The function of transplanted heart in the early postoperative period is analyzed in 20 patients operated on at the Research Center of Surgery of the Russian Academy of Medical Sciences. Cardiac function was assessed by a complex of hemodynamic parameters, among which were the ratio between the ventricular stroke index and end diastolic pressure in the ventricle. Right-ventricular dysfunction of varying severity was detected in all the patients in the immediate postoperative period. Three variants of right-ventricular insufficiency were singled out: isolated right-ventricular insufficiency with increased (20%) and normal (45%) total vascular resistance and right-ventricular insufficiency combined with left-ventricular insufficiency (35%). Isolated right-ventricular insufficiency could be, as a rule, treated by combined intensive care including sympathomimetics and vasodilators. A combination of right-ventricular and left-ventricular insufficiency, which may be caused by incompatability between the sizes of the donor and recipient, as well as hypoxic and metabolic cardiac injury in donor body, is prognostically infavorable, for it requires intensive inotropic therapy and is associated with a high mortality.

Adult↗

PubMedDate not supplied

[Determination of likelihood of the development of pleural empyema in patients with cancer after pneumonectomy].

Management of 150 patients with lung cancer after pneumonectomy has shown that the basic factors causing the onset of postoperative pleural empyema are chronic nonspecific pulmonary diseases, pronounced obstructive syndrome and right heart overload, tumor histology, local tumor size and cancer complications, duration and techniques of surgery, duration of controlled lung ventilation, as well as the onset of postoperative suppurative tracheobronchitis and surgical wound suppuration. The likelihood of empyema development may be assessed only upon analysis of the combination of risk factors with reference to their low informative value, preoperative patients' condition and intraoperative factors which have an equal impact on the onset of this complication. The efficacy of the algorithm elaborated is as follows: if the likelihood of empyema development exceeds 50%, it occurs in 96.3% of cases, if the likelihood of the complication is less than 10%, the postoperative period is uncomplicated in 87.8% of patients.

Algorithms↗

PubMedDate not supplied

[The early postoperative period in orthotopic heart transplantation].

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Heart Transplantation↗

PubMedDate not supplied

[Lomir in the treatment of arterial hypertension after angioplastic surgery].

Isradipine (lomir) is a new highly selective arteriolar vasodilator of the dihydropyridine group, characterized by a slight cardiodepressive effect. The drug effect on the central hemodynamics and oxygen transport was studied after cardiovascular surgery. Arterial pressure and total peripheral vascular resistance were reliably reduced at the peak of the drug action, as was the left-ventricular stroke work and oxygen consumption. A tendency to increase of cardiac output and cardiac index was observed. Pulmonary vascular resistance and pressure in the pulmonary artery did not reliably change. The drug increased the intrapulmonary shunt.

Adult↗

PubMedDate not supplied

[Reduced paired stimulation in patients in the early postoperative period after an open-heart surgery].

The authors provide the technique of underdriving paired ventricular stimulation as a variant of treating drug-resistant tachycardias and a formula of calculating rhythm inhibition and the impulse delay. Basing on the stimulation pathophysiology and positive shifts in hemodynamics, the validity of this stimulation, its advantages and indications are inferred.

Arrhythmias, Cardiac↗

PubMedDate not supplied

[Noninvasive mask ventilation of the lungs in the treatment of acute respiratory insufficiency in heart surgery patients in the postoperative period].

Noninvasive ventilation of the lungs using a mask (NIVLM) was used in 54 patients with hypercapnic (n = 14) and hypoxemic (n = 40) respiratory failure. Respironics (USA) nasal and facial masks were applied. Ventilation regimens were selected individually. Trigger monitored ventilation, intermittent forced ventilation of the lungs, and assisted ventilation with positive expiratory pressure, biphasic positive pressure in the airways, and constant positive pressure in the respiratory contour were used. The efficacy of NIVLM in patients with hypercapnic respiratory failure was 100%. The pCO2 and ETCO2 normalized in all patients both during and after discontinuation of NIVLM. Despite a relatively long period of ventilation (229 +/- 72 min), the patients did not complain of discomfort during the procedure; no complications or individual intolerance of nasal or facial masks were observed. In patients with hypoxemic respiratory failure NIVLM resulted in a decrease of dyspnea, increase of respiratory volume, etc. The detected changes did not disappear after NIVLM was discontinued. Individual tolerance of nasal and facial masks was somewhat worse in this group: patients complained of stuffiness, lack of air, difficult respiration. Six patients (18.2%) developed episodes of psychomotor excitation which required sedative and analgesic therapy. In general, the efficacy of NIVLM was 91%, but resolution of respiratory failure without repeated intubation of the trachea was attained in only 33 patients (87%) with the hypoxemic condition. The mean duration of NIVLM in this group was 464 +/- 47 min. Hence, NIVLM is an effective method for respiratory support in patients with both hypoxemic and hypercapnic respiratory failure, which helps decrease the duration of forced ventilation of the lungs or do without repeated intubation of the trachea.

Acute Disease↗

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[Effects of ventilation of the lungs in prone position on the pulmonary oxygenation function and hemodynamic parameters of heart surgery patients with respiratory insufficiency in the postoperative period].

Effect of ventilation in the face-down position (VFDP) on the oxygenation function of the lungs and hemodynamics is studied in 32 patients (aged 22-64 years) subjected to open-heart surgery complicated by development of acute respiratory failure (RF). In 23 patients with grave respiratory distress syndrome, VFDP was performed with forced ventilation of the lungs (FVL) and in 9 with less grave RF, with noninvasive mask ventilation of the lung (NIMVL). Body position of patients on FVL was changed every 4-12 h, of nonintubated patients, 45-60 min. The oxygenation function of the lungs improved in the intubated patients as early as during the first hour of FVL in the face-down position: PaO2/FiO2 notably increased and a tendency to decrease of A-aDO2 and Qs/Qt was observed. The positive effect was maximal after at least 4-hour FVP in the face-down position: PaO2/FiO2 increased by 76.6%, intrapulmonary shunting fraction decreased by 43%, and the O2 alveolar-arterial difference decreased by 27% in comparison with the initial values. After body position of patients was changed, the above improvements did not disappear, despite a slight decrease of the effect attained. VFDP with NIMVL led to similar results: O2 alveolar-arterial gradient decreased, PaO2/FiO2 decreased by 24.2%, the mean values of this ratio approaching the norm. Positive effect somewhat decreased after catecholamines were discontinued, but the oxygenation function of the lungs remained better than initially.

Adult↗

PubMedDate not supplied

[The determination of cardiac output by the dilution of ultrasonic blood density].

The authors propose assessing cardiac output (CO) by diluting the blood ultrasonic properties. For measuring CO, the peripheral artery and vein were connected with a catheter, and ultrasonic flowmetric pickup was attached to the shunt. Indicator (0.9% sodium chloride) was injected into the central vein. Changes in the blood ultrasonic characteristics during the indicator flow were recorded by ultrasonic flowmeter. Dilution curves were computer processed. The method was tried in 7 experimental dogs and clinically in 11 patients and compared with the thermodilution method. The coefficient of correlation was 0.98 in experiment and 0.97 in clinical trials. Dilution of ultrasonic density of the blood helps accurately assess the CO and is highly informative, which is confirmed by a strong correlation with the results of thermodilution. The method is simple, little invasive, realized using available equipment, the indicators are cheap and available, and repeated studies can be performed within short periods of time.

Animals↗