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Objective: to study of intramyocardial implantation of cultured bone marrow stem cells on myocardial perfusion and contractility in the surgical treatment of patients with coronary heart disease (CHD) and chronic heart failure (CHF), by synchronized single-photon emission computed tomography (SSPECT) of the myocardium., Subjects and Methods: The study included 11 patients. Intramyocardial injection of cell injections into the myocardial periscarring areas was made at coronary bypass surgery. All the patients underwent 99mTc myocardial SSPECT MIBI before and 3, 6, 12 months after surgery., Results and Conclusions: Implantation of bone marrow stem cells into the left ventricular myocardium favorably affects left ventricular remodeling and contributes to the improvement of myocardial perfusion and contractility, as evidenced by 99mTc.

The study was conducted in a group of 440 patients who underwent planned operations for ischemic heart disease. Three current methods of preventive antibiotic therapy were compared. The influence of various risk factors on the incidence of infectious complications was analysed. Experience with closed mediastinitis management was also analysed. The effect of a short-term (1-3 days) course of claforan in prevention of infectious complications is the same as that of a 5-7-day course of cefamezin or gentamicin. Postoperative mediastinitis developed in 11 (2.5%) patients. It was managed in all patients by closed irrigation and drainage of the retrosternal space. The average duration of mediastinal irrigation was 7.4 days. Convalescence was attained in all cases.

The bicycle ergometric testing was performed in different periods within the first year of direct myocardial revascularization by using microsurgical techniques. The parameters of physical fitness and myocardial blood flow were found to be substantially increased in the early periods of postoperation (10-18 days later), less increased at months 2-4, and then unchanged within the year. Thus, it is suggested that cardiovascular performance becomes stable 2-4 months after a successful operation. In this connection, the time the patients with coronary heart disease can resume work after the operation should be revised.

Whether transesophageal echocardiography may be used in the assessment of central hemodynamics has been studied in 40 patients undergoing direct cardiac revascularization in extracorporeal circulation. Changes in the mean values of end diastolic area (EDA) and end-diastolic anteroposterior dimensions, end-systolic myocardial stress (ESMS), anteroposterior size shortening fraction (SF), and area decrease fraction (ADF) of cross left ventricular section are outlined in the paper. It has been indicated that at the beginning of extracorporeal circulation EDA showed, on an average, a 22% decrease (p less than 0.001), after its termination, it practically returned to the baseline values. ESMS remained high at the beginning of the operation, but at the onset of extracorporeal circulation it also dropped by 26% (p less than 0.001), being rather low until the end of the operation. The highest SF and ADF values were observed after termination of extracorporeal circulation. The changes in the parameters in question were found in hypovolemia and decreased myocardial contractility. The application of transesophageal echocardiography along with direct blood pressure monitoring correctly and fully assesses central hemodynamics.

The authors conducted a comparative study of various methods of coronary shunting by means of microsurgical techniques in 240 patients who were operated on for ischemic heart disease. Total myocardial revascularization, including arteries measuring less than 1.5 mm in diameter and vessels in the zones of cardiosclerosis, was found to be more effective than the techniques of shunting of only the affected major branches. The advantages of a mammary-coronary shunt over anauto- logous venous shunt in reconstruction of coronary arteries under unfavourable hemodynamic conditions are demonstrated. It is also shown that multiple bi-mammary-coronary shunting of the branches of the left coronary artery is a promising method.

The study was designed to estimate the clinical status and exercise tolerance in 25 patients in the preoperative and early postoperative periods, as well as at weeks 6-8 of direct myocardial revascularization performed by applying microsurgical techniques. The clinical status improved in all the patients. Their exercise tolerance was increased by 67 and 106% 2-3 and 6-8 weeks after the surgery, respectively. Thus, with uncomplicated coronary artery reconstruction, the patients can perform graded physical exercise in the early postoperative period, which provides evidence for reduction of a patient's stay in hospital.