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 ➤ КФК. 2020; 17 (1): 5-69 ➤ Течение ближайшего послеоперационного периода у больных, перенесших операцию Фонтена в модификации экстракардиального кондуита после ранее выполненного двунаправленного кавопульмонального анастомоза

The course of the immediate postoperative period in patients undergoing Fontaine's surgery in the modification of extracardiac conduit after a previously performed bidirectional cavopulmonary anastomosis

Authors: L.A. Bockeria 1, E.S. Nikitin 1, I.A. Yurlov 1, D.V. Kovalev 1, M.A. Murzov 1, I.M. Makrushin 2

Company:
1 Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, 121552, Russian Federation
2 Pirogov Medical University, Moscow, 117997, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2020-17-1-44-51

UDC: 616.12-007.2-053.1-089

Link: Clinical Physiology of Blood Circulaiton. 2020; 17 (1): 44-51

Quote as: Bockeria L.A., Nikitin E.S., Yurlov I.A., Kovalev D.V., Murzov M.A., Makrushin I.M. The course of the immediate postoperative period in patients undergoing Fontaine's surgery in the modification of extracardiac conduit after a previously performed bidirectional cavopulmonary anastomosis. Clinical Physiology of Circulation. 2020; 17 (1): 44–51 (in Russ.). DOI: 10.24022/1814-6910-2020-17-1-44-51

Keywords:  Fontaine's operation in the modification of extracardial conduit after a previously performed bidirectional cavopulmonary anastomosis cardiac surgery management of the immediate postoperative period

Received / Accepted:  02.12.2019/09.12.2019

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Abstract

Objective. To identify the features of the course (management) of patients in the immediate postoperative period who underwent Fontaine's operation in the modification of the extracardiac conduit after a previously performed bidirectional cavopulmonary anastomosis.

Material and methods. The basis of this study was made by materials of clinical observations of 49 patients, conducted in the nearest postoperative period after surgery on the open heart for the period from 2017 to 2019. All patients met A. Choussat selection criteria, avoiding serious complications in the early postoperative period. The mean age of patients was 5.46 ± 0.29 years, the average height was 109.9 ± 2.03 cm, the average weight was 18.15 ± 0.66 kg. Female patients were 15, male – 34. The main nosological characteristics of the patients included several different diagnoses: a double distal vascular from the right ventricle (11 patients), tricuspid valve atresia (12 patients), a single ventricle (14 patients), transposition of the main vessels with left ventricular hypoplasia (9 patient), general form atrioventricular communication with pulmonary artery stenosis (3 patient). Initially, the mean pressure in the pulmonary artery was 11.27 ± 0.35 mm Hg, and the total pulmonary resistance 2.1 ± 0.07 units. In 7 patients underwent fenestration between the extracardiac conduit and the right atrium. All patients underwent EchoCG study in dynamics. According to ultrasound, the final diastolic volume of the functionally single ventricle and the final systolic volume of the functionally single ventricle, the ejection fraction of the functionally single ventricle, the impact volume were determined. To determine the parameters of central hemodynamics used the generally accepted formulas.

Results. The use of norepinephrine in the immediate postoperative period made it possible to maintain adequate central hemodynamics during a period of insufficient filling of the functionally single ventricle. A smooth increase in preload on the background of intravenous administration of vasodilators and inhalation of nitric oxide allowed to exclude a critical increase in central venous pressure, as well as a significant increase in postcapillary pressure, which led to a slight transudation of fluid through the pleural drains and abdominal in the near postoperative period. On the second day, all 49 patients were transferred to surgical units in satisfactory condition at moderate doses of cardiotonic support with a minimum level of transudation by drainage.

Conclusion. The data obtained convincingly show that noradrenaline serves as a drug that in the immediate postoperative period in this category of patients is able to provide adequate central hemodynamics. Norepinephrine allows you to maintain due, both systolic and diastolic blood pressure, which has a beneficial effect on coronary perfusion, and as a result, an adequate ejection fraction of the functionally single ventricle during the achievement of the proper (necessary) preload. Intravenous administration of vasodilators and inhalation of nitric oxide against a background of smoothly performed preload allows to exclude a critical increase in postcapillary pressure and, as a result, a significant discharge of blood through the cavacaval anastomoses into the inferior vena cava pool. This will ultimately lead to a significant decrease in the rate of transudation into serous cavities, and in some cases to its complete absence.

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About Authors

  • Leo A. Bockeria, Dr. Med. Sc., Professor, Academician of the Russian Academy of Sciences and Russian Academy of Medical Sciences, President; orcid.org/0000-0002-6180-2619
  • Evgeny S. Nikitin, Dr. Med. Sc., Head of Intensive Care Unit for Older Children with Congenital Heart Disease; orcid.org/0000-0002-8150-3384
  • Ivan A. Yurlov, Cand. Med. Sc., Surgeon; orcid.org/0000-0002-5812-8408
  • Dmitriy V. Kovalev, Dr. Med. Sc., Leading Researcher; orcid.org/0000-0002-4586-9258
  • Mikhail A. Murzov, Doctor of Intensive Care Unit
  • Igor' M. Makrushin, Cand. Med. Sc., Associate Professor of Outpatient and Emergency Pediatrics; orcid.org/0000-0002-8476-0431


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