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


Роль межжелудочковой перегородки в развитии 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

Preface. Patients undergoing cardiac surgery under cardiopulmonary bypass are at risk for development of right ventricular failure in immediate postoperative period. The main criteria of the latter was the reduction of right ventricular contractility, impaired motion of ventricular septum, high central venous pressure, reduction of left ventricular end-diastolic volume compared to the baseline level in terms of retained or increased left ventricular ejection fraction (LVEF), abrupt decrease in total peripheral resistance and decrease in arterial pressure. Material and methods. The background of the study was the material of clinical studies in immediate postoperative period in 63 patients, who underwent surgical intervention on the open heart. Right ventricular failure developed in all patients. Mean age was 59.0±1.2 years (from 33 to 85 years), average height was 171.9±0.9 cm (from 162 to 198 cm), mean body weight was 78.9±1.3 kg (from 51 to 106 kg). There were 22 female patients and 41 male patients. The main nosologic characteristics of patients included several different diagnoses: ischemic heart disease in 26 patients, among them 7 patients had postinfarction aneurysm of the left ventricle, 24 patients had valvular heart diseases, 13 patients had ascending thoracic aorta aneurysm. Intravenous infusion of mesatonum was improved to compensate right ventricular failure. Results. While the interventricular septum has any disturbances, intravenous infusion of mesatonum allows correcting of the central hemodynamics. Thus, arterial blood pressure increases, central venous pressure decreases, stroke volume elevates, LVEDV elevates to baseline values, oxygen delivery to tissues also increases. After septal motion recovery, contracticle ability of the right ventricle was also recovered and mesatonum dose gradually decreased. Conclusion. The data show that the abnormal interventricular septal motion in immediate postoperative period in patients after open heart interventions significantly influences on the left ventricular efficiency. IV administration of mesatonum is the method that allows correcting heart failure and normalizing a number of important parameters of central hemodynamics due to decrease of preload, afterload and increase of contractility of the right ventricle (by improving of right coronary artery filling) during the abnormal interventricular septal motion.

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