Clinical Physiology of Circulation

ISSN 1814-6910 (Print)
ISSN 2410-9134 (Online)

 

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Issue's catalogue ➤ Клиническая физиология кровообращения. 2016; 13 (4): 185-240 ➤ Нарушение диффузионной способности легких в ближайшем послеоперационном периоде у больных, перенесших вмешательство на открытом сердце и имеющих признаки правожелудочковой недостаточности

Violation of the diffusion capacity of the lungs in the immediatepostoperative period in patients undergoing intervention on the open heart,and proceeding with symptoms of right ventricular failure

Authors: L.A. Bockeria, E.S. Nikitin, Z.O. Saydalieva, U.R. Ernazarov, M.M. Titov, E.A. Lebedeva, O.V. Kiseleva

Company:
A.N. Bakoulev Scientific Center for Cardiovascular Surgery, Ministry of Health of the Russia, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation;

E-mail: Сведения доступны для зарегистрированных пользователей.

UDC: 616.24-008:616.12-089.168.1-06:616.124.3-008.64-08

Link: Clinical Physiology of Blood Circulaiton. 2016; 13 (3): 219-224

Quote as: Bockeria L.A., Nikitin E.S., Saydalieva Z.O., Ernazarov U.R., Titov M.M., Lebedeva E.A., Kiseleva O.V. Violation of the diffusion capacity of the lungs in the immediate postoperative period in patients undergoing intervention on the open heart, and proceeding with symptoms of right ventricular failure. Klinicheskaya Fiziologiya Krovoobrashcheniya (Clinical Physiology of Circulation, Russian journal). 2016; 13 (4): 219–24 (in Russ.)

Keywords:  right ventricular failure pulmonary edema in right ventricular failure cardiac surgery postoperative complications

Received / Accepted:  25.10.2016/26.10.2016

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Abstract

Objective – the explanation of the mechanism of violation of lung diffusion capacity in the immediate postoperative period in patients undergoing open heart intervention and proceeding with symptoms of right ventricular failure.

Material and methods. The basis of this study is made on the clinical observation of the patient M. materials conducted in the immediate postoperative period, underwent open heart intervention. Patient M., 63 years old, diagnosis: inactive phase of rheumatism, condition after “open” surgery aortic commissurotomy in 1962, Aortic vice: stenosis and insufficiency, Calcined vice mitral valve: stenosis and insufficiency, pulmonary hypertension, persistent atrial fibrillation, performed “AK” prosthesis ON-X № 19, “MK” prosthesis ON-X № 27. To determine the parameters of central hemodynamics was established Svan–Ganz catheter. According to US data were determined: violation movement of the interventricular septum (IVS), end-diastolic volume of the left ventricle (EDVLV) and end-systolic volume of the left ventricle (ESVLV), left ventricular ejection fraction (LVEF), stroke volume (SV). To compensate the right ventricular failure was perfomed intravenous infusion of norepinephrine. During the conducted investigation 6 measurements – reflecting the parameters of central hemodynamics and the changes in the movement of the interventricular septum, were performed.

Results. Central venous pressure (CVP) was high values from the first day to the sixth (18–21 mmHg) despite gradually increasing dose of norepinephrine (0.065–0.15 mcg/kg/min). On ultrasound were found violation of the interventricular septum movement (IVS paradoxical movement during the first four days and akinesia IVS on the fifth-sixth day). Noted gradual decline of EDVLV from 126 ml to 70 ml up to 6 day, with preserved LVEF 55–56%, and CI (cardiac index) consistently top 2.9 l/min/m2. Also was revealed a sharp decrease of total peripheral resistance (609–770 dyn/sec/cm-5), despite the introduction of norepinephrine. Blood pressure – systolic did not exceed 110 mmHg. Against this background, the oxygenation index gradually decreased (277–145) for 4 to 5 day, against of the remaining high level of CVP. Also with the oxygenation index decreased DO2 level from the first day to the sixth (510–415 ml/min/m2).

Conclusion. The cause of pulmonary edema in patients undergoing open heart intervention, can be right ventricular failure. Two main reasons can lead to decrease of oxygen saturation of arterial blood in the immediate postoperative period in patients occurring with symptoms of right ventricular failure: a) violation the diffusion capacity of the lungs; b) violation ventilation-perfusion ratio. Reducing of oxygenation index in these patients caused by increasing of the interstitial fluid volume (retarding the gas diffusion process from acinus to the blood). Violation of the ventilation-perfusion ratios is associated with stroke volume sharp fall of the right ventricle of the heart, and as a result of a sharp decrease in blood flow in the pulmonary artery. Violation of lymphatic drainage from the lungs, arising at right ventricular failure, leads to disruption of fluid resorption of the interstitial space, increasing its oncotic pressure; and progression of pulmonary edema.

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