Clinical Physiology of Circulation

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


Pulmonary edema in the immediate postoperative period in patients who haveundergone open-heart surgery and who have signs of right ventricular failure

Authors: E.S. Nikitin 1, Z.O. Saydalieva 1, U.R. Ernazarov 1, M.M. Titov 1, I.M. Makrushin 2, P.V. Yudin 1, O.V. Kiseleva 1, E.A. Lebedeva 1

Company:
1 Bakoulev National Medical Research Center for Cardiovascular Surgery, Ministry of Health of the Russian Federation, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation
 2 Pirogov Russian National Research Medical University, Ministry of Health of the Russian Federation, ul. Ostrovityanova, 1, Moscow, 117997, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2017-14-4-211-219

UDC: 616.24-005.98:616.12-089.168.1-06+616.124.3-008.64

Link: Clinical Physiology of Blood Circulaiton. 2017; 14 (4): 211-219

Quote as: Nikitin E.S., Saydalieva Z.O., Ernazarov U.R., Titov M.M., Makrushin I.M., Yudin P.V., Kiseleva O.V., Lebedeva E.A. Pulmonary edema in the immediate postoperative period in patients who have undergone open-heart surgery and who have signs of right ventricular failure. Klinicheskaya Fiziologiya Krovoobrashcheniya (Clinical Physiology of Circulation, Russian journal). 2017; 14 (4): 211–9 (in Russ.). DOI: 10.24022/1814-6910-2017-14-4-211-219

Received / Accepted:  25.09.2017/02.10.2017

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Abstract

Objective – the explanation of the mechanism of the development of pulmonary edema 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 research compose the materials of clinical observations of 17 patients conducted in the immediate postoperative period in patients, underwent surgery on open heart due to valve pathology over the period from 2009 to 2014. All 17 patients in the immediate postoperative period suffered from severe right ventricular failure. The average age of the patients was 60,18 ± 2,0 years, the average growth was 167,9 ± 1,2 cm, the average weight of 71,06 ± 2,0 kg. Women were 12, men 5. To all patients to determine central hemodynamics was established Svan–Ganz catheter. On ultrasound determined violation of the interventricular septum movement (IVS), end-diastolic volume of the left ventricle (EDVlv), end-systolic volume of the left ventricle (ESVlv), left ventricular ejection fraction (LVEF), stroke volume (SV). To compensate for right heart failure has been adjusted intravenous infusion of noradrenaline. During the research 6 measurements, reflecting the parameters of central hemodynamics, oxygenation index value and the changes in the movement of the IVS, were performed.
Results. CVP of 1–3 measurements (while selection of adequate doses of noradrenaline to compensate for right heart failure) has its maximum value 19.6 ± 0.5 mmHg. In these measurements was a decrease of EDVlv from 106 ± 7.6 to 90.1 8 ± 5.45 ml and EFLV > 55%, the TPR 600–700 dyne•sec•cm–5, when CI of 2.98 to 3.54 l/min/m2. Oxygenation index from 237,58 ± 5,26 decline to the third measurements to 176,47 ± 6,77. At 4–6 the measurements the reduction in the dose of norepinephrine is marked from 0.3 ± 0.02 to 0.07 ± 0.01 mcg/kg/min, related to the recovery, as the contractility of the right ventricle, and also as the restoration of adequate movement IVS. Against this background, there is a decrease in CVP, EDVlv increase to baseline (110 ± 4.3 ml) with EFLV 55–56%, recorded the TPR growth 917–1016 dyn•sec•cm–5. In the same measurements the oxygenation index continued its decline to 163.12 ± 4.98.
Conclusion. Obviously, in our patients, a sharp decrease in the oxygenation index in the first three days is largely due to a decrease in pulmonary blood flow due to the existing severe right ventricular failure. Starting from the fourth day, when the process of resolving right ventricular failure is obvious, as evidenced by a decrease in the dose of norepinephrine, and the restoration of the movement of IVS, and the growth of EDVlv (to its original value) with a high EFlv remaining, with a parallel increase in the SVlv, on the background of a progressively decreasing level of CVP; in our opinion, a violation of the diffusive capacity of the lungs makes a significant contribution in the further reduction of the oxygenation index. The last is due to a significant deposition of the interstitial fluid in the lung parenchyma, caused by a violation of the return, both venous blood, and the violation of lymphatic drainage from the lungs in the first three days against the background of very high values of CVP.

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About Authors

  • Nikitin Evgeniy Stanislavovich, Dr. Med. Sc., Head of Department of Reanimation and Intensive Care of Older Children with Congenital Heart Diseases
  • Saydalieva Zulikhan Obusup’yanovna, Doctor-Resuscitator Ernazarov Urmat Ryskel’dievich, Doctor-Resuscitator Titov Mikhail Mikhaylovich, Doctor-Resuscitator
  • Makrushin Igor’ Mikhaylovich, Cand. Med. Sc., Associate Professor of Chair of Polyclinic and Urgent Pediatrics Yudin Pavel Vyacheslavovich, Doctor-Resuscitator
  • Kiseleva Oksana Vasil’evna, Doctor-Resuscitator
  • Lebedeva Ekaterina Aleksandrovna, Doctor-Resuscitator

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