[Dynamic control of acute crisis of rejection of the transplanted heart based on echocardiography].
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Biomedical subjects
Publications and source records attributed to V V Bobkov.
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In 198 cardiosurgical patients the treadmill test was performed with the noninvasive evaluation of the pump function of the heart and anaerobic threshold. The results were compared with echocardiographic sizes of the left atrium (LA), systolic and diastolic sizes of the left ventricle (CLV and DLV). It was shown that in patients with mitral stenosis the pump function of the heart reliably corresponded to the size of the LA, in mitral regurgitation--O of the DLV, in aortal defects--that of the CLV and DLV. After isolated prosthezing of the heart valves the correlation found was not retained. It was proved that the maximum consumption of O2 did not reliably correlate with LA, CLV and DLV.
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Surgical treatment of 40 patients with mitral valvular diseases and left atriomegaly is analysed. The dimensions of the giant left atrium in this group of patients must be reduced because it causes compression of the posterobasal part of the left ventricle, constriction of the lumen of the left main bronchus or compression of the inferior and middle lobes of the right lung. Left atrioplasty has a favorable effect on the course of the immediate postoperative period and reduces significantly hospital mortality among this grave contingent of patients.
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The paper reviews a 10-year experience with complex ultrasonic diagnosis of membraneous subvalvular aortic stenosis, a rare congenital defect. Fifteen subjects operated on for this abnormality were examined. Profound systolic closure of the aortic cusps, concentrated left ventricular myocardial hypertrophy, linear-shaped echo signals generated by the membrane in the subaortic area, turbulent systolic blood flow in the ascending aorta are the most significant signs for the diagnosis of the membraneous subvalvular aortic stenosis.
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Echocardiographic findings in 8 patients operated on for Valsalva's sinus aneurysm rupture are summed up: aneurysm and the site of its rupture shown on two-dimensional echocardiogram, abnormal diastolic blood flow through the aneurysm, evidenced by Doppler cardiography, and dilatation of cardiac chambers, dependent on the direction of blood discharge through the aorto-cardiac fistula.
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Echocardiographic findings were analysed in 25 patients after surgical application of biological mitral valve prosthesis BAKS-M and 10 patients with paravalvular fistulas developing after similar operations employing different types of prosthesis. A tendency to increased postoperative size of the heart, left-atrial systolic turbulent flow, normalized ventricular septal movement and high-frequency oscillations of the aortic valve cusps are characteristic echocardiographic signs of paravalvular fistula.
The authors analysed the results of echocardiography of patients with a mild ("ambulatory") form of infectious allergic myocarditis (the 1st group). Enhanced myocardial contractility was revealed in the 1st group as compared to the group of healthy persons (controls), decreased left ventricular contractility was noted in patients of the 2nd group (with dilated cardiomyopathy). A conclusion was made that a mild form of infectious allergic myocarditis was characterized by enhanced left ventricular contractility as a sign of its compensatory hyperfunction in response to myocardial damage.
A simple echocardiographic method for the assessment of the valve regurgitation volume in patients with isolated acquired heart diseases is described. It can be widely used in the routine clinical practice due to its relative simplicity.
Echocardiographic signs of subvalvular fusions are discussed, as they frequently complicate the course of mitral stenosis. The diagnostic value of two-dimensional echo-cardiography is established for this abnormality. Subvalvular fusions of the chordal apparatus are shown to be associated with certain signs on the two-dimensional echocardiogram, such as additional echoes under mitral valve cusps in short-axis heart section (sensitivity 67.2%, specificity 90.7%), and mitral orifice drawn towards the interventricular septum (sensitivity 35.7%, specificity 93.5%), thickened subvalvular structures in the long-axis section of the heart's left compartments (sensitivity 40.7%, specificity 82.9%), and fissural or "coma-like" shape of the mitral orifice.
A study of the clinical pattern and findings of auxiliary investigation in 27 patients with dissecting aneurysms of the thoracic aorta showed that early diagnosis was necessary to improve the results of the treatment. A new non-invasive diagnostic method, computerized tomography, was employed for the first time in domestic clinical practice. The diagnostic value of various instrumental investigation techniques was demonstrated with respect to research and clinical work.
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Possibilities of dopplerography have been examined with respect to mitral incompetence in 20 apparently normal subjects and 24 patients with mitral incompetence documented by surgical or left-ventriculographic findings. Spectrograms and analogue curves of blood flow around the left atrioventricular orifice were assessed. Unlike normal subjects, 21 of 24 patients exhibited turbulent systolic flow in their left atrial cavities, behind mitral cusps, regarded as evidence of mitral regurgitation. Left-atrial blood flow investigation demonstrated a relationship between the distance of recorded systolic flow from mitral cusps and manifestation of mitral incompetence. Therefore dopplerography can detect mitral regurgitation and give an approximate idea of its manifestation in patients with mitral incompetence.
Possibilities of two-dimensional echocardiography using a number of additional cross-sections (right chambers sectioned longitudinally, four-chamber epigastric view, longitudinal cross-section of aortal arc) have been investigated. Heart structures were identified on the basis of comparisons with anatomical cross-sections of the heart in the preset planes. The study is based on sections from 34 hearts and findings of 46 echocardiographic investigations in normal subjects. Some methodological procedures for obtaining such echocardiograms are specified.