Search PubMed⌕ Search

Biomedical subjects

M D Kniazev

Publications and source records attributed to M D Kniazev.

At least 73 records · Page 4Linked to original sources
PubMed1978

[Clinical instrumental and clinical angiographic studies of patients with the anginose forms of ischemic heart disease].

The observations cover 96 male patients, aged from 30 to 61 suffering ischemic heart disease with clearly manifested stenocardia. The diagnosis in all patients was made on the base of a thorough clinical examination, the results from the electrocardiography and the selective coronarography. The data obtained from the clinical instrumental and clinical-angiographic examinations reveal that a correlation exists between the stage of the coronary arteries lesions, the patients's age, number of previous myocardial infarctions, severity of stenocardia and the state of the coronary reserve. The extent growth of the coronary arteries lesion goes in parallel with the patients' age advancement, the number of previous myocardial infarctions, severity of stenocardia and the diminution of coronary reserve. In this respect the character of stenocardia and the state of coronary reserve have the highest informative value. Our examinations failed to establish any correlation between the stage of the coronary arteries lesion and the stage and eytension of myocardial lesion on the electrocardiogram as well as between the stage of coronary arteries lesion and the duration of the illness.

Adult↗
PubMed1977

[Remote results of the aorto-coronary shunting in chronic forms of ischemic heart disease].

Remote results of the aorto-coronary shunting operation performed in 102 patients with ischemic heart disease are reported. Of this number 75 suffered from severe angina pectoris at rest, while the others had angina pectoris on effort of some or other degree of intensity. An excellent late result was achieved (over periods from 6 months to 5 years) in 33.3, good--in 49.5, satisfactory--in 10.1% of the cases, with the surgery being of no avail in 5.1 and aggravating the patients' condition in 2.0% of the instances. Excellent and good results were obtained in 83% of the cases, viz. disappearance of angina pectoris, improved ECG at rest and on effort. The excellent and good results did not depend on the initial coronary reserve, the degree of the coronaries lesion and on the adequacy of the operation, whereas all the other results (satisfactory, ineffective, deterioration) were seen, as a rule, with an inadequate aorto-coronary shunting in patients with extensive cicatricial changes of the myocardium. A direct relationship between remote results and the extent of the myocardial lesion was established.

Adult↗
PubMed1976

[Analysis of some parameters for determining myocardial contractility before and after aortocoronary shunting].

The condition of hemodynamics and the contractile function of the myocardium are considered before and after aorto-coronary shunting performed in patients with critically severe affection of the coronary arteries and the heart muscle. Of great prognostic importance is the final diastolic volume of the ventricles, its relation to the stroke ejection, as well as the ejection fraction. The greater the final diastolic volume of the ventricle and the smaller the stroke ejection, the higher is the risk of applying operative treatment to the patient.

Adult↗
PubMed1976

[Preinfarct stenocardia and acute myocardial infarct from the viewpoint of modern coronary surgery].

The results of aorto-coronary shunting in 36 patients with preinfarction angina and of urgent direct myocardial revascularization in 17 patients with acute myocardial infarction are presented. The surgical mortality comprised 28% in the group of patients with preinfarction angina. Twenty-two patients were followed-up for 8 months to 4 years. Good results were obtained in 9 patients, satisfactory--in 7, unsatisfactory--in 4. One patient died of cardiac insufficiency 1 1/2 year after surgery. The diagnosis of preinfarction angina is a direct indication for urgent coronary angiography and aorto-coronary shunting in case suitable coronary arteries are available for anastomosing. The indications for urgent revascularization of the myocardium in cases of infarction included the inefficacy of drug therapy within 2-3 hours of its onset, an unarrested pulmonary oedema and cardiogenic shock in cases of localized proximal occlusion of the coronaries revealed by elective or urgent coronary angiography. Four patients were operated on in the state of cardiogenic shock (one of them after reversing the state of clinical death), and two patients were operated on with pulmonary oedema. All these patients (with the exception of the one with pulmonary oedema) recovered. Four patients died. The follow-up covered a period of 9 months to 3 years. Good results were obtained in 4 patients, satisfactory--in 3, unsatisfactory--in 4. No late mortality cases were observed. The obtained results permit to analyse the preinfarction angina and acute myocardial infarction from the standpoint of modern coronary surgery.

Acute Disease↗
PubMed1976

[Blood flow in the transplant after aorto-coronary bypass].

With the help of an electromagnetic flowmeter the authors measured the blood flow in the graft during aorto-coronary bypass procedures. The flow was measured in 74 patients with 88 bypass grafts, along them--in 43 grafts to the right coronary artery, in 31 grafts to the anterior interventricular artery, and in 14 cases of double aoroto-coronary bypass grafts. In 21 cases the flow was measured in the coronary artery graft after endarterectomy. The analysis has demonstrated that the flow in the graft depends on many factors, the leading among which is the severity of the coronary lesion, the state of its distal portion and of the cardiac muscle in the zone of the diseased coronary artery. A direct relationship was established between the degree of the narrowing of the proximal coronaries and the flow values in the graft connected with the artery in question. The greater the stenosis in the proximal portion of the coronary artery, the higher the blood flow in the bypass. The highest blood flow was registered in cases of complete coronary occlusions. Blood flow measurements in the bypass grafts during surgery help to determine the amount of blld supplied to the revascularized myocardium and, hence, to assess the direct efficacy of the aorto-coronary bypass procedures in the management of the ischaemic heart disease.

Collateral Circulation↗
PubMed1976

[Reconstructive operations in surgical treatment of vasorenal hypertension].

The experience of 313 reconstructive operations performed in 289 patients with renovascular hypertension is analysed. The importance of choosing the surgical procedure with due regard of the etiology and extent of the pathological process is emphasized. The most effective and frequently employed reconstructive procedures consisted in the author's original technique of transaortic endarterectomy (232 operations), resection of the renal artery with reimplantation of the ostium into the aorta (19 operations), renal artery resection with an end-to-end anastomosis (23 operations). In cases of bilateral lesions of the renal arteries two-stage procedures are recommended, spaced 3-4 months apart. Reconstructive interventions on the single renal artery are described.

Adult↗
PubMed1975

[Intraoperative hemodynamics in patients with pre-infarct stenocardia and acute myocardial infarct].

Intraoperative haemodynamics was studied in 31 patients with pre-infarction angina pectoris and in 3 patients with acute myocardial infarction. Twelve of them (3 with myocardial infarction) were subjected to a graphic examination of 12 haemodynamic parameters. Aorto-coronary bypass procedures using autovenous grafts were demonstrated to improve the contractile function of the left-ventricular myocardium in this group of patients, as manifested in a decrease of the binite diastolic pressure, increase of the cardiac index and stroke volume in the aorta. Tracing the intraoperative haemodynamics helps in determining the immediate postoperative prognosis and in choosing the optimum regimens of drug therapy. The determination of the volume blood flow in the bypass with the help of a flowmeter is a compulsory procedure, since it permits an objective assessment of the adequacy of the conducted revascularization of the myocardium.

Adult↗
PubMed1975

[Emergency direct revascularization of the myocardium in acute infarct].

A new surgical conception of urgent direct revascularization of the myocardium in acute infarction is discussed and substantiated. Clinical observations and results of 13 urgent operations for aorto-coronary shunting in 10 patients with acute myocardial infarction are analysed (double aorto-coronary shunting was performed in 3 cases). Indications to urgent revascularization of the myocardium in infarction were as follows: no effect of drug therapy during 2--3 hours since its onset, a failure to eliminate pulmonary edema and cardiogenic shock in a localized proximal occlusion of the coronary artery, revealed during a planned or urgent coronarography. Three patients were operated upon in the state of cardiogenic shock (one after reanimation), two with pulmonary edema. All these patients (excluding one with pulmonary edema) have made a good recovery. Three patients died. Good immediate and late results obtained evidence the advantage of this policy. The problems of most optimum terms for urgent revascularization of the myocardium are discussed.

Acute Disease↗