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In this article, the definition of a heart attack postinfarction aneurysm of the left ventricle of the heart is given, describe the geometric changes to the left ventricle, proceeding transmural myocardial transferred after a heart attack, they were described the adaptive machinery of the organism on the whole way the anesthesiologist in process of the anesthesia can encounter; and also indicate the presence of a possible sources of pathological threatening the life arrhythmias. At the end of the article is given the evolution of the procedures of correction of the heart attack postinfarction aneurism left ventricle of conducting revascularization myocardial or without it.

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BACKGROUND: Restoration of the spinal blood flow during operations on the thoracoabdominal portion of the aorta is one of the basic and decisive methods of protecting the spinal cord from ischaemia. OBJECTIVE: To decrease the incidence rate of spinal complications during interventions on the thoracic and thoracoabdbminal portions of the aorta at the expense of choosing an appropriate option of aortic reconstruction, determined by preoperative diagnosis of peculiarities of blood supply of the spinal cord. MATERIALS AND METHODS: From November 2005 to April 2007, a total of 34 patients were operated on at the Department of Arterial Pathology. To determine the spinal blood flow, all the patients were subjected to multispiral CT angiography. In 35% of patients underwent prosthetic repair of the thoracic and abdominal portions of the aorta with leaving a nondilated portion part from which originated the identified "critical" artery. In 45% of the reconstructions the verified "critical" artery was included into the distal oblique anastomosis. In 10% of cases, restoration of the blood flow of the spinal cord was performed at the expense of reimplantation of the segmental artery into the graft on the platform. In cases when the "critical" arteries were not involved into the pathological process, we performed isolated prosthetic repair of the aortic portion affected. RESULTS: The great anterior radiculo-medullary artery was visualized in 26 (76.5%) patients, and the anterior spinal artery--in 34 (100%) patients. The overall operative mortality rate amounted to 8.8%. Spinal complications were observed in 2.9% of cases (one patient was subjected to ligation of the 10th intercostal artery preoperatively defined as "critical"). CONCLUSION: Blood flow along the diagnosed "critical" segmental arteries should be restored in all operations on the thoracic and thoracoabdominal portions of the aorta.

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During initial anesthesia, central and peripheral hemodynamic parameters were studied in 32 patients operated on for coronary heart disease (CHD). The patients were divided into 3 groups: 1) those with < 35% ejection fraction (EF) with postinfarct left ventricular (LV) aneurysm (PLVA); 2) those with > 35% EF with PLVA; 3) those with > 35% EF without PLVA. All the examinees were assigned as having NYHA functional class III-IV. During the study, the authors examined central and peripheral hemodynamic parameters: ECG, invasive blood pressure (BP), pulmonary pressure, central venous pressure, and cardiac output. The findings were used to calculate cardiac index (CI) and its changes (CI). In addition, the indices of rate pressure product, a marker of myocardial contractility and the Buffington index (I baf) is a BPmean-heart rate ratio), a marker of possible myocardial ischemia, were calculated. To gain some insight into the role of ischemia in the reduction of SI in the examinees, the authors modified the index I baf: they used the index perfusion pressure in the coronary bed instead of BPmean in the formula.

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The results of this study are at variance with highly prevalent opinion that an increase in Vinsp leads to a parallel growth of Cst. A different degree of relationship between Vinsp and Cst was observed in the studied groups (from 0.33 to 0.92). These relationships in children with congenital heart disease are determined by the state of pulmonary circulation and lung parenchyma before surgery and after correction and depend on the form of the defect and patient's age. Such a variety of values is due to specificity of changes in the lungs depending on the pathomorphology of congenital heart disease and progress of these changes with age.

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Static compliance (Cst), time course and clinical and diagnostic significance of relationship between Cst and Vinsp were studied in 97 patients with congenital heart diseases aged over 3 years after open-heart surgery for correction of the defect during uneventful immediate postoperative period. Three groups of patients were distinguished: 1) patients operated on for Fallot's tetralogy without a previous aortopulmonary anastomosis (TF-1); 2) patients with Fallot's tetralogy with a previous systemic pulmonary anastomosis (TF-2); 3) patients operated on for atrioventricular septal defects and incomplete atrioventricular communication. Age subgroups of 3-5, 6-8, 9-11, and 12-15 years were singled out in each group. The proposed modified method for measuring Cst in children aged over 3 years operated on for congenital heart disease more accurately and reliably characterized the status of lung parenchyma. As a result, the correlation (r) between Cst and Vinsp in all nosological groups and age subgroups was much higher than was previously reported.

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Static compliance and inspiratory resistance were assessed in 218 patients aged over 3 years after open-heart surgery for correction of congenital heart disease during the immediate postoperative period without complications. Cst in the immediate postoperative period in patients with Fallot's tetralogy, intraventricular septum defect, intraatrial septum defect, and incomplete form of atrioventricular communication was higher than in patients operated on for Fallot's tetralogy with a previous systemic-pulmonary anastomosis and pulmonary artery atresia, whereas Rinsp was virtually the same in all groups. Age-specific differences were noted. The data are recommended for use as reference values in stress.

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Pressure-support ventilation (PSV) with supporting pressure (SP) levels 20, 15, 13, 10, and 8 mm H2O was used in 111 patients with congenital heart disease after open-heart surgery during transfer to spontaneous respiration. PSV was associated with a significant decrease of respiratory rate and increase of respiratory volume (RV) at high SP levels. Respiration in the PSV mode permits the patient to control the inspiration flow, duration of inspiration phase, and RV, thus improving the patient-device synchronization. Cardiac index (CI) was changing with decrease of SP from 20-15 to 13 mm H2O in patients with different diseases during high SP PSV. This is caused by changed pulmonary circulation (transfer to intraacinar type) which increased the negative correlation between CI and chosen SP. In addition, CI depends not only on RV, but on the status of lung parenchyma as well.

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Seventeen patients were examined, reoperated on for correction of Fallot's tetralogy on the open heart after a previous aortopulmonary anastomosis. Pressure support ventilation (PSV) was used in all patients during transfer to spontaneous pressure, making use of different levels of pressure support (20, 15, 13, 10, and 8 mm H2O). Decrease of pressure support from 20-15 mm H2O to 13 mm H2O resulted in a sharp increase of cardiac index. We explain this phenomenon by a drastic increase of the respiratory volume during the use of high PSV levels (20-15 mm H2O), surpassing 1.5-2 times the physiological and age-specific norm; this leads to a sharp increase of the mean intrathoracic pressure, disturbing the cardiovascular function.

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Considering beta-endorphin as a sign of tension and adaptation, the changes in its level have been studied during operations and surgery in patients with congenital heart valve defects subjected to cardiopulmonary bypass surgery. The goal of the study was determination of beta-endorphin concentration for the assessment of general anesthesia adequacy. A step-by-step study of beta-endorphin blood concentration, central and peripheral hemodynamics, diuresis, changes in temperature taken in 3 spots, adrenalin, dopamine and noradrenaline blood levels has been performed in 12 patients aged 4 to 17 years. A stable beta-endorphin blood content at all stages of anesthesia and surgery has been established. A correlation has been established between changes in adrenalin and dopamine blood levels, temperature gradient, diuresis intensity and mean BP, on the one hand, and changes in beta-endorphin blood level, on the other hand. Multifactor systemic analysis of the data obtained makes it possible to conclude that beta-endorphin blood level is informative when assessing the adequacy of general anesthesia.

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Three techniques of general intravenous anesthesia were compared, using mathematical parameters of the heart rhythm, hemodynamic and sympathoadrenal system responses, arterial blood Hb saturation with O2 (SaO2) and thermometry. It has been established that anesthesia with dipidolor ensures adequate protection against the operation stress both in patients with tetralogy of Fallot previously subject to interarterial anastomoses and patients with tetralogy of Fallot without anastomoses. Combined fentanyl and ketamine anesthesia ensures an adequate protection against the operation stress only in patients with tetralogy of Fallot without anastomoses. A more marked response of sympathetic autonomous nervous system and hemodynamics in patients with tetralogy of Fallot previously subject to anastomoses is, probably, mediated by a more intensive analgesic sequestration in the lungs in the presence of functioning anastomoses, which attenuates the analgetic effect. Anesthesia in patients with tetralogy of Fallot previously subject to interaortic anastomoses should be performed using higher doses of narcotic analgesics.

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The paper deals with causes of arterial hypertension in the early postperfusion and postoperative periods in treating congenital heart disease (CHD) under artificial circulation (AC). The hemodynamics and parameters of the renin-angiotensin-aldosterone system (RAAS) were examined clinically and biochemically in 100 patients. The findings showed that under hypothermic perfusion with nonpulsing blood flow, plasma renin activator and angiotensin converting enzyme became activated to affect the dynamics of mean arterial blood pressure. A method for RAAS blockage under AC has been developed, which includes administration of sodium thiopental and baralgin during AC. The method provides for reliable prevention of RAAS components activation and guarantees the normalization of the mean arterial pressure in the postperfusion and early postoperative periods.

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The relationship between the activities of the blood angiotensin-converting enzyme (ACE) and the site of the blood collection (radial artery, peripheral vein, left atrium) was examined in 15 patients with congenital heart diseases operated on with artificial circulation. No statistically significant differences in ACE activities in the blood from the vein, artery, or left atrium was detectable (p greater than 0.05). It is recommended that the blood for measuring ACE activity be collected from the peripheral vein.

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