[Myocardial infarct in a 13-year-old].
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Biomedical subjects
Publications and source records attributed to A N Samko.
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Coronary flow reserve was assessed by means of the 133Xe clearance test making use of dipyridamole in the left coronary artery of 11 patients with angina of effort and coronary arterial stenoses involving also the basin of the left coronary artery (group 1), 6 patients with the anginal syndrome showing no angiographic evidence of coronary lesions (group 2A), and 6 patients with cardialgias and intact coronarograms (group 2B). Coronary reserve was shown to be decreased in groups 1 and 2A, as compared to the values shown by group 2B patients.
The dipyridamole test was performed during diagnostic coronaro-ventriculography in 7 patients showing no angiographic signs of coronary atherosclerosis (group 1) and 15 patients with a 75% stenosis in one or more coronary arteries (group 2). The test provoked an anginal attack in 11 (73%) second-group patients that was accompanied with the emergence or aggravation of asynergy in 10 (67%) or ischemic electrocardiographic changes in 7 (47%). In all cases, the anginal attack was associated with a rise in end diastolic pressure. All first-group patients showed no response to the dipyridamole test as evidenced clinically and electrocardiographically. No asynergic zones were identified on any of the ventriculograms recorded after dipyridamole administration.
A repeated retrospective analysis of histoultrastructure of endomyocardial biopsies of patients with diagnosis of myocarditis and with various life span after manifestation of the first disease symptoms. The most unfavorable sign of prognosis is advanced myocardiocyte necrosis, alterative changes and the degree of interstitial cell reaction. Death of cardiocytes due to apoptosis was not typical for myocarditis and was observed only in several patients from the group with long survival. A new type of cardiomyocyte death--extrusion of the nucleus from the cell--was found in the group with low survival.
Light optic and electron microscopic studies were made of endomyocardial biopsies from the right ventricle of 8 patients who had undergone orthotopic transplantation of the heart 7-14 years ago. For this period rejection reaction was not typical, more marked were changes related to transplantation coronary disease and microcirculatory disorders: hibernation of cardiomyocytes (CMC), their apoptosis, interstitial fibrosis, dystrophic alterations of CMC. The results show the CMC pool may be resupplied with pluripotent (stem) cells as well as hibernating CMC which take part in the myocardial activity after myocardial circulation recovery by means of angioplasty and plasmapheresis.
Altogether 30 patients with unstable angina (UA) were examined. In 15 patients omnipaque was used during coronography and ventriculography (VG), in the rest of 15 patients--verografin at common dosages. A study was made of the changes in the indices of central hemodynamics and myocardial contractility resulting from the action of these radiopaque media during VG, and of ECG changes during coronography. VG with verografin was accompanied by more noticeable disorders of left ventricular contractility, an increase in myocardial oxygen consumption; coronography with omnipaque was characterized by later ECG changes, less noticeable disorders of intraventricular conductivity. It is advisable that coronaroventriculography in patients with UA should be performed using a new group of radiopaque media, in particular omnipaque.
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A method for imaging the interventricular septum of the heart by digital subtraction ventriculography in the left oblique projection is proposed: 20 ml of contrast agent is injected in the right atrium, and the right ventricle is imaged, then the left ventricle is seen on the left phase. In order to discern the interventricular septum, the right ventricle image is taken as a "mask", then the left ventricle is fixed, and the interventricular septum is seen between two contrast cavities on the final image. The dual subtraction method by choosing the later "mask"-frame at the maximally contrast right ventricle for imaging the septum was used for the first time.
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