Biomedical subjects
Publications and source records attributed to A I Kirienko.
Clinical presentation of acute thrombophlebitis affecting lower limbs, classification of its forms and the response of the patients to essaven-gel are reviewed. Indications to such treatment are provided. High efficacy of essaven-gel is stated.
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Examination of blood rheologic properties in 38 patients with chronic ++post-embolic pulmonary hypertension revealed an elevated blood viscosity at all shift rates and a reduced erythrocyte deformability. A close positive correlation was found between blood viscosity and perfusion deficit. Hemorheologic disorders in patients with chronic post-embolic + pulmonary hypertension are caused by pachyhemia and blood acid-base imbalance due to respiratory failure. They deteriorate pulmonary and systemic hemodynamic disturbances and contribute to progression of blood flow derangement.
Three variants of hemodynamic reaction to massive thromboembolism of the pulmonary artery are encountered--hyperkinetic, eukinetic, and hypokinetic. Their manifestations are determined by the patient's cardiovascular status at the onset of thromboembolism, the volume of the embolic obstruction, the degree of pulmonary hypertension, and the concomitant cardiopulmonary pathology. Effective treatment leading to marked reduction of pulmonary hypertension is conducive to increase in the proportion of the hyperkinetic type; ineffective thrombolysis, thrombosis of the inferior vena cava antiembolic filter, recurrent thromboembolism, and infarction pneumonia are the causes of diminished right-ventricular systolic function and reduced cardiac index, i. e. the formation of a hypokinetic type.
The article is based on study of the immediate results of REPTELA cava-filter implantation in 750 patients and the late-term results in 400 patients. The incidence of the complications is low. Hematoma at the site of subclavian vein puncture developed in 1.6%, retroperitoneal hematomas in 0.1%, migration of the cava-filter occurred in 0.9% of cases. The main causes of the complications are linked with improper methods of implantation of the cava-filter.
The study examines the potentialities of using radionuclide methods in the diagnosis of cardiac dysfunctions in chronic post-embolic pulmonary hypertension (CPPH). The most informative parameters are shown to be ejection fraction of the right (RV) and left ventricles (LV), severity of RV hypertrophy and dilation, which show changes in relation to the severity of pulmonary hypertension and the disease length. Radiocardiography employed in CPPH has some limitations. Chronic cor pulmonale decompensation due to CPPH is provided by elevated LV contractility. The stage of decompensation is characterized by signs of myocardial dystrophy and impaired perfusion, as judged from 201Tl myocardial scintigraphy, a sharp fall in RV and LV ejection fraction, severe RV myocardial hypertrophy and its cavity dilation.
The results of scintigraphy of the right ventricular myocardium with 201T1 and equilibrium ventriculography were described in patients with the acute stage of thromboembolism of the pulmonary artery and chronic post-embolism pulmonary hypertension. A method of quantitative assessment of a degree of right ventricular hypertrophy and dilatation was proposed. Some regularities in the pulmonary heart formation were revealed with regard to a period of disease and the gravity of hemodynamic disturbances in the lesser circulation.
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Haemodynamic studies were undertaken in 30 patients with chronic post-embolic pulmonary hypertension (CPEPH), and the findings were compared with those found in acute thromboembolism of the pulmonary artery. The study showed that radiocardiographic examination is a useful supplementary method for diagnosing postembolic lesions of pulmonary arteries and for dynamic examination of patients after pulmonary embolism. The appearance of a "single-hump" curve on the radiocardiogram was an unfavourable prognostic sign and attested both to an increase of pulmonary hypertension or to a latent heart failure. The importance of radiocardiographic examination for determining the prognosis of the disease and for choosing the most suitable method of its treatment is analysed.
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Radiopaque and radio-isotope findings in the pulmonary arterial channel in 43 patients with postembolic lesions of the pulmonary trunk and its major branches are reported. Angiographic and scanographic symptoms are described. The significance of detected systolic-pressure gradient in the probing of pulmonary vessels is demonstrated. Possible sources of diagnostic errors are analysed, and ways of eliminating them are suggested. Total and selective multipositional angiopulmonography is believed to be the principal method of diagnosing this condition, while pulmonary scanning only allows topical diagnosis in cases of markedly stenosed major pulmonary arteries.
The study is based on data of radiopaque investigation of pulmonary vessels in 400 patients with pulmonary arterial thromboembolism. A retrospective assessment of noncontrast chest roentgenograms was carried out in 200 of those. Conventional pulmonary roentgenology was shown to be a fairly unreliable tool of the diagnosis of pulmonary embolism owing to low specificity of the symptoms. Only arterial filling defects and "amputations" may be regarded as specific angiographic signs of thromboembolism. The value of indirect angiographic symptoms was demonstrated. Angiographic semiotics of embolism was studied with reference to the duration of the affection. Vascular filling defects and stenoses are angiographic markers of prolonged presence of thromboemboli in pulmonary arteries.
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