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. 2019; 16 (1): 1-80 ➤ Лечение правожелудочковой недостаточности в ближайшем послеоперационном периоде у детей старшего возраста с врожденными пороками сердца, перенесших вмешательство на открытом сердце

. Treatment of right ventricular failure in the near postoperative period in older children with congenital heart defects who underwent open heart surgery

Authors: E.S. Nikitin 1, P.V. Yudin 1, I.M. Makrushin 2, M.M. Titov 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/10.24022/1814-6910-2019-16-1-36-44

UDC: 616.124.3-008.64-08:616.12-007-053.5-089.168.1

Link: Clinical Physiology of Blood Circulaiton. 2019; 16 (1): 36-44

Quote as: Nikitin E.S., Yudin P.V., Makrushin I.M., Titov M.M. Treatment of right ventricular failure in the near postoperative period in older children with congenital heart defects who underwent open heart surgery. Clinical Physiology of Circulation. 2019; 16 (1): 36–44 (in Russ.). DOI: 10.24022/1814-6910-2019-16-1-36-44

Keywords:  treatment of right heart failure cardiac surgery postoperative complications

Received / Accepted:  15.01.2019/05.02.2019

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Abstract

Objective. Development of a concept (strategy) for treating right ventricular (RV) failure in the immediate postoperative period in older children with congenital heart defects who underwent open heart surgery.

Material and methods. The basis of this research compose the materials of clinical observations of 65 patients conducted in the immediate postoperative period in patients, underwent surgery on open heart over the period from 2014 to 2018. All 65 patients in the immediate postoperative period suffered from severe RV failure. The average age of the patients was 3.0±0.36 years, the average growth was 90.1±2.8 cm, the average weight of 13.9±1.3 kg. Female patients were 32, male – 33. The main nosological characteristics of the patients included several different diagnoses: Fallot tetrad (21 patients), a double distal vascular from the right ventricle (17 patients), pulmonary atresia (10 patients), interventricular septal defect (10 patients), Ebstein abnormality and obstructive hypertrophic cardiomyopathy (2 patients), transposition of the main arteries (3 patients). On ultrasound determined violation of the interventricular septum movement (IVS), end-diastolic volume of the left ventricle (EDV LV), end-systolic volume of the left ventricle, left ventricular ejection fraction (LVEF), stroke volume (SV). To compensate for right heart failure has been adjusted intravenous infusion of noradrenaline. During the research 5 measurements, reflecting the parameters of central hemodynamics and the changes in the movement of the IVS, were performed.

Results. The rise in arterial pressure, heart rate and blood pressure decrease after readjustment of intravenous infusion of noradrenaline. Systolic output and heart index increased, left ventricular end-diastolic pressure increased up to baseline values. Tissue oxygen consumption and oxygen delivery increased. At this total peripheral resistance (TPR) increased up to normal values. Adrenalin dose was decreased and diluted to therapeutic. As contractile capacity of RV had been recovered, noradrenaline dose slightly decreased.

Conclusion. Use of noradrenaline with RV failure allows to establish the right ventricle perfusion, both systole and diastole, due to the increasing pressure in aorta and decreasing of central venous pressure (CVP). Noradrenalin infusion reduces the pressure in the right ventricle and right atrium, which promotes good venous outflow by RV system. All this eventually leads to increased contractility of the right ventricle, ventricular septal motion recovery. Compensation (resolution) of RV failure should be determined by increasing of EDV LV to proper (basis) of its value (while maintaining its EF), thus increasing the SV and reducing CVP, relying on TPR values.

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About Authors

  • Evgeniy S. Nikitin, Dr. Med. Sc., Head of Department of Intensive Care Unit for Older Children with Congenital Heart Disease
  • Pavel V. Yudin, Doctor of Intensive Care Unit
  • Igor' M. Makrushin, Cand. Med. Sc., Associate Professor of Chair of Outpatient and Emergency Pediatrics; orcid.org/0000-0002-8476-0431
  • Mikhail M. Titov, Doctor of Intensive Care Unit

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