cases. The main causes of the complications were acute heart failure (64.3%) and arterial embolism (14.3%). In only one case concomitant affection of the branches of the aortic arch was found to be the main cause of the development of a transitory ischemic attack. It is concluded that the development of acute heart failure in the patients may sharply increase the incidence of neurologic complications.

Aorta, Abdominal↗
PubMed1992

[Risk factors and methods of prevention of complications in digestive organs after myocardial revascularization in patients with generalized atherosclerosis].

The clinico-hemodynamic and angiographic findings in 66 patients with ischemic heart disease were analysed to identify the risk factors of complications in the digestive system and to determine the methods for their prevention after myocardial revascularization. It was found that complications in the gastrointestinal tract develop after extracorporeal circulation more often in patients with lesions of the visceral branches of the abdominal aorta than in those without them. With purposeful preventive therapy and observance of definite precautions before, during, and after the operation, the incidence of complications in abdominal organs and the organs of the retroperitoneal space reduced to one fourth while the nature of these complications was less aggressive. This was confirmed by no postoperative deaths in the group of patients who had undergone preventive treatment.

Adult↗
PubMed1991

[Simultaneous reconstructive operations in combined lesions of the coronary arteries, abdominal aorta and arteries of the lower extremities].

The work deals with the results of one-stage reconstructive surgical interventions in 15 patients with affection of the coronary arteries, abdominal aorta, and lower limb arteries. All patients underwent operation for the creation of an aortocoronary shunt in combination with various types of vascular reconstructive operations, including the formation of an ascending aorta -bifemoral shunt in 3 patients. The total hospital mortality was 26.7%. The authors discuss the indications and the surgical tactics of one-stage reconstructive interventions in combined affection of the coronary and peripheral arteries.

Anastomosis, Surgical↗
PubMed1991

[Tactics of the surgical treatment of combined occlusive diseases of the coronary arteries, the abdominal aorta and the arteries of the lower extremities].

On the basis of experience in reconstructive operations on 250 patients with combined affection of the coronary arteries, abdominal aorta, and arteries of the lower limbs the authors discuss the diagnostic and tactical features of surgical management of these patients. The article dwells upon the necessary preoperative diagnostic algorithm as well as that in tactical variants of surgical treatment: (1) one-stage reconstructive operations on several vascular beds; (2) successive stage-by-stage treatment of patients with combined vascular pathology; (3) reconstructive vascular intervention on only one of the vascular beds. Correct practical solution of all these problems allowed the authors to reduce postoperative lethality to 5.4% among this grave contingent of patients with combined vascular pathology.

Aorta, Abdominal↗
PubMed1990

[Experience in the surgical treatment of combined atherosclerotic lesions of the coronary arteries, abdominal aorta and arteries of the lower limbs].

A comprehensive clinicoangiographic and functional examination was made of 180 patients with combined coronary and vascular abnormalities. With this, a diagnostic algorithm was developed, which determined the authors' approach to evaluation of the severity of patients and the choice of surgical policy. A total of 150 patients were operated on, the total mortality being 7.3%. The examination of operative and hospital mortality rates in patients with combined abnormalities showed that pre-aortocoronary bypass surgery before a reconstructive vascular operation in patients with severe coronary diseases made it possible to avoid serious coronary events in the following postoperative period.

Adult↗
PubMed1990

[Reconstructive vascular operations in patients with an inoperable form of ischemic heart disease].

The authors performed 153 reconstructive vascular operations in patients with associated atherosclerotic lesion of the coronary arteries, abdominal aorta and arteries of the lower extremities. According to the findings of ventriculography and coronarograms, in 13 patients, the inoperable form of the ischemic heart disease was revealed. In all these patients, the vascular operations were performed. The indications for the different reconstructive vascular operations in inoperable coronary pathology have been developed.

Adult↗
PubMed1989

[Endovascular laser methods in the treatment of arteriosclerotic cardiovascular diseases].

Employment of laser for restoration of adequate blood flow in atherosclerotic vessels is a radically new approach to treatment of cardiovascular diseases of atherosclerotic genesis. Since 1983, wide-scale experimental work has been done at A.N. Bakulev Institute of Cardiovascular Surgery, USSR Academy of Medical Sciences, which has formed the basis for transluminal laser angioplasty (vascular recanalisation with high-intensity laser beam), laser atherolysis (regression of atherosclerotic formations under low-intensity laser beam), and their combinations. Clinical application of these procedures was started in 1985. Sixty-two patients with ischaemic heart disease, Takayasu's and Leriche's syndromes, chronic occlusion of pelvic and lower-limb arteries, and with combined lesions of the arterial bed were exposed to targeted transluminal laser. Laser endovascular therapy alone and in combination with balloon angioplasty or bypass surgery was used. Application of these methods showed their high efficacy. Successful recanalisation and restoration of adequate flow (confirmed by Doppler echography and angiography) were achieved in 93 per cent cases; results were poor (no effect, complications) in 7 per cent cases.

Adrenergic beta-Antagonists↗
PubMed1989

[Acute disorders of the blood circulation and cardiac insufficiency following open heart surgery].

General theoretical aspects (classification of circulatory disorders and heart failure) and results of research into specific subdivisions of cardiovascular and respiratory system pathology in cardiac surgical patients are discussed. The material is aggregated by the applied clinico-mathematical approach that has been developed and introduced into clinical practice in the recent 15 years at the Bakulev Institute of Cardiovascular Surgery. The extension of the clinico-mathematical approach onto the intraoperative control and analysis of the patients' status, assessment of the anaesthetic administration and cardioplegic protection is first overviewed.

Acute Disease↗
PubMed1989

[Indications for aortocoronary bypass in patients with combined lesions of the coronary arteries, abdominal aorta and blood vessels of the legs].

The literature and original research data on the incidence of combined lesions of coronary arteries, abdominal aorta, and lower-limb vessels are presented. Operative intervention was undertaken in 112 of 170 examined patients with combined coronary and vascular abnormalities. Fifteen patients underwent one-stage reconstruction of the coronary artery and aortofemoral segment; in 57 patients aortocoronary bypass was performed as the first stage; in 40 patients only vascular reconstruction was performed. Operative risks in these patients are discussed, as well as the diagnostic problems, surgical tactics, and the sequence of operation stages in combined coronary and vascular abnormalities.

Anastomosis, Surgical↗
PubMed1988

[Surgical tactics and results of aortocoronary shunting in patients with chronic forms of ischemic heart disease and reduced left-ventricular ejection fraction].

Two groups of patients whose ejection fraction was below 0.45, underwent aortocoronary shunting of one to five arteries: patients without myocardial scarry changes (group 1) and those with expansive intra- and transmural myocardial scarry changes (group 2). The latter group was more difficult in terms of coronary bed affection, myocardial contractility and a greater proportion of patients with circulatory insufficiency, which dictated the type of anesthesia, myocardial protection and the surgical techniques in these patients. Aortocoronary shunting is shown to be quite justified and effective in patients with reduced left-ventricular ejection fraction, particularly so in group 1, yet it requires careful selection of patients, provision of adequate myocardial protection and maintenance of myocardial activity at all stages of the intervention.

Adult↗