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


Лечение правожелудочковой недостаточности в ближайшем послеоперационном периоде у пациентов, перенесших вмешательство на сердце в условиях искусственного кровообращения

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Link: Clinical Physiology of Blood Circulaiton. 2012; (): -

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Abstract

If the right ventricle does not pump up enough volume of blood intent to body need, the limit of cardiac output in left ventricle is appeared without regard to function adequacy. Blood pressure is low in patients with right ventricular failure due to decrease of left ventricle preload (decrease ratio of the last one depends on right ventricle decompensation ratio). Material and methods. The basis of this research is made up of case studies of 63 patients, which were conducted in immediate postoperative period, patients underwent open-heart surgeries. The right ventricular failure is developed in all patients (decrease of right ventricle contractility, high central venous pressure, abnormal interventricular septal motion, decrease in left ventricular end-diastolic pressure in comparison with initial one). There is a sudden decrease of total peripheral resistance and reduce of blood pressure in preserved or high left ventricular ejection fraction. Average age of patients was 59.0±1.17 years (from 33 to 85 years), middle height was 171.9±0.99 cm (from 162 to 198 cm), average weight was 78.9±1.31 kg (from 51 to 106 kg). There were 22 women and 41 men among the patients. The main nosological characteristic of patients included some different diagnoses: ischemic heart disease in 26 patients, among them 7 patients had postinfarction aneurysm of LV; valvular heart diseases in 24 patients; aneurysm of ascending thoracic aorta in 13 patients. Results. The rise in arterial pressure, heart rate and blood pressure decrease after readjustment of intravenous infusion of mesatonum. 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 increased up to normal values. Adrenalin dose was decreased and diluted to therapeutic. As contractile capacity of RV had been recovered, mesatonum dose slightly decreased. Conclusion.The compensation of right ventricular failure suggests preload for RV, the rise of its contractility and decrease of total pulmonary resistance (decrease in right ventricle preload). Obtained data conclusively present that mesatonum intravenously for right ventricular failure is the method that allows to correct heart failure. It can lead to the norm of important parameters in central hemodynamics, by means of preload/afterload decrease and right ventricle contractility (due to right loading in coronary artery).

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