Biomedical subjects
Publications and source records attributed to V I Shumakov.
The authors propose a design of an axial shovel pump for extracorporeal circulation. They show how to introduce it into various cardiovascular segments and make a comparative assessment of its efficacy in relation to the type and severity of heart failure, surgical access, and treatment policy.
Explore the source record for details and available documents.
The first clinical experience with orthotopic transplantation of the liver was summarized. Within the period of from February 1990 to May 1991, 8 operations were performed, including one retransplantation of the liver. The peculiarities and variants of surgical technique, general principles of the performance of operation, methods for vascular and biliary reconstruction are presented. After the operation, 3 patients are alive, no surgical complications were observed.
Intraventricular blood-forcing-principle-based pneumo- and hydraulic assistance circulation device test results are proposed. The system consists of a uninipple valveless dome pump, a pneumo- or hydraulic drive, and an artificial pericardium. Stand tests of these systems and medical-biologic experiments on dogs and 17 calves were performed. The duration of these experiments was up to several days. In this report, the features of surgical techniques, perfusion parameters, control principles, hemodynamic variations, complications, and other problems concerning realization of the proposed method are discussed.
The totally artificial heart (TAH) is now in development in two trends. First, there is the development of a bridge system for temporary support of cardiac function. The TAH with the extracorporeal pneumatic driving system Sinus-IS is more efficient and safer. Parallel with this, a portable pneumatic driving system has been developed. That can be considered a stage in the development of the second trend: a totally implantable TAH. This article reviews problems of building of the Micron energy system to be used in implantable TAH designs.
The article discusses the results of surgical treatment of patients suffering from ischemic heart disease with extensive cicatricial affections of the myocardium and circulatory insufficiency. Thirteen patients of group I were treated by various reconstructive operations (resection of an aneurysm, formation of an aortocoronary shunt, septoplasty), 10 patients of group 2 underwent orthotopic heart transplantation. Perioperative and long-term (up to 3 years) mortality rates were, respectively, 7.6 and 8% in group I and, respectively, 30% and zero in group 2. The unfavorable prognosis of survival and medicamentous therapy in such patients, the lack of donors, and the acceptable results of reconstructive operations are evidence that they should be undertaken whenever possible. The main criteria of the selection of patients for a reconstructive operation are the values of regional contractility of the left ventricle, the severity of the dystrophic processes in the preserved segments, and the condition of the coronary arteries.
Results of morphological diagnosis of acute rejection on the material of 265 endomyocardial biopsies from 26 patients after an orthotopic donor heart transplantation are presented. The structural characteristics of different stages of acute rejection are given which is revealed in 85.7% observations. Ultrastructural myocardial changes in the early postoperative period not connected with the acute rejection crisis but resulting from a reperfusion cardiomyocytes damage are described. Results of electron microscopic examination of myocardium in rejection crisis are also given.
Holter monitoring was performed in 15 patients surviving over 3 months after homotopic cardiac transplantation. The frequency and types of arrhythmias occurring in the grafted innervated heart were studied according to its postoperative period duration. The follow-up lasted 3 to 29 months. Supraventricular arrhythmias were detected in 80%, whereas ventricular ones were found in 86.7%. Ventricular arrhythmias accompanied chronic graft rejection in 2 patients. It was ascertained that Holter monitoring was of greater diagnostic value than routine ECG recording. Innervation is not essential in the occurrence of cardiac arrhythmias.
The article analyses the results of one-stage transplantation of the kidney and pancreas in three patients suffering from insulin-dependent diabetes mellitus with diabetic nephropathy in the stage of terminal renal failure which called for programmed hemodialysis. The specific features of early postoperative management of patients are described, particularly the various routes of drug administration.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Three cases of chronic rejection occurring 7.5, 10, and 24 months after transplantation of the heart are analysed. The clinical features of chronic rejection in the late-term periods after transplantation of the heart are discussed. The problems of clinical diagnosis of chronic rejection, the role of endomyocardial biopsy and disorders of lipid metabolism are dealt with. Tactics of saving the patient are recommended. The authors substantiate the necessity for heart retransplantation and, in the absence of a donor's heart, for two-stage transplantation of the heart through an artificial heart or a biventricular approach by means of artificial heart ventricles.
The work analyses infectious complications after 35 orthotopic transplantations of the heart. The infectious complications are divided into 2 groups. Group 1 consisted of 6 patients with local complications. Group 2 was made up of 8 patients who died from bacterial infectious complications (mediastinitis 3, sepsis 2), from miliary tuberculosis of the lungs 1, cytomegaloviral infection 1, and systemic candidiasis 1.
The article deals with material concerning the performance of 4 operations for orthotopic liver transplantation (OLT). The operations were carried out on 2 males and 2 females whose ages ranged from 20 to 52 years. The indications for OLT were as follows: ++hemangioendothelioma of the liver, hepatocellular carcinoma, cirrhosis-carcinoma of the liver, and metastatic affection of the liver. One male patient died immediately after the end of the operation, another patient died 3 days after the operation due to nonfunctioning of the transplant. In 2 female patients the operations were carried out successfully. One of them was discharged from the clinic in 62 days in a satisfactory conditions and a well functioning transplant. The other patient died from a complication which was not connected with the operation--perforation of the small intestine 69 days after OLT. The technical aspects of and the provision for the operation and the postoperative management of patients are discussed. The encountered complications are analysed.
Explore the source record for details and available documents.
The article discusses the first clinical experience of the donor maintenance of the program of heart transplantation. Under analysis are etiology and terms of the process of death of the brain in 65 potential donors. The authors propose a scheme of the three-stages assessment of fitness of his heart for transplantation. Specific features of intensive therapy of the donors are considered. Twenty donors were used for clinical transplantations of the heart, in 18 cases (90%) satisfactory recovery of functions of the transplanted heart was noted.
The article analyses the first clinical experience in orthotopic allotransplantation of the heart at the Scientific Research Institute of Transplantology and Artificial Organs, USSR Ministry of Health, in the period from October, 1986 to July, 1989 (26 transplantations of the heart and one two-stage transplantation of the heart with the use of "Poisk-10M" artificial heart for 3.5 days in the first stage). Eleven patients are alive. Follow-up periods: maximum over 2.5 years, minimum 3 months. Sixteen patients died in different periods (up to 12 months). Three-component therapy (cyclosporine A, methylprednisolone, azathioprine) was applied for immunosuppression. The authors analyse the problems of the selection of potential recipients (indications and contraindications) and donor, the optimum surgical techniques, complications of immunosuppressive therapy, and infectious complications. The first clinical experience in two-stage transplantation of the heart is analysed. The first experience in transplantation of the heart in patients allows the conclusion that the use of this method for the management of the terminal stage of congestive cardiac insufficiency is a reality.
The authors discuss three various methods of initial hypothermic perfusion applied in 160 donors. The function of the donor kidneys was evaluated according to the results of clinical transplantation. The advantage of high-current perfusion in situ is shown, it allows the number of donor kidneys which are unfit for transplantation to be reduced to minimum. The method of in situ perfusion of organs in multiorganic collection ensures the most adequate antiischemic protection of all organs removed for transplantation, particularly in donors after circulatory arrest.