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A variant of fibrin glue has been designed. This glue can be prepared on the basis of cryoprecipitation in departments of blood transfusion (fibrinogen concentration 60-90 g/l). The glue has been used in urgent abdominal and cardiac surgery in particular for facilitation of hemostasis after sternotomy and suturing of the aorta, pulmonary artery and atria.

Arterial switch is a relatively novel surgical approach aimed at augmentation of blood flow at the account of less important arterial branches. The method consists in suturing vessels of different diameter end to end and end to side. Arterial switch is used for perfusion of donor organs, kidney in particular. The authors suggested a variant of arterial switch--intrapericardial subclavian to pulmonary arterial anastomosis--in the presence of stenosis of right ventricular outflow tract in tetralogy of Fallot. This anastomosis has several advantages over classical methods of surgical correction of Fallot's tetralogy. Coronary artery bypass surgery using mammary artery grafts is based on arterial switch principle and represents the most effective technique of treatment of coronary artery stenoses. Multiple experimental and clinical methods of arterial switch having been proposed and investigated by the authors since 1955 have found wide application in reconstructive surgery.

Last years in the country gace rise to the problem of treatment of fire-arm's wounds in civil population. The results of treatment of victims with firearm thoracoabdominal wounds have evidenced unprepareness of surgeons for rendering specialized aid in conditions of "military-urban" surgery. The study performed by the authors has shown that there are substantial and principal differences between many postulates of war-field surgery and "military-urban" surgery. It consists in early hospitalization of victims with combined thoraco-abdominal injuries, prevalence of bullet wounds over fire-mine explosive injuries which have an effect on the extent of surgical intervention, results of treatment and development of complications. The proposed treatment modalities in victims with combined penetrated thoracoabdominal injuries in great measure may contribute to optimization of surgical aid in conditions of "military-urban" surgery.

The paper analyzes the data on the examination and surgical treatment of 426 (313 males and 113 females) patients aged from 16 to 60 years with various aortic valvular diseases. Isolated aortic stenosis was detected in 122 (28.6%) patients, isolated aortic failure in 128 (30.0%), and aortic valvular disease concurrent with other valvular diseases in 176 (41.4%) patients. Some problems in the diagnosis of latent myocardial insufficiency and in the compensation of intracardiac hemodynamics, as well as the association of aortic valvular disease, angina pectoris, and coronary heart disease are dealt with. A contribution of risk factors, such as valvular calcification, age, etiology, and their influence on the outcome of surgical treatment are discussed in the paper.

A comprehensive angiocardiographic study with computer-aided data processing were performed in 46 patients (mean age 34.2 years) with multivalvular diseases. Thirty two patients were diagnosed as having mitral and aortic defect, 14 had mitral, aortic and tricuspid defect. Three-valve disease, unlike two-valve disease, showed a "paradoxical" improvement in some parameters, such as end-diastolic volume, end-systolic volume, myocardial mass, ventricular performance rates. An analysis of circular intramyocardial tension, coronary sinus blood oxygen extraction and saturation indicated that myocardial function was less intensive in three-valve disease, suggesting the compensatory pattern of tricuspid valve involvement. However, this "compensation" results in a further decrease in cardiac output and cannot be regarded as a genuine compensation. In multivalvular disease, the integral intramyocardial tension and its ratio to coronary sinus blood oxygen saturation may serve as the only diagnostic criterion for myocardial dysfunction and a predictor in determining the outcome of surgical intervention.

The paper describes the procedure developed by the authors for surgical myocardial revascularization in patients with coronary heart disease (CHD) via direct reconstruction of the ostium and all the segments of the right coronary artery by performing direct endarterectomy and subsequent plasty with free autopericardial flaps. The findings indicate that this surgical method is beneficial for CHD patients. In some cases, it may be the method of choice in the surgical treatment of CHD patients.

Aorto-coronary bypass were performed in 10 patients aged from 34 to 55 years 7 to 30 days after the occurrence of angina pectoris for the first time. Coronarography demonstrated stenosis (of more than 75%) of the coronary arteries in all patients. Angina pectoris disappeared and did not recur in postoperative periods of up to 12 months in all cases. Shuntography was carried out 6 weeks after the operation in one patient: the shunt was potent.

The authors evaluate the efficacy of aortocoronary shunting in the treatment of 10 patients with progressive angina pectoris (unstable stenocardia) in follow-up periods of up to 12 months after the operation. In none of the patients did angina pectoris or myocardial infarction develop in the indicated postoperative periods.

Aortocoronary shunting was performed in 15 patients with unstable and early postinfarction angina pectoris. Coronarography revealed an isolated lesion of a coronary artery in all the patients. Two years after the operation the patients had no angina pectoris; no myocardial infarctions occurred.

Experience gained in the surgical management of 21 patients with atherosclerotic lesions of the aorta and arteries of the lower extremities treated by open endarterectomy extending for a distance of 20 to 70 cm is summarized. Only the outer coat of the artery and the external elastic membrane were preserved during open endarterectomy. A graft of autologous or allogenic vein was stitched into the incision made in the anterior wall of the aorta to repair it completely. In the distal portions open endarterectomy was supplemented by closed endarterectomy. In 2 patients with a follow-up period of 18 months thrombosis occurred at the site of the operation. In all the other patients patency of the reconstructed vessels was preserved. The author believes that the arterial bed should be expanded in such a way that no stenosed parts reducing the volume of the blood flow in the reconstructed artery should remain proximal to the zone of the reconstruction. The universal extraperitoneal approach to the aorta including thoractomy in the ninth intercostal space with the diaphragm cut off at the site of its attachment was used in 2 patients (with aneurysm of the abdominal aorta and Leriche's syndrome in conjunction with vasorenal hypertension). The conditions for and possibilities of applying allogenic veins in reconstructive operations on the arteries are discussed.

The condition of coronary arteries and left-ventricular function were assessed in 62 patients with a history of myocardial infarction 1 month to 4 years prior to coronarographic investigation. It was demonstrated that the detectability of an occlusion in the artery supplying blood to the infarcted area decreased with time elapsed since myocardial infarction, the correlation being more characteristic of the anterior interventricular branch of the left coronary artery. An analysis of ventriculograms showed that myocardial infarction due to a lesion of the left coronary artery results in a smaller left-ventricular dysfunction and is less commonly associated with circulatory insufficiency. The frequency of spontaneous thrombolysis is shown to be relatively high in postmyocardial-infarction patients.

Experience with echocardiographic diagnosis of a tricuspid defect, using one- and two-dimensional and Doppler echocardiography, is reviewed. Dopplerography is the most informative method for the detection of tricuspid incompetence that enables auscultatory determination and graphical recording of blood regurgitation from the right ventricle to the right atrium. A classification of tricuspid incompetence on the basis of its markedness as assessed by dopplerography is proposed. Dopplerography can also be used for tricuspid valve monitoring and the assessment of early and late results of tricuspid annuloplasty.

The authors analyze the experience of the treatment of eight patients with primary acute septic endocarditis (SE), 35 patients with rheumatic heart disease complicated by secondary subacute SE, 68 patients with early postsurgery SE including 25 who had had closed mitral comissurotomy, and 43 with prosthetic SE. Surgical treatment consisting in the removal of the infection source (the impaired valve or prosthesis) and the implantation of a new prosthesis should be carried out before the development of irreversible alterations of the internal organs.

Problems concerned with surgery of the heart conduction system are discussed. Two operations performed directly on the heart conduction system are analysed: operation for dividing the bundle of His or Keith's node with subsequent implantation of electrocardiostimulators in ventricular tachycardia unresponse to drugs and operation for dividing the walls of the right atrium and interatrial septum leading to the development of atrioventricular rhythm. The incisions mentioned were used in approach to the mitral and tricuspid valves for their prosthetics. The second part of interventions on the heart conduction system involves surgical techniques aimed at avoiding damage to the conduction system in manipulations mainly on the cardiac septum. The author believes that this branch of cardiac surgery is new and promising.

A new methodical variant of annuloplasty of the tricuspid ostium is described, consisting in placing two meeting semi-purse-string sutures on the external support teflon patches in the area of the antero-medial and postero-medial commissures. The method enables the authors to obtain good functioning of the tricuspid valve which is confirmed by 9 clinical observations lasting up to 3 1/2 years.

An experience of 31 cases of treatment of anterior purulent mediastinitis after operations on the heart enabled the author to conclude that the active surgical treatment by the proposed method (extensive repeated mediastinotomy with drainage and active aspirative washing) allows the primary focus of the infection to be revealed and the concomitant complications to be diagnosed. In their opinion, the active surgical tactics results in the successful treatment of most critical cardiosurgical patients with purulent pericarditis, pleurisies, sepsis and septic conditions when other methods of treatment practically fail to give good results.

Two patients who underwent 28 and 20 years ago operation for correction of coarctation of the aorta and its restoration by synthetic dacron prostheses were examined. They had characteristic complaints. Examination by functional and invasive methods revealed changes in the synthetic prostheses which caused the characteristic complaints and elements of the disease. The findings of autopsy were studied in a case of sudden death 25 years after repair of the aorta by a dacron prosthesis in coarctation. Morphological examination revealed essential changes in the synthetic dacron prosthesis which led to complications in the late postoperative period.

A study of early and late results of closed mitral commissurotomy demonstrated a 1.8-fold increase in two-dimensional mitral opening area, as compared to preoperative data, largely due to an increase in intercommissural diameter, with intercuspid diameter only slightly changed. In most cases, the operation was not conducive to complete recovery of the mitral opening area that averaged 3 cm2. Impulse doppler-echocardiography showed a 2.1-fold postoperative decrease in diastolic blood pressure gradient. The operation was less effective in cases of mitral calcinosis. One-dimensional investigation demonstrated an insignificant postoperative variation in Vef of the mitral anterior cusp.

The experience of 68 cases of prosthetic valve replacement for congenital heart diseases is presented. The majority of the cases were 57 patients with the Ebstein anomaly and tetralogy of Fallot. In the patients with the Ebstein anomaly the tricuspid valve was replaced, in those with the tetralogy of Fallot--a plastic enlargement of the pulmonary artery trunk and prosthetic replacement of the pulmonary valve with a ball valve or xeno-graft. Original techniques of radical correction of the Ebstein anomaly and tetralogy of Fallot are presented.

On the basis of experience in the use of adrenomimetics in the treatment of acute circulatory disorder in 112 patients who underwent operation on an open heart under extracorporeal circulation, the authors find that these agents are often the only effective measure in the control of low cardiac output that is not caused by hypovolemia. An increase in the cardiac output caused by adrenomimetic with a potent vasoconstrictive effect relieves the peripheral spasm because of the prevalence of their cardiostimulating effect. The doses of the adrenomimetics should be minimum at the beginning of treatment, and then should be doubled subsequently till the necessary effect is produced. It is advisable to combine them with agents which reduce myocardial excitability. Adrenomimetics should not be used as substitutes for measures which cause an effect on the ethiopathogenetic links of circulatory disorders: hypovolemia, hypoxemia, side-effects of anesthesiological agents, vagal hyper-reactions, disorders of the electrolyte balance, etc.