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The study was performed in 53 children aged 3 months to 4 years who had ventricular septal defect. Systolic pressure in the right ventricle, pulmonary artery and the severity of pulmonary hypertension were determined by two way: 1) from arteriovenous shunt via ventricular septal defect before its surgical closure; 2) from systolic regurgitation via the tricuspid valve after its seal. Right ventricular diastolic pressure was measured by Doppler echocardiography using diastolic blood flow through the tricuspid valve. Before ventricular septal defect closure, the correlation ratio of Doppler echocardiographic to cardiac catheterization values was 0.76 and that of Doppler echocardiographic to intrasurgical manometry was 0.79. In the postoperative period, a catheter was left in the right ventricle in 14 children and its pressure was simultaneously measured by the blind method. The correlation was 0.97 for right ventricular systolic pressure and 0.89 for diastolic one.

Surgical treatment of patients with post-infarction defect of the interventricular septum is highly effective. Despite the complexity and large volume of operation in this contingent of patients results of the operation are much better than in patients treated conservatively. At late periods after operation fairly high physical activity of patients is observed, which permits return to work to some of them, and to patients of pension age, enables them to do house chores, while the survived nonoperated patients are hardly capable of self-help.

In 120 patients with "functional" murmurs and congental cardiac defects with sinistodextral shunts at the aorto-pulmonary level and at that of the cardiac cavities the platinum-hydrogen test was employed in diagnostic probing. In all cases of the shunts this test revealed a distinct ejection of the body from the left to the right, whereas the oxygenonetry of the blood samples failed to indicate any increased oxygenation at a corresponding level, or else it proved questionable in 26 per cent of the interatrial septum defects, in 32 per cent of the interventrical septum defects and in 19 per cent of aorto-pulmonary communications. An analysis of the material showed the method to display a high degree of sensitivity. Its simplicity, reliability and safety for the patient justify recommending the platinum-hydrogen test for a wider application in the clinical practice.

The role of pulmonary metabolism of adrenaline, noradrenaline (NA), serotonin and histamine in the pathogenesis of hemodynamic disorders was examined in relation to the magnitude of intracardiac discharge (ID) in 30 patients with septal defects. Irrespective of the magnitude of arteriovenous ID, pulmonary tissue deactivation of NA is shown to be disrupted. Where ID averages 7.7 +/- 2.1 1/min, venous blood NA level is 59.8% higher (p less than 0.05) than that of patients with average ID of 3.1 +/- 0.7 1/min. A positive correlation (r = 0.51) is demonstrated between venous NA levels and ID in the latter group. The data obtained suggest that high ID values are associated with disturbed pulmonary metabolism and increased arterial levels of serotonin and NA, a significant contribution to the development of functional and morphologic vascular disorders of systemic and pulmonary circulation.

The authors carried out a comprehensive examination of patients operated on for the radical correction of a ventricular septum defect through the right atrium and with a temporary excision of the septal cusp of the tricuspid valev. The ECG, PCG, and roentgenogram were found to be altered at a long-term period. Examination of the tricuspid valve showed its good function at a long-term period. Practical recommendations on examining this group of patients are offered.

Comparison of the electrocardiographic characteristics of hypertrophy of the ventricular myocardium with the hemodynamic indices of systemic and pulmonary circulation and the indices of intracardiac hemodynamics provides testimony to the significance of the hemodynamic factor in the genesis of the electrophysiological changes. With due account for the role of the morphologic factor, these data allow the essence of myocardial hypertrophy to be placed in the electrophysiologic, hemodynamic, and morphologic category.

A retrospective study of postoperative electrocardiographic and pulmonary hemodynamic changes in 145 patients operated on for isolated interventricular heart defects demonstrated that the ECG-documented reverse development of the hypertrophic process in the right and left ventricles was not always in evidence. Positive ECG developments were mostly observed within the first 2 years. Residual signs of the hypertrophic process persisted at further follow-up. Pathologic changes in the right ventricle are more flexible and regress rapidly following the operation. Indications for surgery should be established at least from the time of the onset of the first electrocardiographic signs of developing cardiac compensation.

Short-term ischemia (up to 10 minutes) induced by clamping of the aorta in correction of a ventricular septal defect causes no essential ultrastructural, metabolic or functional changes in the myocardium. In much longer period of ischemia (of up to 40 minutes) during operation for congenital heart diseases, the use of deep hypothermia is effective. Cold cardioplegia is a sufficiently reliable method for myocardial protection when the aorta is clamped for up to 60 minutes in operations for acquired heart diseases. Changes in the structure and metabolism of the myocardium are reparable, their degree depends on the initial condition of the heart muscle and proper fulfilment of the methodical conditions of this type of protection. Pharmacological cardioplegia combined with external cooling of the heart makes it safe to disconnect the heart from circulation for a loger period (up to 120 minutes).

A total of 214 patients with a defect of the interventricular septum have been examined starting from the first days of their life and to the age of 7 years. In 50 of them the defect closed spontaneously (23.4 per cent). Twenty of these patients had a complicated course of the defect (circulatory insufficiency, colds and pneumonia). The spontaneous closure of the interventricular septum defect occurred most frequently at the age of from 1 to 4 years (86 per cent).

The authors studied the indications for surgical treatment of patients with congenital heart diseases and increased pulmonary blood flow, depending on the degree of pulmonary hypertension. Particular attention is focused on the indications for operation in ventricular septal defect. The work is based on the experience of the workers of the institute, embracing 3,521 operations performed on this category of patients among whom there were 863 children under 3 years of age. The indications for surgery are determined in conformity with clinico-hemodynamic groups according to a classification elaborated at the institute. The late results studied in 213 patients in follow-up periods of up to 12 years show that the main evidence of the efficacy of surgical treatment are the hemodynamic data, which determine the prognosis and the subsequent working capacity of the patients.

Results consequent upon investigations into variations of the water metabolism, central and intracardiac hemodynamics and myocardial contractility in 42 patients with congenital heart defects are reported. It is established that an increase in the content of total water in the body and of the intracellular liquid may be considered to be a significant sign pointing to circulatory insufficiency, even in the absence of any clinical manifestations of this condition.

The results of direct pressure measurement in pulmonary circulation in 452 patients with ventricular septal defect (216 males and 236 females), whose age ranged from 12 months to 37 years, were analysed. The findings of diagnostic catheterization of the heart in 150 practically healthy persons 12 months to 40 years of age were used to elaborate the normal values of pressure in pulmonary circulation. The results of pressure measurement in pulmonary circulation repeated at intervals of 1 to 6 years in 46 patients with ventricular septal defect, 18 months to 23 years of age, were analysed. Reverse evolution of pressure in pulmonary circulation after surgical rehabilitation was followed up in 85 patients in 1, 2, 3, 5, and 7 years after the operation. At the age of 12 months to 7 years, systolic pressure in the right ventricle and pulmonary artery comes down to a possible minimum due to expenditure of the adaptational reserve. In large ventricular septal defects, however, the organism proves incapable of reducing the pressure in the early and first periods of childhood as a rule, and so the pressure increases throughout life.