[Causes and prevention of sudden arrest of circulation in surgical treatment of rheumatic mitral defect].

Analysis of case histories of patients operated on in 1965-1995 is presented. Ventricular fibrillation or asystole was observed in 3.34ë 1.1% of 480 patients subjected to closed mitral commissurotomy and in 6.25ë 1.1% of 98 ones subjected to cardiopulmonary bypass surgery for replacing mitral valves. The incidence of complications directly correlated with the stage of mitral valvular disease and reoperations and inversely with monitoring of hemodynamics, blood gases, etc. Examination of the myocardium before the development of ventricular fibrillation or asystole most often revealed 1) myocardial ischemia of different degree and localization; 2) changed stimulation and conduction of the myocardium; 3) total myocardial hypoxia; 4) electric current action in cases with diathermal coagulation of vessels and/or poor grounding of devices; 5) injection of potent drugs, etc. Electromechanical dissociation of ventricular myocardium was observed in 6 patients. Sudden heart arrest was not caused by blocking of the bloodflow in any of the cases. Thus, some signs can be regarded as predicting the risk of sudden arrest of circulation. Monitoring of the functions of the body helps timely detect these signs. If ventricular fibrillation developed, defibrillation was carried out immediately.