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al., 1989; E.Henry et al, 1989; J. Monterrosso et al., 1989; R.Kryne et al., 1989;
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// . - 1984. - 2. - . 8-12.
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14. . ., . ., . .
// . - 1980. - 2. - . 2334.
15. . . // .-
, . - 1995. - 1. - . 41-46.
16. . ., . ., ..
// . - 1980. - 3. - . 76-79.
17. . ., . 3., . . //
: . 5- .
. - ., 1987. - . 15-16.
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// .-, . - 1990. - 3. - . 8-14.
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// . - 1989. - 4. - . 5-13.
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:
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.-, . - 1998. - 6. - . 61-62.
22. . ., . ., 3. .
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. - 1997. - 2. - . 23-24.
23. ., .
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- 1 9 8 0 . - 2 . - . 45-51.
25. . . ., . ., . .

, // .
- 1987. - 2. - . 2 8 - 3 3 .
26. . ., . , . . .
.
// - , 5-:
. - ., 1984. - . 11-12.
27. Ahmed S. S., Haider ., Regan . J. Silent left coronary artery-cameral fistula: Probable
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28. Aikawa E., Kawano ., Ono T. Studies on the third coronary artery // Acta Anat. Nipp.
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30. Berry J. M., Einzig S., Krabill K. A., Bass J. H. Evaluation of coronary artery anatomy in
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artery anomalies in children // III World Congress of Pediatric Cardiology. - Abstracts.
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32. Bogers A. J. J. C, Anaegebeur J. M., Huysmans H. A. Early and late results of surgical treat
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33. Bogers A. J. J. C, Gittenberger-de Groot A. C, Dubbeldam J. A., Huysmans H. A. The inade
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nexions with arterial t r u n k s // I n t . J. Cardiol. - 1988. - Vol. 220. - P. 117-122.
34. Brooks . ., Bates P. D. Coronary artery-left ventricular fistula with angina pectoris //
Amer. Heart J. - 1983. - Vol. 106. - P. 404-406.
12

35. Bunton R., Jonas R. A Lang P. et al. Anomalous origin of left coronary artery from pul
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36. Chaitman B. R., Lesperance J., Saltiel J., Bourassa M. G. Clinical, angiographic and hemody
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37. Cheitlin M. D., DeCastro . ., McAllister H. A. Sudden death as a complication of anomalous
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the pulmonary t r u n k : Its clinical spectrum and current surgical management // Thorac.
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repair of tetralogy of Fallot: Successful aorta-coronary polytetrafluoroethylene graft // J.
Thorac. Cardiovasc. Surg. - 1987. - Vol. 93, 3. - P. 468-470.
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44. Edwards B. S., Edwards W. D., Edwards J. E. Aortic origin of conus coronary artery, evidence
of postnatal coronary development // Brit. Heart J. - 1981. - Vol. 45. - P. 555-558.
45. Farooki Z., Paridon S. M., Perry B. L. et al. Results of t r e a t m e n t long-term follow-up of ano
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46. Fellows K. E., Smith J., Keane J. F. Preoperative angiocardiography in Infants with tetralo
gy of Fallot. Review of 36 cases // Ibid. - 1981. - Vol. 47. - P. 1279-1285.
47. Gerlis L. M., Ho S. Y., Milo S. Three anomalies of the coronary artery co-existing with a case
of pulmonary atresia with intact ventricular septum // Int. J. Cardiol. - 1990. - Vol. 29.
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48. Gittenberger-de Groot A., Sauer H., Oppenheimer-Dekker A., Quaegebeur J. Coronary arterial
anatomy in transposition of the great arteries: A morphologic study // Ped. Cardiol. - 1983.
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49. Gittenberger-de Groot A. C, Sauer U., Quaegebeur J. Aortic i n t r a m u r a l coronary artery in
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50. Guihahue M., Sidi D., Kachaner J. et al. Anomalous left coronary artery arising from the pul
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51. Harthorne J. W., Scanell J. G., Dinsmore R. E. Anomalous origin of the left coronary artery:
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52. Henry E., Arancot A., Raffoue H., Doesburg H. N. et al. Two dimensional colour doppler flow
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53. Hurwitz R. A., Smith W., King H. et al. Tetralogy of Fallot with abnormal coronary artery:
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54. Keeton B. E., Keenan D. J., Monro J. L. Anomalous origin of both coronary arteries from the
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56. Kirklin J. W., Barratt-Boyes B. G. Cardiac surgery. - New York: Willey, 1986. - P. 945-970.
13

57. Kryne R., Deng M. C, Heinrick K. W. Anomalous origin of the left coronary artery from the
pulmonary t r u n k with multiple valvar incompetence // I n t . J. Cardiol. - 1989. - Vol. 24,
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58. La Porta A., Suy-Verburg R. et al. The spectrum of clinical manifestations of anomalous ori
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59. Laborde F., Marchand M., Leca F. et al. Surgical t r e a t m e n t of anomalous origin of the left
coronary artery in infancy and childhood. Early and late results in 20 consecutive cases // J.
Thorac. Cardiovasc. Surg. - 1981. - Vol. 82. - P. 4 2 3 - 4 2 8 .
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6 1 . Liberthson R. R., Gang D. L., Custer J. Sudden death in an infant with aberrant origin of the
right coronary artery from the left sinus of Valsalva of the aorta: Case report and review of
the literature // Pediat. Cardiol. - 1983. - Vol. 4. - P. 4 5 - 4 8 .
62. Miyzaki M., Kato M. Third Coronary artery: Its development and function // Acta Cardiol.
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63. Monterroso J., Merino Y. ., De Rubens J. et al. Anomalous left coronary artery from the pul
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Pediatric Cardiology. - Abstracts. - Bangkok, 1989. - P. 132, F. 547.
64. Nahazawa M., Oyama K., Imai Z. et al. Criteria for two-staged arterial switch operation for
simple transposition of great arteries // Circulation. - 1988. - Vol. 78, 1. - P. 1 2 4 - 1 3 1 .
65. Okura ., Sekiya M., Sumitomo T. et al. Anomalous origin of the left anterior descending
coronary artery with dilated cardiomyopathy // Cathet. Cardiovasc. Diagn. - 1990.
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66. Pacifico A. D., Sand M. E., Bargeron L. M., Colvin E. C. Transatrial-transpulmonary repair of
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67. Piovesana P., Corrado D., Verlato R. et al. Morbidity, associated with anomalous origin of the
left circumflex coronary artery from the right aortic sinus // Araer. J. Cardiol. - 1989.
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68. Planche C, Bruniaux J., Lacour-Gayet F. et al. Anatomical repair of transposition of the
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Pediatric Cardology. - Abstracts. - Bangkok, 1989. - P. 119.
69. Planche C, Chambran P., Bruniaux J. et al. Surgical closure of ventricular septal defect in
the first 6 months of life - 194 infants // Ibid. - P. 120.
70. Planche C, Lacour-Grayet F., Bruniaux J. et al. Complete transposition of the great arteries
(TGA) and ventricular septal defect (VSD) 91 patients // Ibid. - P. 120.
71. Quaegebeur J. M., Rohmer J., Ottenkamp J. et al. The arterial switch operation, a light year
experience // J. Thorac. Cardiovasc. Surg. - 1986. - Vol. 92. - P. 361-384.
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73. Sreeram N., Hunter S., Wren C. Acute myocardial infarction in infancy: Unmasking of ano
malous origin of the left coronary artery from the pulmonary artery by ligation of an arteri
al duct // Brit. Heart J. - 1989. - Vol. 6 1 , 3. - P. 307-308.
74. Tiraboschi R., Manasse E., BorghiA. et al. Anomalous origin of the left coronary artery from
the pulmonary artery. Experience with 13 cases // J. Cardiovasc. Surg. - 1988. - Vol. 29.
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75. Van Praagh R. Coronary artery anomalies: Anatomic considerations // Presented at the
Annual General Meeting, Association of European Pediatric Cardiology. - Rhodes, 1973.
76. Vouhe P. R., Baillot-Vernant F., Trinquet F. et al. Anomalous left coronary artery from the
pulmonary artery in infants // J. Thorac. Cardiovasc. Surg. - 1987. - Vol. 94. - P. 192-199.


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P. Angelini, 1989), ,
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.


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24

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, ,

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25

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.


.
. , .
,
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- ),
.
.

4.

, ,
(. . , 1968; . . , 1972; . . , 1975; . . ,
1978; . . , 1985; G. Martin, 1894; S. Levis, 1904; . Bennett, 1936; S. Rao,
1958; J. Wilson, 1961; S. Viragh and Challice, 1981; G. Hutchins et al., 1988;
P. Angelini, 1989) , , .
(. . , 1975; A. Hirakow, 1983) ,

. R. Licata (1955, 1956),
6-7- . , ,
-,
. ,
42-45- (J. Wilson, 1961), 37- (XVIII
Streeter; N. Sissman, 1970), 38-42- (. ., 1972), 39-
(D. Goor W. Lillehei, 1975). Z. Rychter . Ostadal (1971),
, , ,
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().

. ,
. G. Conte
A. Pellegrini (1984),
() . XIX
(
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),
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), .
,
, - 26

.
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J. Wilson, 1961; R. Hirakow, 1983; G. Conte and A. Pellegrini, 1983; A. Bogers et al., 1988;
G. Hutchins et al., 1988).
,

(F.Orts-Llorca et al., 1982; A. Bogers et al., 1988; G. Hutchins et al., 1988;
P.Angelini, 1989) ,
(A. Bogers, 1988; P.Angelini,
1989).
(A. Bogers, 1989) .
. ,
, -
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,
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. 4. . (1911) . Hackensellner
(1955).
- ; - ; - ; - .
.

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(1894),
(),
. , ,

, (). 27

( )
.
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A. Bogers . (1988), G. Hutchins . (1988),
,
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,
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( )
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- .
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,
(A. Bogers, 1989) (. 5).

(. Maron et al., 1974; . Meredith et al, 1979; S. Teal et al, 1986;
M. Lomonico et al, 1986; A. Bogers, 1989).
7


,
. R. Rowe L. James (1957),
. . Bull . (1982),
. . Lomonico . (1986)
G. Hutchins . (1988), -
(XVI-XIX no Streeter).

28


,

.
A. Gittenberger-de Groot .
(1983) ,



.

,

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5.
.

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1990; M.Bartelings et al., 1988; A. Bogers et al., 1988; A. Bogers, 1989).

,
.
.
(. ., 1981; .. ., 1982; . . ., 1987; . , 1990; . .
., 1990; R. Collett and J. Edwards, 1949; L. Van Mierop, 1963, 1978; R. Van Praagh and
S. Van Praagh, 1965; D. Gooret al., 1972; R.Anderson et al., 1974; G. Rosenquist et al, 1976;
L.Kutsche and L. Van Mierop, 1987) ,
: , .
-
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(T.Pexieder
et al., 1989).
. Laane (1978) . Bartelings . (1988),
29

,
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31

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1981). G. Hutchins . (1988) A. Bogers (1989) ,

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6.

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T.James, 1961; Z.Vlodaver et al., 1975; W.McAlpine, 1976; M.Trivellato et al. 1980;
H.Neufeld and A. Schneeweiss, 1983; P.Angelini, 1989; A.Bogers, 1989).
- ?
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(S. Van Praagh et al., 1982; P.Angelini, 1989;
A. Bogers, 1989), ,
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(A. Gittenberger-de Groot et al., 1987; Bartelings et al., 1988; A. Bogers, 1989).
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.


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33

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34

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36

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, 1970; .., 1972; . . . ., 1974; . X. , 1977),
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38

()
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KHirakow,
1983;A.Bogers,
1989).
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39

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40

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(. . 19) ,
(. . 18,) (. . , 1959; . Meng et al., 1965; W. McAlpine, 1975;
B.Edwards et al., 1981; A. Gittenberger-de Groot et al., 1983). 1- 20 , 2- - .
, - - .

(. . 18,).
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(J.Meyer et
al.,
1975;
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et
al.,
1980;
D.Velimirovich
,
et al.,
1989).

();
,
(. . ., 1994)
().
.
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( ) 42

. 19. .

(1), (2-4) (5). (1,2)
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12

(
) (. . ., 1976; . Mievis et al., 1979; R. Bestetti et al., 1985)
(D. Ferguson et al., 1985).

43

, ,
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al, 1975; L. Muldermans et al., 1985).

44


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. ., 1974; . . , 1987).
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.
,
(..
., 1985; . . ., 1986; . . ., 1986; . . .,
1991; . . ., 1997-2000; . Barratt-Boyes et al., 1984; D. Cosgrove et al, 1984;
J. Kirklin et al, 1985; G. Lawrie et al., 1987; R. Zeff et al., 1988; P. Davis et al., 1989).

.
(
, W.Roberts, 1976),
. 46

1 ,
50% (. . ., 1985; . .
., 1997; F. Loop, 1983). ,
, ,
(.., 1977; .., 1979; W.Roberts, 1976; F.Loop et al., 1983),
,
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(J. Kim et al., 1982; J. Rich et al.,
1988). (. . . . , 1978),

,
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()
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, .

1. . , . ., . ., . .
// .-, . - 1991. - 6. - . 3-6.
2. ., ., . .
(, , ) // . - 1981.
- 2. - . 34-47.
3. . . :
. ... . . - , 1972.
4. . .
// . - 1959, 2.
5. . ., . ., . . .
// . . . .
- 1 9 9 1 . - 3 . - . 26-35.
6. . ., . ., . . (
) // .-,
. - 1994. - 3. - . 4-12.
7. . ., . ., . . .
2 0 1 1 // .
- 1999.- 4 . - . 21-28.
8. . ., . ., . . 100
( -
) // . - 1998. - 6. - . 26-32.
9. . ., . ., . . :
// .-, . - 1999. - 6. - . 102112.
10. . ., . ., . .
// . - 1997. - 4. - . 31-45.
11. . ., . ., . . .
- .: , 1987. - . 78.
12. . ., . , . .
// . - 1985. - 5. - . 5-10.
13. . //
. - ., 1990. - . 7-31.
14. . . -
, (
): . . ... - . - , 1978.
47

15. . . -
. - : , 1980.
16. . .
// . - . . -
-, 1973. - . 1. - . 201-204.
17. - .
// . - ., 1990.
- . 89-92.
18. .., . . . - .: , 1967.
19. . ., . ., 3. .
. - : , 1982.
20. . . ,
// . . . : . . 1.
- , 1972. - . 56-57.
2 1 . . . : . ...
- . . - ., 1979.
22. . ., . .
// . . - 1966. - 4. - . 59-65.
23. . ., .., . ., . . //
. - 1986. - 5. - . 20-25.
24. . ., . . . - .: ,
1 9 7 4 . - . 33-37.
25. . . . - .: , 1977. - . 28-32.
26. . . . - , 1969.
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//
. - , 1979. - . 56-64.
28. . . - : -
, 1973.
29. . . . - .: , 1987. - . 190.
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. // .-
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3 1 . . . . - : , 1975.
32. . ., . ., . . .
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33. . .
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34. . , . ., . . .: ,
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35. . X. . - .: , 1977.
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37. . , . ., . , . .
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, //
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39. . ., . ., . ., . .
//
. - ., 1990. - . 146-151.
40. . . - . - :
, 1980.
4 1 . . . -
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1. . 3., . ., . . .

// . . - 1988. - 6. - . 3 5 - 4 1 .
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6. .. . - .: , 1989.
7. . //
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1990.-. 7-31.
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// . -
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13. . . // . . - 1958. - . 20, 5. - . 3 - 1 1 .
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, 1 9 7 4 . - . 3 3 - 3 7 .
18. . . // . - .:
, 1 9 8 7 . - . 183-218.
19. . . . - . : , 1977. - . 26-32.
20. . . . . .
// . - 1981. - 3.
- . 8 0 - 8 7 .
21. . .
// . . - 1939. - . 17, 4. - . 3-16.
22. . . // . . . . - 1927.
- 9. - . 26.
23. . . - : -
, 1973. - . 2 9 - 3 3 .
24. . ., . . .
- .: , 1976.
25. . . . - .: , 1987. - . 184.
26. . . . - . 190.
27. . . -
// . - 1965.
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28. . [. . . . . (1974)].
133

29. . . . - .: , 1951.
30. . ., . ., . .
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3 1 . . , . 3., . .
// .-.
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32. . , . . . - .: , 1974. - . 112-125.
33. . . :
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34. . .,. . . // :
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35. . X., . ., . .
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36. . X., . ., . . // . - 1974. - 2. - . 5-10.
37. . , . .
// . - 1978. - 12. - . 4 1 - 4 4 .
38. . ., . ., - . .
// . . - 1979.
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39. . , . , . . .
. - .: , 1975.
40. . . . - .: , 1970.
4 1 . . .
: . ... - . - ., 1982.
42. . ., . .
. - . , 1963.
43. . .
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44. . . // :
6 . - . : , 1980. - . 207-208.
45. . ., . ., . ., . .
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46. . .
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47. . ., . . [. . . . . (1974)].
48. . ., . ., . . .

// . - 1976. - 4. - . 2 0 - 2 4 .
49. . ., . . //
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etal., 1981; E.Aikawa et al., 1982; M. Miyzaki and M. Kato, 1988).
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, .91.
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1990).

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.
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146

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al., 1982; 1.1. Berishuili and M. Vakhromeeva, 1996). ,
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147

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1978; . Neufeld and A. Schneeweiss, 1983)
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1987; . Ishimori et al., 1987; A. Ferugi et al., 1978; J. Kramer et al., 1982; P.Angelini et al,
1983; D. Visscher et al., 1983; W. Voelker et al., 1989), .
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Siew Yen Ho et al., 1985).
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1980; D. Kimbiris ,1985). W. McAlpine (1975) ,
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1985), (
100 ). (/), G. Allen
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J. Ogden (1970), 1,4%
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1950; C.Ramirez, 1960; C.Longenecker et al, 1961; .., 1961; W.Laurie and
J. Woods, 1964; J. Ogden and A. Goodyear, 1970; B. Chaitman et ah, 1976; Siew Yen Ho et al,
1985),
, .
,
(. . . . , 1974 -
. McAlister ., 1975 - )
(A. Gittenberger-de Groot et al., 1985).
1971 . 86
. 1989 . 21
(L. Hillestad and H. Eie, 1971; . Cheitlin et al, 1974; W. Roberts et al, 1982; D. Barboeur
and W. Roberts, 1985; L. Blieden et al., 1989). ,
1- 2 0 , , ,
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, , (. . ,
1961; D. Kimbiris, 1965; Siew Yen et al., 1985), . Greenspan (1979)

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- . .
- .

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150

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10
,
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.
and D.Wixson, 1977; D.Murphy et al., 1978;
1 2 - 1- 2- .
H.Neufeld and A. Schneeweiss, 1983).
1- ,
, . Jokl (1962). . Chaitman .
(1976) 4 7 ,
1- ; D. Kimbiris (1985) 3 4
, 1- . 1986 . . Barth
W. Roberts
1- , .
1979 . R. Liberthson . 18
( ) .

,
, . , D. Kimbiris (1985), D. Barboeur
W. Roberts (1985) , 65- , , ,
D. Murphy . (1978)
12- , ,
, 1- .

(. Chaitman et al., 1976; D. Spring
and J. Thomsen, 1979), ,
(A. Becker, 1981).
, ,
,
2- (. . 95),
(W.Roberts et al., 1982; S.Husaini et al., 1983; C.Muus and B.McManus, 1984;
D.Barbouer and W.Roberts ,1985). 1989 . L. Blieden .
. 1-
, 2-
(W.Bange et al., 1980; R.Berdoff et al., 1986; W.Roberts,
1986) (. Muus and . McManus, 1984; . Yagita et al., 1986).
,
- 1% . ,
151

.
, , . . . . (1974),

. ,
.
67
. ,
0,1-4,4% . ,
3,2% (2 63 ).
.
7 , 1 % (3 42 ),
3 9 % .
(Z.Vlodaver et al., 1975;
. Neufeld and A. Schneeweiss, 1983; . Planche et al., 1988; F. Iddriss et al., 1988)
(Z. Vlodaver et al., 1975; D. Velimirovlch et al., 1989).
2 1 % (14 67 ),
100% .
16,7% (2 12 ),
D. Velimirovic . (1989) 30% (3 10 ).
.
. Z. Vlodaver .
(1975) Siew Yen . (1988) .

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A. Gittenberger-de Groot et al., 1983), , ,
( ).
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, W. Causing . (1967) 83- ,
.
.

(P. Michaud et al., 1963; G. Hallman et al., 1965).
R. Murray (1963) (
). J. Ruddock (1943), G. Anselmi . (1961) . . . . (1979)
, .

G. Hallman . (1965).

(W.Roberts and Morrow, 1969; D.Kimbiris, 1985).

(. Yacoub and R. Radley-Smith, 1978; G. Piccoli et al., 1983;
D. Gooret al., 1982; A. Gittenberger-de Groot et al., 1983) ,
(. . . . , 1979).
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3.
1- (A. Dollar and W. Roberts, 1989;
Th. Lesser and A. Schneiner, 1990).
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5.
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,
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, ,

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1989; C.Ilsley et al., 1982).
, .

, .

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).

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: . ... - . - ., 1989.
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3. . . : . . ... . . - , 1972.
4. . ., . .
// 2- . .-, . - 1993. - . 24-26.
5. . ., . ., . .
// . - 1986. - . 5. - . 5-15.

159

6. . . // .-. . - 1995. - 1. - . 41-46.


7. . . : . ... . . - .,
1949.
8. . ., . ., . .
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9. . .
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10. . . : ....
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11. . . : . . - , 1955.
12. . ., . . . - .:
, 1 9 7 4 . - . 33-37.
13. . . . - . : , 1977. - . 26-32.
14. . . . - .: , 1987. - . 190.
15. . , . . . - .: , 1974. - . 112-125.
16. . ., . 3., . ., . .

// . - 1989. - 4. - . 5-13.
17. . . //
. - , 1968. - . 156-158.
18. . ., . .
. - . , 1963.
19. . .
// . . . -. . 1.
- , 1964. - . 129-142.
20. ..
. - , 1900.
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// . ., ., . - 1961. - . 40, 2. - . 8 2 - 8 3 .
22. . ., . .
// . - 1979. - 9. - . 115-116.
23. . . // . . - 1953. - . 73. - . 3.
24. . ., . ., . . .
,
// . - 1964. - 5. - . 111-112.
25. . . : . - , 1962.
26. Adachi . Das arterien-system der J a p a n e r BD. 1. Verlag der Kaiserlich-Japanischen
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150. Wilkins C. E Betancourt ., Mathur V. S. et al. Coronary artery anomalies, a review of more
than 10.000 patients from t h e Clayton Cardiovascular Laboratories // Tex. Heart Inst. J.
- 1988. - Vol. 15. - P. 1 6 6 - 1 7 3 .
151. Yacoub M. H., Radley-Smith R. Anatomy of the coronary arteries in transposition of the great
arteries and methods for their transfer in anatomical correction // Thorax. - 1978. - Vol. 33,
4 . - P . 418-424.
152. Yagita M., Senda Y., Nakashima Y. et al. A case of anomalous origin of the right coronary
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- P . 571.


SURGERYLiB.RU



1.





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D. Sabiston et al.
A. Gonzalez-Angullo et al.
S. Rao et al.
M. Thibert et al.
J. Askenazi and A. Nadas
R. Hawker and J. Bowdler
W. Pinsky et al.
W. Wilcox et al.
U. Squarcia et al.
S. Menahem and A. Venables

G. Rowe and W. Young

. . . .

R. Feldt et al.
A. Gonzalez-Angullo et al.
M. Monselise et al.
E. Sennari et al.
U. Kory et al.
...

1960
1966
1970
1973
1975
1976
1978
1979
1981
1987

1
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1960

1980

1965

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. . ., 1980; . . . . , 1982; G. Hallman et
al., 1966; .Berry and D.McGoon, 1973; J.Meyer et al., 1975; R.Dabizzi et al, 1980;
T. Bianchi et al., 1984; C.Dietl et al., 1989).
(R. Hurwitz et al., 1980; Geggel et
al., 1982; D. DiCarlo et al., 1987; M. De La Cruz et al., 1989; S. Jureidin et al, 1989). Bee
:
8-38,.
(.. , 1977; . . ., 1989; J.Kirklin et al, 1959; . Berry and
D. McGoon, 1973; R. Hurwitz et al., 1980; Dietl et al., 1989).
, ,

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1979 1989 . 0 11 .
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1983). , S. Van Praagh . (1982)
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. Fellows et al., 1975),
3%. ,
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20% (. . 108).

(D. Bianchi, 1928; . Schlesinger, 1949; G. Baroldi and G. Scomazzoni, 1967; W. McAlpine,
1975; B. Edwards et al., 1981; M. Miyzaki and M. Kato, 1988). 2 177

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8 5 % , (..,
1967; C.Meng et al., 1965; R.White et al, 1972; R.Dabizzi et al, 1980; H.Neufeld and
A. Schneeweiss, 1983). . . . (1989)
9 5 % ( 39 41). ,
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178

9
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(1980) S. Jureidini . (1989).
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181

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2% (. . 10). . 12,
(. Lev and F. Eckner, 1964; . Meng et al., 1965;
. . , . . , 1979; . . ., 1989).

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)
(. . ., 1980), .

12

(
, - )

. Longenecker et al.
. Meng et al.
. .
. Fellows et al.
R. Dabizzi et al.
R. Hurwitz et al.
. .
.
. Gordon et al.
. . .
. .
( 1989 .)
...

1961
1965
1967
1975
1980
1980
1979
1980
1986
1989

1
1
1
1
1
1
1
1
1

12

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.

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.
(R. Dabizzi et al., 1980; R. Hurwitz et al., 1980),
, ,
(P.Angelini, 1989). , -
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183

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98-120.
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)
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.

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-
184

13

( )


III

II

IV

W. Evans

1933

G. Hallman et al.

1966

G. Nagao et al.
F. Robicsek et al.

1967
1967

K. Fellows et al.

1975

1980

1989

. .
.
. .
.
. .
. (
1989 .)

1
3

1/43
1

2,3

3/195

1,5

2/11

5/41

-
R. White et al.
. Berry and
D. McGoon

1972
1973

..
..

1974

. Fellows et al.
J. Meyer et al.

1975
1975

1
1

J. Brenner et al.

1977

R. Dabizzi et al.
L. Parenzan et al.

1980
1981

T. Gordon et al.

1986

J. Berry et al.

1988

. .
1972
.

3/1400
2

1/84
1/926

0,1

1
2

2/119
4/148

1
2

1
2/29

2,7
6,9

. Arciniegas et
al.

1980

1/209

0,5

G. Calza et al.
S. Jureidini et al.

1989
1989

1
2

1
2/45

4,4

...

31

43

. , -
. I-V . 115.
, 5 6 .
-
, - . , , 185

14

( )

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. . 115.
- ,
5
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, .
, ,
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, , ,
,
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5 ( ) , 6.
, ,
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.
. 1 3 ,
,
( 3 5 4 3 , 8 1 % )
, . . 14,
.
186

, W. Evans (1933) F. Robicsek . (1967),


. , -,
,
(P.Angelini, 1989).
, ,
,
,
. ,
,
. , ,
. -
, .
, .
.
.
, ,
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- (. 116).

. 116. - . () (), (.
. ) .
() .
. () () -
, 2- (). ,
() , (), .
. . , , .
2- .
. . , 1- ().
- .



: 1) 2) () ,
(. . .., 1982; . . ., 1986; . , 1965; .Berry
and D.McGoon, 1973).
, , -
187

(. . ., 1986; R. Hurwitz et al., 1980;


C.Dietl et al., 1989; A.Pacifico, 1989). (L.Edmunds et al., 1976;
C. Dietl et al., 1989) ,

(K.Kawashima et al., 1981; A. Pacifico et al., 1987; L. McGrath and L. Gonzalez-Lavin,
1987; C. Dietl et al., 1989). , ,

. , ,
(
- )
. , ,

(. . ., 1982,1983). ,

. ,
, .


, , .
, (. . ., 1986; . .
., 1989; E.Arciniegas et al., 1980; A. Pacifico et al., 1989), ,

(
).
.
, , ,
, : .

()
- (J. Kirklin et al., 1981; R. Anderson et al., 1981).
,
5- , , -
(J. Kirklin et al., 1981; S. Pahl et al., 1989).

,
0,2-0,4% (. Daniel et al., 1970; F. Fesani et al., 1977). ,
9% ,
2% , (. Krongard
et al., 1972; J. Meyer et al., 1975).
(Th. Hoffman and F. Cross, 1972; A. Pickoff et al., 1982)
(S.Phillips et al., 1973; J.Meyer et al., 1975; D.Arani et al., 1978;
D. Sabiston and J. Lowe, 1984). 3 6 - 4 2 %
(A. Galbraith et al., 1981; J. Kronzon et al., 1982; B.A. ., 1983),
3% (. .
. . , 1979; .. ., 1989; G.Hallman et al., 1966;
V. Bukharin et al., 1984).
( 3 9 - 4 1 % ) (.. .., 1989; F.Heidenreich et al., 1969;
Th.Hoffman and F.Cross, 1972; J.Mejer et al., 1975)
( 2 6 - 3 3 % ) (. . ., 1989; J. Ogden and H. Stansel, 1974; SaMontella et
al., 1974; V. Bukharin et al., 1984), - (.
. ., 1982; L. Humblet et al., 1969) -
(A. Galbraith et al., 1981). ,
( 5 - 6 % ) ( 2 - 3 % ) 188

1 5
( )

(.. ., 1983; S. King et al., 1975; A. Midell et al., 1977; D.Arani et


al., 1978; Liberthson et al, 1979).
. 15, , ,
. 10 ,
( 32 3% ).
70%
, ( 9 0 % )
( ).
-

, .
.
,
(coronary steal)
,
(V. Bukharin et al., 1984; D.Sabiston and J.Lowe, 1984;
. . ., 1988).
, -
, , - , 189

(.. ., 1989; J.Dark and J. Pollock, 1985).


, ,
. ,
2 1 ,
.

. -
- .
. ,
-
(.. ., 1983; .. .,
1988; S.Munsi et al, 1979).
(.. ., 1988; ..
. ., 1989).

.
- - (.. .., 1989; A.Pickoff et al, 1982; J.Kronzon et al,
1982).



,
(. . . . , 1979; . .
., 1989; J.Askenazi and A.Nadas, 1975; . Vouhe et al., 1987).
, , ,
, ,
, -
(. . . . , 1979; . . ., 1980; D. Levin et
al, 1978; G. Mint2 et al., 1983; J. Bagger et al., 1985; S. Menahem et al., 1987).


.
, ,
.
,
(. . . . , 1980;
. . ., 1981,1987; . . . . , 1982; R. Feldt et al,
1965; . Rao et al, 1970; W. Pinsky et al, 1978; W. Wilcox et al, 1979; E. Sennari et al,
1982; M. Menahem et al, 1987).
: () , . ,
,
: , ,
,
, ,
.
.


21
-
.

190

(J. Williams et al.,


1951; J.McArthur et al., 1971; E.Krongrad et al., 1972; E.Arciniegas et al., 1980;
0. Hansen et al., 1988).
J. Williams . (1951).
.
,
.

. 17 ,
, . 16.

16

,
.
,
.

.

.
.
,
.
191

.
(. . . ., 1988; J. Choh et al., 1980; . Gutgesell et
al., 1980; E. Henry et al., 1989; J. Monterroso et al., 1989).
,
(P.Lurie et al., 1977; W.Pinsky et at, 1978; W.Wilcox et al,
1979; S. Menahem et al, 1987).
, ,
. ,
,
.

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-,
. ,
,

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,

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192

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Jatene (1976) (. 117),
, (J. Stark, 1984; G. Wernovsky et al., 1988).

. 117. ()
Jatene () ( . Bove ., 1988).
1 - () () .
.
2 - (Y. Lecompte et al. // J. Thorac. Surg. - 1981.
- Vol. 82. - P. 629631) ( - ).
3 - () ()
, .
4 - .
5 - () .
6 - ( ).

J a t e n e (1976),
,
.
:
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.
193

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43
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, - . - .
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103 234, ,
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5-11 .
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5-11
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,
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. 118.

(U. Rowlatt et al, 1963; L. Elliott et
al., 1966; U.Hvass, 1977; M.Yacoub
and R. Radley-Smith, 1978; R. Shaker
and G. Puddu, 1979; A. Gittenberger-de
Groot et al., 1983; O. Bical et al., 1984;
J.Quaegebeur, 1986; E.Bove et al.,
1988; D. Sidi et al., 1987; W. Brawn et
. 118.
al., 1988; W.Norwood et al., 1988;
-
C.Planche et al., 1988),
().

-

8
69%
, -
(. 119, 120).
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, - (),
1- (1) 2- (2)
7 - 19% (. 121).
, - ().
8 8 %
-

. - .
, . 2 1 .
.
194

12%,
. -
6-11 7 5 % ,
8-10,
, :
8 - 6 0 , 7 % , 9 - 2 1 , 2 % ,
1 0 - 1 8 , 1 % .

-
2, 4 5,
. ,

(R. Van Praagh et al,
1971; J. Wilkinson et al., 1975)

. 119.

.
()
( - 1, - 5)
(P. Brandt et al., 1976; . Coto et

al, 1979; R.Rivera et al, 1980; D. Murphy et al,
() . 8- (
1981; M.Subirana et al, 1984),
)
.
,
2-4.

,

. 120. .
8 .
- . , 2- (), ,
() , .
, 1- , ()
() .
- . () .
- , - , -
, - .

195

,

.
, ,
.

, 80-90.
, -,

2-4 ,
A. Gittenberger-de
Groot . (1983),

, ,
2-4.

,
( 9 3 , 1 % ) 6-10.
. 121.
7
.
.


. 7- .
,
(. . 119)


( )
() ().

.
(5) (2) ,

(3).
.
.
(U.Hvass, 1977; R. Shatter and
G.Puddu, 1979; A. Gittenberger-de Groot et al., 1983; J.Quaegebeur et al., 1986;
W. Norwood et al., 1988; O. Planche et al., 1988),
3 9% . 41 D-
(7,3%).
69 , 4,4%,
39 6 ( 1- )
28 - 7 ( 2- ).
, 5, .

. 5 6
7. D-
6 7 , , 5. ,
, . ,
- , ,
4 ( 1 % 4% ). , ,
, - , , , - .
A. Gittenberger-de Groot . (1983),
: 1) 1- ( 6
) 2) 2- (
6 ). ,
( 6) . ,
. 1, (
6 2,5% , 6 - 0,8% ).
196

A. Gittenberger-de Groot . (1983)


, .
,
, , ,
, (6 ) 1-
,
(R. Shaher and G. Puddu , 1979; W. Norwood et al., 1988).
He ,
, 5 - 7 ,
(A. Gittenberger-de Groot et al., 1983; A. Castaneda, 1986; D. Sidi et al., 1987),
(, ,
Jatene) .
(. Planche et al., 1988).
- ,
(25%)
.
41 D-TAJIA 4 (9,7%)
. 7 .
( 8) 1-
( 10) - ,
2- .
7,3% .
(. Planche et al., 1988)
, 5 ~ 7
.

(D. Goor et al., 1982). ,
, ,
, 1- ,
A. Castaneda (1986) .
, 7,4%. ,
5 , 1 % .
: -
7 - 2-
- 8 - 1-
.
,
.
.
(L-TAJIA - 11) 1-
. ()
8 .
, , ,

. ,
,
. ( 8)
,
.
.

(U.Rowlatt et al, 1962; L.Elliott et al., 1966; U.Hvass, 1977; M.Yacoub and
R Radley-Smith, 1978; R. Shaher and G. Puddu, 1979; A. Gittenberger-de Groot et al.,
1983; . . , 1990). , 197

, , ,
.
,
.
, -,
A. Gittenberger-de Groot . (1983).
(R.Anderson and
A. Becker, 1981; A. Gittenberger-de Groot et al., 1983).

. , ,
( ),
.
. -,
, , -,
, . -,
, ,
. -, ,
,
- .
- .
, ,
() ( A. Gittenberger-de Groot et al., 1983),
, .

.
,
, , .
,

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.
:
- - ( - 2,
4, 5) ;
- (7-11) - (
) () ,

(. Neufeld and A. Schneeweiss, 1983).
: (2, 4 5
) -
8-11 ( - 9) .

.
5 ~7 ,
().
-, , , .
( )
( 5 ) ( 6 7 ).
,
198

() 1- ( ),
1- (, , ).
, ,
, (
7 , 19% , - )
( 20,6% ). ,
, L. Elliott .
(1966), R. Shaher G. Puddu (1979), A. Gittenberger-de Groot . (1983) .,
,
: ,
.
,
2- (A. Gittenberger-de Groot et al., 1983)
, (R. Shaher and G. Puddu,
1979). ,
A. Gittenberger-de Groot . (1983), ,
( ) .
.
( , )
, , ,
.

1. .
. R. Shaher G. Puddu (1979), . Planche . (1988)
2,0% ( 3 147) 2,5% ( 3 120) . ,
- .
( ) V. Barresi A. Susmano
1973 . , , . Mievis . (1979),

.
R. Bestetti . (1985),
(6 ) . ,
( R. Shaher G. Puddu, 1979 G. Planche ., 1988),
. .
2. 2-
.
1550 ,
, 12 (0,8%) .
(K.Anderson et al., 1978, - 1 ; J.Quaegebeur et al., 1986, - 1 ;
W.Brawn ., 1988, - 2 ; W.Norwood et al., 1988, - 1 ),
- () (L. Elliott et al., 1966, - 2 ; R. Shaher
G.Puddu, 1979, - 4 ; W.Norwood et al., 1988, - 1 ).
.
. Nakazawa . (1988) 2-
(. 122) .
, .
( 7 ). J a t e n e
, , -,
. ,
.

.
199

. 122.
( . Nakazawa ., 1988)

, ,

,
Jatene.
- , - , -
, -
.

2- , 1- , ,
(J.Mustafa et al, 1981; D.Zipes, 1982;
D. Barboeur and W. Roberts, 1985; J. Bett et al, 1985; D. Kimbiris et al, 1985; A. Kragel
and W.Roberts, 1988). ,
, , ,
.
3. , L. Elliott
. (1966) . Shaher G. Puddu (1979), -,
, . ,
. ,
, ,
A. Gittenberger-de Groot . (1983),
.
4. (. 123).
A. Gittenberger-de Groot . (1983, 1986).
J. Quaegebeur (1986), W. Norwood . (1988) . Planche
. (1988). ,
.

. 123. ( A.Gittenberger-de Groot ., 1986).


- (); -
() (); - ()
.
- , - ,

200

5. (. 123,) .
, ,
, .
. 1988 . A. Castaneda .
.
L. Elliott . (1966).


() ,
, . ,

, ,

.
,
,
J a t e n e (S.Balderman et al, 1974; U.Hvass, 1977; H.Sievers et al, 1985),
, ,
(D. Sidi et
al, 1987; F. Idriss et al, 1988; W. Norwood et al, 1988; G. Wernovsky et al, 1988).
, ,
, ,
2- , 2- .
.
2-

.
. Planche . (1988).
, ,
(F. Idriss et al, 1988).
, , D. Goor
. (1982)
.
. Planche . (1988)
( )
( ).
,
, , (. . 121)
(. 124, 125),
(D. Goor et al, 1982; . Planche et al, 1988).


. ,
( ,
.),
,
(. Bical et al, 1984; J. Quaegebeur et al, 1986; F. Idriss et al, 1988).

(K.Anderson et al, 1978; F. Idriss et al, 1988).
,
. ,

201

. 124. ().
() () (
) .
. 125 - .

. 125. ()
Y. Lecompte (, ) ().
(M.Yacoub and R. Radley-Smith, 1984; J.Quaegebeur et al,
1986; D. Sidi et al., 1987). ,
, , (D. Goor et
al., 1982; . Planche et al., 1988; . Sakamoto et al., 1989).
( ),
, (. . 123),
, , . , ,
, - ( )
2- . ,
5% ( 5 - 7 ) .
,
, 2-

.
- , ,

J a t e n e .
202


,
( ) (. .
., 1990; M.Lev, 1972; R.Anderson et al, 1983; G.Piccoli et al, 1983; A.Mazzuco et al,
1985), ,
(. . ., 1990; .
., 1990; . Capelli et al, 1983; F. Macartney et al., 1984),
(. . ., 1986,1990; . Kanter ., 1986; . Bove
et al., 1988; P. Russo et al., 1986; J. Waldman et al., 1988)
,
,
(J. Quaegebeur, 1983; R. Firmin et al., 1983;
J. Quaegebeur et al., 1986; E. Bove et al, 1988; J. Waldman et al., 1988).
, ,
, -
(. . ., 1988; U.Hvass et al., 1983)

(. . ., 1982;
J. Judson, 1983),
.
67 ,
4 17 (1975-1990 .). 36 (53,7%)
, 31 (46,3%) - .
(. . , . . , 1990; . . , . . , 1990)
. ,
,
-
.

(. . ., 1988-1990).
,
- . . .
(. . ., 1988-1990).
: 1) , ; 2)
; 3)
; 4)
;
5) -
; 6)

; 7) ,
,
; 8)
, ; 9)
,
, ; 10)
.

17, 18 . 126 127.
203

17

.
SDD(*) (**).

18

204

. 126. ()
( ) (
SDD, ADD SDL).
, . 21.
, (59
67, 88%) D- .
( SDD)
57 , ( SDL) - . ,
(situs ambiguus - )
. (
ADD) (
).
(12%) ,
.
(
SLL), - ( ILL). ,
,
,
. , -
.
205

1.



1-5, 6 , 7 , 8 11.


. 126,

OAJIA - . 17.
1.
(21 59, 35,6%)
,
: 1 (
1). -
, 0 D, DA
DC. 74,1
55 82 (. . 126).

, .

1- 2-
,

( ).
, ,


. 127.


( SLL ILL).

, . 2 1 .
, ,

.
, , ,
( ).
(. 128,129).
.

,
, .
,
.
, , , ,
, , ,
() () (
). .
(
).
2. (16 59, 27,1%). ,
, 206

. -

,
2-3 ,

.
(.
. 128).

81,5 72 90.
(10 16, 62,5%)
.
D
, - DA DC.

, ,

.


. 128. .
,
.
. ,
- , -

, -
(
.
90") 37
(. . 18),
(62,7%)

S D D 2 2 .
(28
37, 75,7%).
( 80%
) ,
-
( 42,8%)
DA DC.
D

. 129. .
(. . 18).
()

.
1 2 ,
- , 1 - , 2 -

, 3 - , 5 -
.
.
3 .
,
( 9 2 ) .
1,7%. ,
( )
. , 1-
, , 22

SDL
. SDL . .

207

.
, .
2-
.
,
.
4. .
100 (95-105).

.

.
. ,
, .
5. .
, 2-
. 102
(98-106). .
,
- D.
, 2- ,
, ,
- ,
.
( ),
. ,
,
.
, ,
.
6 .
85 120 (
106,5).
( ) - , , DA
DC. ( DA),
( , ) .
2- , 1-
, .
,
, 2-
( ). ( )
,
. , , (
) . ( )
(2-)
( ). ( )
2-
, , -,
. 2- ,
.
2- ,
,
. -,
.
208

7 .
. 2- ,
, ,
, - 1- . 131.
8. ( )
( D ) .
142,5 (125-160).
2- , - 1-.
9 10. .
11. ( D)
SDL.
L-
.
, - .
- ( ILL).

L- . - ( SLL).
( - L).
,
- .
L--
.
- ;
,
,
.
- : 1, 2, 6 8.
,
- . 19 . 127.
, - .

() :
SLL
( )
. S(I)LL
(25%) - ;

D- .

.

7- 8- ,
.
6 () 1-
, .

2 1 ,
, .
L-
( SLL)
(25%) ,

.
209

,
,
,
(. . ., 1988; S. Van Praagh et al., 1982; U. Hvass et al., 1983).
,
. , , ,

.

, A. Gittenberger-de
Groot (1983).
, L- (-)

.
1-
,
2- - ;





.



(. 130) ,
(ZAOB /Li),
,

( )
( bb),




(A. Becker et al, 1975).






(. . . . . 130.
, 1982).
(Z2) .

- , (T)
() , - - ,

() (),
. ,
,
, L\ - , aa, bb, Z.2

, - , , , R L

( - anterior - , - posterior -

) - (R - right - , L - left )
.
. , 210

( b-b)
( -),
, ,
( -) ,
( ),
.
( b-b) ( -) ,
,
, .


.
.

:
.
, ,
.
,
.
2.

. , ,
(. . ., 1990).


, , .
, . Hightower . (1969) R. Guerin . (1970) ,
. S. Van
Praagh . (1982),
(103 ), , ,
.
S. Van Praagh . -
, , . i. R. Anderson . (1983), G. Piccoli . (1983),
:
.
3 9 2 3 67 ,
5 8 % . ,
L- ,
(. Wilcox et al 1981;
U.Huass et ah, 1983; J. Kirklin and B. Barratt-Boyes, 1986J.
, 20
(29,9%) . U. Hvass . (1983), 39
, (12,8%) , F. Macartney
. (1984) (1,9%) 52.
SDD,
, D-, D (dextro - ) - .
S. Van Praagh . (1982),
!3

L- .

211

SDD 7 5 % (75 91),


- 8 5 % (59 67).
, ,

(G. Danielson et al., 1972; . Lincoln, 1972; R. Van Praagh et ah, 1975; F. Macartney et al,
1984). situs solitus, D- L- (H. Sondheimer et al., 1977)
(1,25%) 80; U. Hvass . (1983)
(5,1%) 39; F. Macartney . (1984) (1,9%)
52 . (3,1%)
SDL. R. Van P r a a g h . (1975) 6 (5,8%)
L- SDL.
.
SLL S. Van Praagh . (1982)
18% (19 91) , ,
. 8 (12,1%)
SLL. (4,5%) ,
(7,6%) - .
3.
(
)

S(A)DD

(57

,
(S.Allwork et al., 1976; S. Van Praagh et al., 1982), (S, I )
.

, . , ,
SDD ADD S(A)DD,
SLL ILL - S(I)LL.
. (39 ). ,

5 8 % . ,
.
. (20 ).
(29,9%). 2 4
, 1- ,
- , D-
. (A. Gittenberger-de Groot et al., 1983),
D-
. 1- ,
- .
D-
.
, ,
, ( 5 -7 )
.
SDL.
( )
, 3,1%
. S. Van Praagh . (1982)
.

212

, , ( ),
. , D-
,
, 1- ,
- 2-, ,
, ;
, D-
.
S(I)LL (. 127)
(8 - 12,1%). S. Van Praagh . (1982),
18%)
. -
. , , ,
, 1-
, (
), - 2-
(
).

, .
,
. ,
-
.
4 .
5 , 6 7 -
- .
(. ),
(
,
, )
-
-
(. . 17,).
,
(. . 17,).
() .

.
, 6 - 8
(
), .
. , ,
,
( 7 ).
2- (

)
(. Planche et al., 1988). ,
,
(F. Idriss et al., 1988). D. Goor .
(1982)
.
213

( 4 ), ,
, ,
,
,
95-105.

( - .
), , (. Longenecker, 1961; . Meng
et al., 1965; . Berry et al., 1973).

(
)
- .

-
.

, .
,
, -
.

,
.

, (S. Van Praagh et al., 1982),
,
(. . ., 1988;
. Trivellato et al., 1980; U. Hvass, 1983).
.
, , ,
(. . ., 1987, 1988; .., 1989),
, 26,4%,

.
. ,
26% ? ?
, - ,
.
,
1-4 8-11 .

.
. ,
5-7 .
. - ,
, , , .
, ,

. , 13 (19,4%) 67 ( D- L- ) 5-7 13(!)
(100%) . ,
.
214

, - 4 . ,
(. . ., 1986; .
et al., 1988),
.
. Udoff . (1978).
. Neufeld A. Schneeweiss (1983) 5 % , U. Hvass (1983) 7,7%, S. Sridaromont . (1978) - 8 , 1 % , . . . (1988) - 7,5%.
,
-
. ,
7,5% (5 67), -
7,1% . , 4 ,
,
- , .
.
.
,
, - (. . ., 1980).
(B.Agarwala et al., 1979;
U. Hvass, 1983; . Neufeld et al., 1983) , 1-
, (. Neufeld et al., 1983).
, ,
. ,
, ,
(. Planche, 1986).
Damus-Kaye-Stansell
(J. Waldman et al., 1984,1988).
, ,
Damus-Kaye-Stansell, ,
.
, ,
, (. .
., 1986; . . ., 1988; U. Hvass, 1983).
> ,
Damus-Kaye-Stansell,

(J. Waldman et al., 1984; 1988).

Taussig-Bing (J.Quaegebeur et al., 1986; E.Bove et al., 1988; W. Brawn et al.,
1988; F.Idriss et al., 1988).
( ) 1-

(. Bove et al., 1988).

, ,

(D. Gooret al., 1982; S. Van Praagh et al., 1982).

, .
1. 1-5 ()
.
215

2 . 7 - 1 1 (, )
,
.
3 . 1-5 ( ) .
4 . 7 - 1 1 .
5. 3 - 9 ( 6) .
6 . 5 7 1- . 6 1-
.
7 . ,
.
-
1- .
,
, ,
, . :.
( )
(. .
. . ,
1990; . .

. . ,
1990;
. . ., 1994).

1. . .
// . - 1959. - 2.
2. . . // . .
- 1983. - 9. - . 142-145.
3. . ., . ., . ., .
// . - 1980. - 6. - . 21-24.
4. . ., . .
, // . - , 1990. - . 2 3 .
5. . ., . . // .
- 1979. - 11. - . 9 9 - 1 0 1 .
6. . ., . ., . ., . . -
// . - 1990. - 8.
7. . ., . ., . . .
//
. - 1988. - 4. - . 8 5 - 8 6 .
8. . ., . ., . ., . .
// . . - 1990.
- 5 . - . 21-27.
9. . ., . ., . ., . .
? // . - 1988. - 12. - . 75-79.
10. . ., . ., . . (
) // .-.
. - 1994. - 1. - . 4 - 1 2 .
11. . ., . . // . . - 1982. - 6.
- .141-145.
216

12. . .
// 7- . . . - , 1990. - . 36-38.
13. . ., . ., . . .
// , .-, . - 1990. - 1. - . 4-10.
14. . ., . ., . .
// . - 1986. - 5. - . 5-15.
15. . ., . , . .
// .
- 1 9 8 1 . - 2 . - . 5-10.
16. . . : . ... -
. - ., 1967. - . 4 3 - 4 8 .
17. . ., . ., . X.
// . - 1983. - 3. - . 11-16.
18. . . // .-
, . - 1995. - 1. - . 4 1 - 4 6 .
19. . ., . .
, //
- .
- , 1990. - . 44.
20. . ., . ., . 3. .
// . - 1988.
- 1 2 . - . 71-77.
21. . ., . ., X. ., . .
//
. - , 1972. - . 2 5 1 .
22. . ., . ., ..
// . - 1980. - 3. - . 76-79.
23. . ., . ., . ., . .
//
. - ., 1990. - . 119-124.
24. . ., . . , //
. . - 1956. - . 34, 10. - . 7 2 - 7 3 .
25. . . : . ... . .
- . , 1962.
26. . ., . 3. -
// . - 1989. - 6. - . 6 0 - 6 3 .
27. . ., . 3., . ., . . //
. - 1989. - 6. - . 2 3 - 3 1 .
28. . , . ., . . . - .: ,
1982.-. 70-71. *
29. . , . . . - .: , 1974. - . 112-125.
30. . ., . 3., . ., . .

// . - 1989. - 4. - . 5-13.
31. . ., . .
// . - 1982. - 3. - . 74.
32. . ., . 3.
//
5- .
. - ., 1987. - . 18.
33. . ., . 3., . .
//
. - 1988. - 2. - . 2 6 - 3 4 .
34. . ., . .
// . - 1982. - 4. - . 25-86.
217

35. . ., . ., . ., . . - 6 // . . - 1988.
- 3. - . 71-72.
36. , ., . // 5- .

. - ., 1987.
37. . .,- . ., . .
// .
- 1980.- 2 . - . 45-51.
38. . ., . .
// . - 1979. - 9. - . 115-116.
39. . ., . ., . . - I
// . - 1982. - 4. - . 17-20.
40. . . // . - 1977. - 2. - . 22-28.
4 1 . . , . .

8,5 // . - 1980. - 5. - . 9 0 - 9 1 .
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247

(W. Thies et al., 1986; A. Cifarelli et al., 1989).


,
, (W. Thies et al., 1986).
, ,

, , ,
. -

() - (
, ), -

. .
.
.
, ,
(
),
- .

,
(.. ., 1974; .. ., 1980; . Wesselhoeft et al., 1968).

(. . ., 1989;
W. Thies et al., 1986).

( ) , ,

(.. ., 1989; R.Caldwell et al., 1983;
P. Robinson et al., 1984; S. Jureidini et al., 1987; E. Henry et al., 1989; J. Monterroso et al,
1989).
:
) ;
) ;
)
.
. ,

.
.
,
.
(. 19), .
. 19, , ,
. , 8 3 %
,
.
,
(. Geens et al., 1971),
, ,
3 9 - 4 0 % .
248

19


( )


.

.
.
.
,

,


(. 143)

(. . 141).


( )

.

. 143.
( )


().
,


,
().
,
- .
,

.
, ,
,
(. . 141,).

.
,

(.. ., 1988; U.Sauer et al., 1989).

, ,
- - (. . .,

249

1990). , ,

, .

,
-
, .
(D. McNamara and
G. El-Said, 1973; . Wilson et at, 1977; Landholt et al., 1986; P. Vouhe et al., 1987)
,

(.. ., 1989; C.Wilson et al., 1979;
R. Kerwin et al., 1985; S. Westaby and G. Davies, 1986). ,
, , ,
,
(.. . . , 1974; W. Causing et al., 1977; Siew
Yen Ho et al., 1985; Th. Lesser and A. Schneider, 1990).

. ,
,
, ,
.
( )
,
.
,

(J. Mahowald et al., 1986; J. Partridge et al., 1986).
,
.
, , , ,
,
. (. 20)
,
. ,
. ,
, , , -,
,
.
,
, (. . ., 1988; R. Kerwin et al., 1985;
P. Vouhe et al., 1987; R. Kryne et al., 1989) :
1) ;
2) ;
3) .
, ,
, .
:
1) ;
2) ( )
;
3) ;
4) .
250

20

. Chan

1978 [97]

. . .

1980 [39]

1- , %
.

.
5/11

%
46,5

2/5

40,0

46,5

. Arciniegas et al.
D. Driscoll et al.

1980 [57]
1981 [118]

1/1
2/4
6/8

100,0
75,0

50,0
75,0

F. Laborde et al.

1981 [194]

4/5

80,0

80,0

.
.
R. Bunton et al.

1984 [32]

36,0

36,0

1987 [90]

52,0

52,0

1989 [9]

51,0

51,0

. .
.
Z. Faraoki et al.

1989 [126]

R. Hurwitz et al.

1989 [166]

...

50,0

5/14

100,0

100,0

8/8

21/26

81,0

1/2

50,0

13/32

40,6

50,0

. - , -
.

.

.
, ,

, ,
(
) .
. ,
,
,
- .
.

,
. .


, , .
,
,
, .

.
.
, ,
,
,
.
251

,
(E.Arciniegas et al, 1980; R. Bunton et al, 1987; P. Vouhe et al., 1987;
M. Guikahue et al., 1988; Z. Faraoki et al., 1989).
. ,
.
, ( /
, ,
) (G.El-Said et al., 1973; L.Chiariello et al., 1975; J.Bagger et al., 1985;
C. Landholt et al., 1986; R. Hurwitz et al., 1989),

, .


(A. Bogers et al., 1988). ,
, ,
, .
- , -,
18-24- , P. Vouhe . (1987).
, ,
. (
), -,
.
, ( 5 )
.
S. Kitamura . (1988),
, .
,
.
(. . .,
1989; D. Hamilton et al, 1976; S. Takeuchi et al, 1979).

2.


-
(. . ., 1981; S.Menahem and
A. Venables, 1987; . et al, 1988).
, ,

. , ,
, , ,
, -
(.. .., 1979; . . ., 1980, 1984;
J.Askenazi and A.Nadas, 1975; W.Pinsky et al, 1978; D. Sabiston and J.Lowe, 1984;
P. Vouhe et al, 1987).
252

(. . ., 1989; T.Vesterlund et al., 1985;


P. Vouhe et al., 1987; M. Guikahue et al., 1988; R. Tiraboschi et al., 1988).
,
, .

.
, - .
,
. : (
) .
, ,
. ,
, ,
.

W. P i n s k y . ( 1 9 7 8 ) . O r t i z . ( 1 9 8 6 ) .
, ( . 2 1 ) .


( )

253

21

21
1
. Wilson et al.

2
1982

3
1

4
+

"


"

S. Menahem and
A. Venables

1987

B. Gasul and
E. Loeffler
A. Jurishica
H. Wesselhoeft et
al.
Z. Vlodaver et al.
S. Suzuki et al.
E. Ortiz et al.

1949

1957
1968

1
1

1975
1978
1986

1
1
1

S. Menahem and
A. Venables
N. Sreeram et al.
P. Agins et al.

1987

,,

1989
1970

1
1

To
OAC

"

J. Richardson et al.
G. Hallman et al.

1979
1966

1
1


"

, ,
,
. .
, , .
,
(W. Pinsky et al., 1978).

, .
,
, ,
(. . 21).
. 21, ,
. ,
. (. Ortiz et al., 1986).

. ,

(W. Pinsky et al., 1978),
( )
.

.
.

254


.
,
(P.Lurie, 1977; W.Pinsky et al., 1978; E.Ortiz et al., 1986; S.Menahem and
A.Venables,1987).


(.. .., 1989; J.Choh et al, 1980; H.Gutgesell et al., 1980;
R.Caldwell et al., 1983; D.King et al., 1985; E.Henry et al., 1989; J.Monterroso et al.,
1989)
, . ,
,
(. . 21).

,
,

.
S. Rao . (1970), W. Wilcox . (1979) . . . (1997)
.
.
(. Goldblatt et al., 1984).
,

(Arthur et al., 1971; E.Krongrad et al, 1972; E.Arciniegas et al., 1980; O.Hansen
etal.,1988).
,
(. 22).

22


( )


, (
), , .
,
255

.

. , ,

. ,
. ,

. ,
.
L. Masel
. (1960) U. Boning . (1983). ,
,
.

3.

-
. 51 (.. ., 1981; S.Glanz et al, 1981; V.Kanjuh et al, 1989; U.Vario et al., 1992;
D. Marik et al., 1995).
. 27 ,
23 - .
, 13 23 .
S. Brooks (1886). 60- XX

, (J. Monckeberg, 1914; J. Schley, 1925; R. Jordan et
al, 1950; E. Cronk et al, 1951; Tedeschi and M. Helpern, 1954; R. Prible, 1961).

1957 . (. Schumacher).
. Ranninger . (1967).
6,5 .
42-
S. Wald . (1971). 37
, 14 - .

J. Tingelstad . (1972). ,
12- .
.
,
, . Schumacher (1957).
, ,
. . 1980 . (. . . . , 1980; . . ., 1981; . ., 1987).
.
,
A. Abrikossoff (1911) . Hackensellner (1955).
. ,
, ,
(. ., 1987).
, 256

, .
,

.
.
, ,
.
-,
, .
.
, -
.
,
. 22 13
(. 23), - , -
, -- , -
- (. 24.).
.

(G.Mintz et al., 1983).

- .
(. Rannitiger el al., 1967).

,
(K.Ranninger et al., 1967; G.Mintz et al., 1983; H.Mahdyoon et al., 1989).

, (G.Mintz et al., 1983;
H.Mahdyoon et al., 1989) (R.Prible, 1961; S.Wald et al.,
1971; D. Bregman et al., 1976; D.Lerberg et al., 1979). steal-

,
(. Mahdyoon et al., 1989).
,
,
(S. Glanz et al., 1981; . Mahdyoon et al., 1989). , ,
, 64 (. ., 1987;
R. Prible, 1961; R. Rhantigan and A. de la Torre, 1971). 1995 . D. Marik .
67- . ,
(G.Mintz et al., 1983;
U.Vairoetal.,1992).

.
( ).
(L. Blieden, 1974; . Honek et al., 1984).

, (J.
etal.,1982).

. , , (. Pernot
et al., 1984; D. Tammer et al, 1984; V. Kanjuh et al, 1989; T. Okura et al., 1990).
,
(. Pringle et al., 1980),
257

23

( )

. Shumacher

1957

J. Burroughs et al.
1962
A. Morrow et al.
P. Deverall et al.
L. Blieden and
J. Moller
H. Stopfkuchen et al.
J. Richardson et al.
S. Luisi et al.

1962
1969


1


+

1 (+)


1 (+)

"

1974
1979

1
1
1 (-(-

"
"

"
"

1982,
1987
1982

1987
. Honek et al.

1986
1988

1 (+
)
1
1

1992

1984
J. Cassilas et al.
A. Corno et al.
V. Sreenivasan and
M. Jacobstein

1974

1980
. .
., . .
. . ,
. 3.


'

(J. Ma et al., 1994) ,


(W. Wilcox et al., 1979; R. Humes et al., 1987; M. Yamaguchi
et al., 1991). , W. Wilcox . (1979),
.
-
, , - .
, R. Schwartz F. Robicsek (1971),
J. Ma . (1994),
. ,
,
( 16 55 - 33 ) (. 3. , 1989; P. Probst
et al., 1976; . Baltaxe and D. Wixson, 1977; R. Donaldson et al., 1979; T. Pringle et al.,
1980; R. Singh et al, 1983; J. Evans and J. Phillips, 1984; W. Roberts and M. Robinowitz,
1984). ,
. ,
, , 258

24

( )

(D. Tammer et al., 1984). ,


- ,
(W. Roberts and M. Robinowitz, 1984).
2 0 1 1 9 9
,
.

(J.Edwards, 1959; R.Schwartz and F.Robicsek,
1971).
(R. Donaldson
et al., 1983).
. , . Ranninger . (1967),
(R. Achtel et al., 1975; D. Bregman et al., 1976;
U.Bartolotti et al, 1981; G.Mintz et al, 1983; H.Van Meurs-Van Weezikh et al, 1984;
C. Worsham et al, 1985; J. Cassilas et al, 1986; H. Mahdyoon et al, 1989; U. Vairo et al,

259

1992; D. Marih et al., 1995). - .


, (. Ranninger et
al., 1967; G. Mintz et al., 1983; H. Mahdyoon et al., 1989).
.
(. Worsham et al., 1985;
R. Shah et al., 1986; U. Vairo et al., 1992; D. Marih et al., 1995).
.
J. Tingelstad (1972).
13 (G. Engster et al., 1973; A. Chantepie et al., 1982;
G. Mintz et al., 1983; U. Vairo et al., 1992; D. Marih et al., 1995).

(D. Marih et al., 1995).

(. 23).
, . Burroughs (1962).
56- .
- .

4.

,
.
- ( ) .
.
, .
, .
, ,
, ,
(W. Roberts and M. Robinowitz, 1984),
. ,
, . ,

,
.
,

.




J. Edwards (1954),
37- , .
24 , 13
(R. Schwartz and F. Robicsek, 1971; P. Probst et al., 1976; H. Baltaxe and D. Wixson,
1979; T. Pringle et al, 1980; R. Singh and P. Taylor, 1983; W. Roberts and M. Robinowitz,
1984; D. Tammer et al, 1984; M. Derrick et al, 1992; M. Fu et al, 1992; F. Fernandes et
260

al., 1993; J. Ma et al., 1994). R. Donaldson . (1979), W. Wilson . (1979),


U. Sauer . (1989) .

, - .
-,
,
- .
, .
. ., 16 ,
07.11.84 . 14 . :
, ,
. . -
. . -

4 . II 4 .
: ,
. ,
. - 2 6 % , - 4 1 % ,
- 376,1 3 / 2 .
201
1 (50 ), ,
,
(. . 39). 20% ,
/ 1,2. , 12/6, - 42/0, - 42/15, - 115/72, - 115/2-9 . .

.
(. . 40).
: . 23.11.84 .
. .
4-5 ,
. . .
3,2 .
-
. . -:
, (
). ( QRS III, aVL) .
.
50 100 .
. -,

: ,
, ,
- .
. -, -
( 12 )
, 14
(J. Isner and W. Roberts, 1978). -,
,
, ( )
,
.
261

,
, ( )
(. ., 1989; R. Donaldson et al, 1983; D. Tammer et al, 1984),
( )
(. Pringle et al., 1980; R. Donaldson et al., 1982; R. Singh and P. Taylor, 1983;
J. Evans and J. Phillips, 1984; Pernot et al., 1984; W. Roberts and M. Robinowitz, 1984;
D. Tammer et al, 1984; M. Derrick et al., 1992).
:
(R.Donaldson et al., 1982;
D. Tammer et al., 1984), -
(. Pernot et al., 1984)
(R. Donaldson et al., 1982). M. Yamaguchi . (1991)
Tadeyru
.
, ,
.
8 5 7
.
.
(W.Roberts and M.Robinowitz, 1984). 32
, ,
.
, -
.
. 9
.
,
. . .

,
.
(W.Roberts and M.Robinowitz, 1984)
- .

, :
.
,
.

, ,
.
(J. Liebman
et al, 1963; . Chaitman et al., 1976; D. Ott et al., 1978; U. Boning et al., 1983).
-, J. Liebman . (1963).

(. Honey et al, 1975; D. Ott et al., 1978; U. Boning et al, 1983).
U. Boning . (1983)
. D. Ott . (1978) ,
().
,
.
5 . . 262

.
, , . steal-.
. ,
.
, .
()
:
,
. , . Chaitman . (1976),
.
. -
, , ()
,
,
. , ,
: 1) 1-
; 2)
; 3)
. , .




( )
.
20 (. . . . , 1964;
. . ., 1975; . . ., 1975; . Hackensellner, 1955; J. Chinn
and M. Chinn, 1961; J. Ogden, 1970; D. Goor and Lillehei, 1975; V. Kanjuh et al, 1989).
, ,
, . , J. Baylis
. Campbell (1952) 76- ,
. ,
.
.
, -, W. Krause (1865)
. Brooks (1886). , ,
.

G. Rowe W. Young (1960).
.
1975 . . . . .
,
. ,
, , .
60-
P. Depelchin . (1985).

, .
, .
. , ,
, - .
263

, ,
, ,
, .
,
, (.. .., 1974). , ,
P. Depelchin . (1985),
.
-
. ,

(G. Rowe and W. Young,
1960; R. Gasior et al., 1971).
OB .

5.

- . 30
. ,
( ). ,
(. ., 1989;
S. Heifeltz et al., 1986).
.
.
( - ),
- . (. 25).
11
.
( - ).
19 (. 26).

( 1 - , 2 - ,
1 - 2 - ) , -
(,
, .). 30
-
.
A. Tow (1931).

, .
. Tedeschi . Helpern (1954).
.
L. D'Alessandro . Di Lorenzo (1976).
. Goldblatt . (1984).
14 2 .
,
, (Roberts, 1962; S. Heifeltz et al., 1986).

( A. Abrikossoff, 1911), ( . Hackensellner, 1955).
.
264

25

( )

. Tedeschi and
. Helpern
R. Alexander and
G. Griffith


(),
()

1954

13

1956

1961

/iv

1962

,
000
-

R. Colmers and
C. Siderides

1963

33

H. Blake et al.
J. Ogden

1964
1969

1
1

1
6

1*
1

,
000

W. Schulze and
A. Rodin
W. Roberts

B. Keeton et al.

1983

E. Goldblatt et al.
S. Heifeltz et al.

1984
1986

1
1

V. Kanjuh et al.

1989

2
1

1
1*

. - , 0 0 0 - , -
. . 26: * - , ( ).

26

( )


(),
()

A. Tow
D. Grayzel and
R. Tennant

1931

1934

M. Limbourg

1937

10

,
,

265

26
2

J. Williams et
al.

1951

W. Swann and
S. Werthammer

1955

, ,

"


, 0 0 0

R. Feldt et al.

1965

A. GonzalesAngullo et al.

1966

M. Monselise
et al.
L. D'Alessandro,
M. Di Lorenzo

1970

1976

39

J . Richardson
et. al.

1979

E. Sennari et al.

1982

G. Hoganson
et al.

1983

S. Bharati
etal.

1984

E. Goldblatt
etal.

1984

W. Kory et al.

1984

S. Heifeltz et al.

1986

T. Lloyd et al.

1987

1,5

"
"

14

11

1 -

"


000

000

1*

..

. - , -
, - , -
. , . 25.

266

, ,
, , , .
, , ,


. S. Rammos . (1989)

. ,
, (
, )
,

.
,
( ) .
. ,
: , - .
,
, -, .
, .
.
.
, , ,
. ,
( ) (. Blake et al., 1964; S. Bharati
et al., 1984; E. Goldblatt et al., 1984). , ,
.

, - .
, ,
(. 144, ).
( ).
, (S. Heifeltz et al., 1986).
- , . Monselise . (1970),
(. . 144,).
, ,
. ,
, , (. . 144, ,).
,
, -
(. . 26).
, , - ( 12 19 ),

, , 11 13. , ,
( )
(. . 26).
.

(C.Tedeschi and M.Helpern, 1954;
W.Roberts, 1962; E.Sennari et al., 1982; S. Heifeltz et al, 1986). R. Colmers
. Siderides (1963) 33 .
. Goldblatt . (1984) 267

. 144. (
).
- () (. ). -
(. ). - (. );
- .
- , - , - .

.
( , ,
), . ,
. Sennari . (1982)
, a R. Feldt . (1966) - . L. D'Alessandro
. Di Lorenzo (1976) 39- ,
.
, ,
(M.Limbourg, 1937; J.Ogden, 1969).

. (D. Grayzel and
R. Tennant, 1934; J. Williams et ah, 1951; S. Heifeltz et ah, 1986).

. ,
.

(J.Edwards, 1964; J.Askenazi and A. Nadas, 1975; La Porta et al., 1977).

( )
( )
( 3-10 ) .

, ,

(S. Heifeltz et al., 1986).
,
, , : 1)
2)
.
.
, S. Heifeltz . (1985), 8 5 % 268

.
.
- ( 30 )
(L. D'Alessandro . Di Lorenzo, 1976; . Goldblatt et al., 1984).
( )
. Goldblatt . (1984). Q
II, III, avF, V 5 V 6 ST.
. ,
,
. ,
, ,
(R. Feldt et al., 1965; . Sennari et al., 1982).
, -

(R.Colmers and . Siderides, 1963; J.Ogden, 1969; . Goldblatt et al.,
1984).

(R. Feldt et al., 1965; L. D'Alessandro and M.Di Lorenzo, 1976;
E. Sennari et al., 1982).

. ,
( ) (
).
. .
.
.
. ,
, .

. .
(
)
, () .
-
. , 19 ,
, 11 13
( ). ,

. ,

.
.
, ,
(S. Rao et al., 1970; . Goldblatt et al., 1984; U. Kory et al., 1984).

. ,

. , ,
(R. Feldt et al., 1965; U. Kory et al., 1984).
,
.

. 269

(. . 26), ,
,
.

. , , D. Doty . (1976) S. Bharati . (1984). S. Rao . (1970)
. U. .
(1984)
.
. Goldblatt . (1984). , S. Rao . (1970) U.
. (1984), ,
.
(. Goldblatt et al., 1984).

, ,
.

.

6.


1 3 %
( 81 620) (. 27).
(. . 7), (. 28), (. . 29), (. 30),
(. Gasul and E. Loeffler, 1949;
A. Jurishica, 1957; Z. Vlodaver et al., 1975; Y. Suzuki et al., 1978; E. Ortiz et al., 1986;
S. Menahem and A.Venables, 1987; N. Sreeram et al., 1989).
8 5 % .

(A. Tow, 1931; A. Gonzalez-Angullo et al., 1966; G. Hallman
et al., 1966), (S. Heifeltz et al., 1986), (G. Rowe
and W.Young, 1960; D. Sabiston et al., 1960), (R.Achtel et al., 1975;
Z. Krajcer et al., 1978)
(D. Grayzel and R. Tennant, 1934; M. Limbourg, 1937).
,
,
.
, ,
, , , , ,
.
,
, , .
.
, ,
. 270

27


...


10

15

17

14

17

15

15

11

3
1

12

29

34

1
J

20

,
3

1
'

17

2
-

2
2

69

2
2

81

20


; ,
( 8 2 , 4 % ) .
( 1 7 , 6 % ) ,
.
, , ,
,
.
, , ,
. , ,
.
.
- .

.
271

28


.
,
, , , .
, , ,
, , ,
, - ,
. , -,
,
2- .
, 9,
. - .
-
.
,
( 69 81 - 85,2%). 272

29

( 9 81 - 11,1%)
( 3,7% ) - .
. , .

.
,

( 59 81 - 73%),
.
,
, , ,
.
, , .
,
.
,
, , .
, -
.
273

30


( ) ,

,

.

1. . 3.
// . - 1987. - 5. - . 8 0 - 8 4 .
2. . 3.
: . ... - . - ., 1989. - . 135-140.
3. . 3., . ., . . .

(- ) // . .
- 1988. - 6 . - . 3 5 - 4 1 .
4. - . ., . .
// . - 1974. - 9. - . 132-140.

274

5. . ., . ., . .
// . - 1975. - 3. - . 115-116.
6. . ., . ., . ., .
// . - 1980. - 6. - . 21-24.
7. . ., . . //
. - 1979. - 1 1 . - . 9 9 - 1 0 1 .
8. . ., . ., . . .
// .-, . - 1997.
- 4. - . 65.
9. . ., . ., . .
// .-, . - 1990.
- 10. - . 3-8.
10. . ., . ., . 3.
// . - 1989. - 2. - . 5-11.
1 1 . . ., . ., . . .
- .: , 1967. - . 1 6 - 1 7 , 78, 114-118.
12. . ., . ., . .
,
// . - 1982. - 6. - . 1 3 - 2 1 .
13. . ., . , . .

// . - 1981. - 2. - . 5-10.
14. . ., . ., . . .
: // . - 1989. - 6. - . 5-12.
15. . .
3,5 // ,
. - 1928. - 2. - . 131.
16. - . . ( ), 1991.
17. - .
// . - .,
1990. - . 8 9 - 9 2 .
18. .., . ., X. ., . .
//
. - , 1972. - . 251.
19. . ., . . . - .:
, 1 9 7 4 . - . 8-34.
20. . ., . ., . .
//
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