Biomedical subjects
Publications and source records attributed to V S Rabotnikov.
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Experience with the detection and surgical treatment of combined lesions of brachiocephalic arteries in coronary patients is reported. Noninvasive screening of 500 coronary patients detected brachiocephalic arterial lesions with transitory ischemic attacks or without cerebral ischemic symptoms in 82 patients. Simultaneous reconstructions are recommended for severe lesions of the main cerebral vessels and coronary arteries, and two-step operations, with cerebral flow recovery as the priority, for cases of mild clinical anginal manifestations. Forty-one operations were performed, 18 of them being simultaneous. One (2.4%) patient died. Cerebral and coronary symptoms were largely improved in discharged patients.
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Two hundred patients with unstable angina were examined. Of those, 100 were on medication only, while another 100 had undergone aortocoronary shunting. Five-year survival rate was higher, and the quality of life was better, in the surgical patients, as compared to conservative cases.
Survival rates were evaluated in 3 groups of patients: those with an isolated lesion of the anterior interventricular branch of the left coronary artery (group 1), multiple coronary arterial lesions (group 2) and a more than 50% narrowing of the left coronary-arterial trunk (group 3) following autovenous aortocoronary shunting of 1 to 5 coronary arteries. Drug-treated patients with similar coronary arterial lesions and clinical manifestations were taken as controls. Long-term survival rates of surgical patients were significantly higher, as compared to those of medication-treated patients in groups 2 and 3. There was no significant difference in survival rates of first-group patients. Long-term survival was dependent on the scope of revascularization and pretreatment myocardial contractility.
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The results of surgical treatment of post-infarction left ventricular aneurysms (PILVA) in 121 patients are analyzed. 64 patients underwent resection of the aneurysm, in 57 the resection was combined with aortocoronary shunt. Hospital mortality amounted to 11.6%. Analysis of mortality in relation to the initial values of the clinical, haemodynamic and contractility indicators has shown that the results of surgical treatment depend on the contractile function of the viable part of the left ventricle, on the blood flow in the left ventricular lateral wall and on the cardiac output. After surgery, signs of heart failure diminished or disappeared in 81% of the patients. The postoperative clinical course depended on the preoperative value of the ejection fraction of the contracting part of the left ventricle. Stenocardial pain disappeared or its frequency decreased in 91% of the patients. The patients' survival rate in the five-year postoperative period was 68%. The main factors of long-term prognosis were the degree of the coronary affection and the contraction capacity of the viable myocardium.
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The condition of the distal bed of the cardiac coronary arteries was studied in 150 patients with ischemic heart disease. It proved to be affected with stenotic atherosclerosis in 20,6% of cases. The distal bed in patients with the chronic stage of ischemic heart disease hardly differed from that in patients with acute myocardial infarction. Total revascularization may be accomplished in 33% of cases with affection of three vessels of the cardiac coronary bed with stenotic atherosclerosis and in 96,5% of cases with affection of one vessel.
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Cardiac conditions were examined in 48 patients with nonspecific aorto-arteritis. The authors assume that nonspecific aorto-arteritis may be accompanied by lesions, although usually moderate, of the valvular apparatus. Such defects, even moderate ones, are accessible to intravital diagnosis based on auscultation findings. Additional study is required for resolving whether such valvular defects are manifestations of the primary disease or sequelae of nonspecific aorto-arteritis combined with a rheumatic affliction. The most frequent form of cardiac lesion, however, is myocardial hypertrophy resulting from systemic hypertension. Signs of coronary insufficiency may signalize coronaritis and result from relative coronary insufficiency. Besides, there also occur symptoms of myocardial dystrophy, which in some patients may be caused by thyrotoxicosis, occasionally encountered in patients with nonspecific aorto-arteritis.
Over 400 operations of an indirect revascularization of the myocardium have been performed at the A.I. Bakulev institute of Cardiovascular Surgery of the USSR Academy of Medical Sciences. Since 1970, the direct method have been developed, predominantly those of aorto-coronary bypass. Careful examination of 709 patients was carried out, 445 of them were subjected to selective coronary angiography, 108 were operated on. In 1974, 56 operations were undertaken, among them 36 aorto-coronary bypasses, in 6 of them with a preliminary endarterectomy from the coronary artery, 8 double bypasses, 6 procedures for acute myocardial infarction, 5 combined operations of aorto-coronary bypass and resections of cardiac aneurysms, and 15 resections of postinfarction aneurysms of the heart. Twelve patients died in the postoperative period, mainly due to acute cardiac insufficiency. The high figures of mortality are caused not only by the faults of the surgical procedures but also by the grave initial state of the patients (multiple coronary lesions large focal cardiosclerosis due to preceeding infarctions, high degree of initial cardiac insufficiency). The improvement of the results of surgery for the ischaemic heart disease will depend on the perfection of the surgical technique, on proper selection of the patients, and on the precise determination of the indications for such treatment.