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Eleven patients operated on under extracorporal circulation (ECC) following acutely occurring massive pulmonary emboli were studied. The values of the following parameters were registered: pulmonary artery pressure, pulmonary capillary wedge pressure, intrapulmonary shunt and pulmonary vascular resistance. The measurements were carried out before the surgical procedure and in the postoperative period. The authors defend the opinion that the accurate and timely diagnostics and the correct perioperative management has crucial importance for the determination of the moment for surgical treatment and its successful outcome.

A retrospective study comprising patients undergone cardiac surgery is done. In the study some measurable parameters of external breathing are followed up. The measurements are carried out by portable respiratory monitor. The following parameters are included in the study: FVC, FEV1, PEF and FEF 25-75%. The lowering values of these parameters is taken into account and the degree and way to restore these values is discussed.

We describe a case of a patient with moderate hemophilia B, undergoing CABG. Substitution therapy was realized with factor IX concentrate (Bebulin-TIM4-IMMUNO). We discuss which of the following factors: hypothermia, hemodilution of heparinisation has a substantial role in alteration of FIX coagulant activity during cardiopulmonary bypass.

The well established long-term patency of the internal thoracic artery (ITA) makes it a conduit of choice for coronary revascularization. Recent data suggest that patients with bilateral ITA grafts have a greater survival benefit and improved life-style quality, but it is worth noting that increased use of both ITA may have an adverse effect on morbidity and mortality. It is the purpose of this report to assay the first series of patients with bilateral ITAs, and analyze morbidity and mortality rates. In the period April 1992 through January 1994, ten patients undergo coronary revascularization using both ITAs, supplemented by saphenous grafts. In the series analyzed hospital mortality amounts to zero, and there is no perioperative myocardial infarction--neither respiratory deficiency, nor reoperations for bleeding. There is a single case of sternal infection--10 per cent. As shown by the early results, the use of bilateral ITA for coronary artery bypass grafting is a safe procedure, and does not increase operative mortality and morbidity.

The rupture of the sinus of Valsalva is a rare heart disease with a heavy clinical manifestation, the treatment of which is surgical. It is diagnosed with echocardiography and cardiac catheterisation. The anesthesiologist has to answer many and important questions about anesthetic treatment. There is a little information is the literature on the anesthetic consideration of the patients with a ruptured sinus of Valsalva. On the basis of the results in our hospital the authors want to present the clinical treatment and management of these patients in the perioperative period and to compare these results with other cases like these in world literature.

Over the last ten years (1984-1994), 124 patients undergo one-stage operations for diseases of the heart valves and coronary arteries and other surgical conditions. This makes 3.38 per cent of the total of 3661 patients subjected to open-heart surgery in the observation period. The indications for undertaking surgical treatment in the series of 124 patients reviewed are classified in three groups, as follows: Group A. Life-threatening conditions due to concomitant surgical disease (bleeding from the gastrointestinal tract, acute calculus cholecystitis, obstructive jaundice, peritonitis, end-stage pregnancy)--16 patients. Group B: Serious non-heart surgical diseases (malignancy, hypersplenism, aneurysm of the abdominal aorta)--47 patients. Group C. Non-heart diseases giving rise to serious complaints and life style deterioration (advanced inguinal hernia, hiatal hernia with gastroesophageal reflux, duodenal ulcus, thyroidism, etc.)--61 patients. The early postoperative mortality and complications rates--2.41 per cent and 3.22 per cent, respectively--do not differ essentially from those in patients with open-heart surgery alone. One-stage surgical procedures after careful assessment of the indications are recommended.

In a preliminary analysis the level of plasma fibronective as well as the total protein and albumin were followed dup in cardiac patients. The dynamic changes of values of the parameters perioperatively and up to the 96-th postoperative hour were taken into consideration. The authors make the conclusion that the fibronectine reduction is not specific and reflects not so much the destruction of the heart muscle but the reparation processes following the surgical trauma.

In an effort to make initial clinical and functional assessment of the "dishabituation" from controlled ventilation by pressure-assisted ventilatory regiments, the authors studied 24 patients in whom valvular prosthesis operations had been performed and who required long-term artificial pulmonary ventilation. The dynamic changes and the parameters observed in one group of patients, designated as control, served as basis for the second, tested group. Half of the patients of the tested group passed through SIMV + Druckunterst and the other half--through Druckunterst-ventilatory regimens, which helped by pressure spontaneous breathing. Such clinical characteristics and functional parameters as: duration of "dishabituation" from assisted breathing, need of re-intubation, changes in oxygen consumption etc, caused by change in the ventilatory regiment, were evaluated and analyzed. The following conclusions were made: 1. Druckunterst has no advantages over SIMV + Druckunterst, as regards the duration of "dishabituation" from assisted breathing: 2. Both pressure-assisted regimens improved [correction of imfr ved] arterial oxygenation, which probably was due to increase in the alveolar volumes, which had been reduced during the bypass circulation period.