163 research outputs found
COMBINED HEART-KIDNEY TRANSPLANTATION
No full textCombined heart-kidney transplantation may be performed in carefully selected patients with end-stage heart disease and renal failure. There are two types of combined transplantation of heart and kidney: 1) simultaneous heart-kidney transplantation (SHKT) from the same donor; 2) staged transplantation of heart and kidneys from two genetically different donors. The ISHLT registry in 2014 reported an increase in the number of SHKT over the years: from 22 in 1994 to 97 in 2012. World experience demonstrated excellent results of SHKT. Recipients of SHKT had superior survival, lower rates of acute cardiac and renal rejection compared to heart recipients. This article discusses the indications for simultaneous or staged heart-kidney transplantation in patients with dialysis-independent or dialysis-dependent renal failure, results and posttransplant survival of SHKT recipients. The author describes his own experience of 2 staged combined heart-kidney transplantations
Hemodynamics and Gas Exchange Effects of Inhaled Nitrous Oxide in Patients with Acute Respiratory Distress Syndrome
No full textInhaled nitrous oxide (iNO) therapy aimed at improving pulmonary oxygenizing function and at decreasing artificial ventilation (AV) load has been used in foreign clinical practice in the past decade. The study was undertaken to evaluate the hemodynamic and gas exchange effects of iNO in acute respiratory distress syndrome (ARDS) that developed after car-diosurgical operations. Fifty-eight (43 males and 15 females) patients aged 21 to 76 (55.2±2.4) years were examined. The study has demonstrated that in 48.3% of cases, the early stage of ARDS is attended by the increased tone pulmonary vessels due to impaired NO-dependent vasodilatation. In these patients, iNO therapy is an effective therapeutic method for correcting hemodynamic disorders and lung oxygenizing function
СОЧЕТАННАЯ ТРАНСПЛАНТАЦИЯ СЕРДЦА И ПОЧКИ
No full textCombined heart-kidney transplantation may be performed in carefully selected patients with end-stage heart disease and renal failure. There are two types of combined transplantation of heart and kidney: 1) simultaneous heart-kidney transplantation (SHKT) from the same donor; 2) staged transplantation of heart and kidneys from two genetically different donors. The ISHLT registry in 2014 reported an increase in the number of SHKT over the years: from 22 in 1994 to 97 in 2012. World experience demonstrated excellent results of SHKT. Recipients of SHKT had superior survival, lower rates of acute cardiac and renal rejection compared to heart recipients. This article discusses the indications for simultaneous or staged heart-kidney transplantation in patients with dialysis-independent or dialysis-dependent renal failure, results and posttransplant survival of SHKT recipients. The author describes his own experience of 2 staged combined heart-kidney transplantations.Сочетанная трансплантация сердца и почки является одним из возможных направлений эффективного лечения больных c сочетанием терминальной застойной сердечной недостаточности (ЗСН) и почечной недостаточности. Выделяют одномоментную, комбинированную, или симультанную (simultaneous), трансплантацию сердце–почка (КТСП) от одного и того же донора, а также последовательные (staged) трансплантации сердца и почки от двух генетически различных доноров. ISHLT также отмечает рост числа ежегодно выполняемых КТСП – от 22 (1994 г.) до 97 (2012 г.). В статье приводится мировой опыт выполнения КТСП, обсуждаются показания к ее выполнению, в том числе у пациентов с диализ-независимой почечной недостаточностью. Отмечается, что особенностью КТСП по сравнению с изолированной ТС и аллотрансплантацией трупной почки является меньшая частота и выраженность отторжения как сердечного, так и почечного трансплантата, а также частота возникновения болезни коронарных артерий пересаженного сердца. Приводится собственный опыт двух последовательных трансплантаций сердца и почки. Обсуждаются показания для одномоментной (симультанной) и последовательной трансплантации сердца и почки
HEART TRANSPLANTATION IN DIABETIC RECIPIENTS
No full textDiabetes mellitus is one of the most prevalent chronic metabolic disorders. Its role in patients with heart transplantation is not unifi ed. According to some authors, post-transplantation diabetes mellitus increases the risk of acute rejections and infections, increases the incidence of coronary artery disease of the graft and reduces long-term survival of patients with heart transplantation. On the other hand other studies did not confi rm these fi ndings. However, when diabetic patients were stratifi ed by disease severity, recipients with less severe disease achieved better survival. Accordingly, posttransplant survival was not signifi cantly different between recipients with uncomplicated diabetes and nondiabetic recipients. Diabetes alone should not be a contraindication to heart transplantation. Well-selected diabetic patients achieve the same survival as nondiabetic patients. Conversely, patients with complicated diabetes have signifi cantly worse survival. Therefore, given the critical shortage of transplantable organs, maximal benefi t may be achieved by exploring alternative treatment options in individuals with severe diabetes. These include use of high-risk transplant lists and destination therapy
Гемодинамика и газообменные эффекты ингаляционного оксида азота при ОРДС у кардиохирургических больных
No full textInhaled nitrous oxide (iNO) therapy aimed at improving pulmonary oxygenizing function and at decreasing artificial ventilation (AV) load has been used in foreign clinical practice in the past decade. The study was undertaken to evaluate the hemodynamic and gas exchange effects of iNO in acute respiratory distress syndrome (ARDS) that developed after car-diosurgical operations. Fifty-eight (43 males and 15 females) patients aged 21 to 76 (55.2±2.4) years were examined. The study has demonstrated that in 48.3% of cases, the early stage of ARDS is attended by the increased tone pulmonary vessels due to impaired NO-dependent vasodilatation. In these patients, iNO therapy is an effective therapeutic method for correcting hemodynamic disorders and lung oxygenizing function.В последнее десятилетие в зарубежной клинической практике при лечении острого респираторного дистресс-синдрома (ОРДС) стала применяться терапия ингаляционным оксидом азота иNO), направленная на улучшение оксиге-нирующей функции лёгких и снижение напряженности ИВЛ. Целью исследования явилась оценка гемодинамических и газообменных эффектов иNO при ОРДС, развившемся после кардиохирургических операций. Обследовали 58 больных (43 мужчин и 15 женщин) в возрасте от 21 до 76 (55,2±2,4) лет. Исследование продемонстрировало, что в 48,3% наблюдений начальная стадия ОРДС сопровождается повышением тонуса лёгочных сосудов, обусловленных нарушением NO-зависимой вазодилатации. У этих больных иNO-терапия является эффективным лечебным методом коррекции расстройств гемодинамики и оксигенирующей функции лёгких
MECHANISMS OF RIGHT VENTRICULAR FAILURE AND BIVENTRICULAR MECHANICAL CIRCULATORY SUPPORT
No full textThe paper presents a review of the problems of mechanical circulatory support with left ventricular bypass in total cardiac failure. Dysfunction of right ventricular defines the high mortality on left ventricular device. One of the effective methods for solving this problem is the use of right ventricular assisted devices. There are considered of the basic physiological mechanisms of interaction between the right and left ventricles of the heart, affecting on the function of the right heart. Shows the need to assess right ventricular function before deciding on mechanical circulatory support. Provides examples of the estimation the predictors of the right ventricular failure. The basic methods and devices of biventricular circulatory support were con- sidered
SUCCESSFUL APPLICATION OF PERIPHERAL VENO-ARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION FOR CARDIAC ALLOGRAFT ANTIBODY-MEDIATED REJECTION WITH SEVERE HEMODYNAMIC COMPROMISE
No full textIntroduction. Acute antibody-mediated rejection (AMR) is one of the severe complications of early and late period after heart transplantation (HT). Only few case reports and studies presented of mechanical circulatory support (MCS) application for refractory acute rejection causing hemodynamic compromise. Aim. We report the case of a woman with cardiogenic shock caused by severe AMR that was successfully treatment by peripheral venoarterial extracorporeal membrane oxygenation (VA ECMO). Material and methods. In december 2014, a 60-year-old woman with dilated cardiomyopathy was operated for HT. The patient had a good initial cardiac allograft function and no and was discharged from ICU on the 4th day after HT. 1st endomyocardial biopsy (EMB) (the 7th day after HT) showed absence of acute cellular and antibody-mediated rejection. On the 11th day after HT patient aggravated and presented clinical signs of life-threatening acute cardiac allograft dysfunction: arterial blood pressure 78/49/38 mm Hg, HR 111 in min, CVP 20 mm Hg, PAP 47/34/25 mm Hg, PCWP 25 mm Hg, CI 1.5 l/min/m2, adrenalin 110 ng/kg/min, dopamine 15 mcg/kg/min. ECG showed impairment of systolic left (LVEF 25%) and right (RVEF 15%) ventricle function, left and right ventricle diffuse hypokinesis, thickness of IVS, LV and RV wall 1.7, 1.4 and 0.8 cm, tricuspid and mitral valve regurgitation 2–3 degrees. EMB presented AMR. In conscience peripheral VA ECMO was installed. We used peripheral transcutaneous cannulation technique via femoral vessels – arterial cannula 15 F, venous cannula – 23 F, vascular catheter 14 G for anterograde leg’s perfusion. ACT 130–150 sec. AMR therapy included: methylprednisolon pulse-therapy (10 mg/kg for 5 day), IgG, plasmapheresis (No 7), rituximab. Results. Under MCS by VA ECMO we noted quick improvement of hemodynamic, metabolic homeostasis and organ functions. On the 6th day of VA ECMO (blood flow 1.8 l/min): arterial blood pressure 133/81/54 mm Hg, CVP 5 mm Hg, PAP 31/21/12 mm Hg, PCWP 12 mm Hg, CI 3,4 l/min/м2, HR 85 in min, LVEF 53%, IVS 1.3 cm, mitral valve regurgitation <1 degree, inotropic support was discontinued. Control EMB showed resolution of AMR. Duration of VA ECMO was 7 days. Patient was discharged from ICU on the 2nd and 26th day after VA ECMO in stable clinical status. Conclusion. VA ECMO should be crucial component of treatment of cardiac allogaft antibody-mediated rejection with severe hemodynamic compromise
Noninvasive Assisted Ventilation in Pulmonary Gas Exchange Dysfunctions in Cardiac Surgical Patients
No full textBackground. Postextubation pulmonary gas exchange dysfunctions are a potential complication in the activation of cardio-surgical patients in the early periods after surgical intervention. Objective: to evaluate the efficiency of noninvasive assisted ventilation (NIAV) as a method for correcting the pulmonary gas exchange disturbances developing after early activation of cardiosurgical patients. Subjects and methods. The study included 64 patients (36 males and 28 females) aged 21 to 72 (54±2) years who had been operated on under extracorporeal circulation (EC). The duration of EC and myocardial ischemia was 104±6 and 73±4 min, respectively. The indications for NIAV were the clinical manifestations of acute respiratory failure (ARF) and/or PaCO2>50 mm Hg and/or PaO2/FiO2Results. During NIAV, there was improvement (p<0.05) of lung oxygenizing function (the increase in PaO2/FiO2 was 23%), a reduction in Qs/Qt from 21.1±1.9 to 13.9±1.0% (p<0.05). NIAV was accompanied by a decrease in PaCO2 (p<0.05). Hypercapnia regressed in 7 patients with isolated lung ventilatory dysfunction (PaCO2>50 mm Hg) an hour after initiation of NIAV. During and after NIAV, there were reductions in right atrial pressure, mean pulmonary pressure, indexed total pulmonary vascular resistance (ITPVR) (p<0.05). Prior to, during, and following NIAV, mean blood pressure, cardiac index, and indexed total pulmonary vascular resstance did not change greatly. In hypercapnia, the duration of NIAV was significantly less than that in lung oxygenizing function (2.8±0.2 hours versus 4.7±0.5 hours). That of ICU treatment was 23±4 hours. Fifty-two (81%) patients were transferred from ICUs to cardiosurgical units on the following day after surgery. Conclusion. In most cases, NIAV promotes a rapid and effective correction of postextubation lung ventilatory and oxygenizing dysfunctions occurring after early activation of cardiosurgical patients. Key words: non-invasive assisted ventilation, early activation of cardiosurgical patients
Endopulmonary Bronchoalveolar Lavage Cytogram in the Prediction of Infective Pulmonary Complications in Concomitant Injury
No full textThe purpose of the study was to examine the time course of changes in the cellular composition of bronchoalveolar lavage (BAL) fluid to assess the possibilities of using the values of an endopulmonary cytogram (EPC) for the prediction of the development of infectious pulmonary complications and death in victims with severe concomitant injury. Sixty-three victims divided into 2 groups by the injury severity scale (ISS) (Beaker et al., 1974) were examined. For BAL sampling, a BF-XT40 endoscope (Olympus, Japan) was applied to bronchofibroscopy. To study BAL, the authors used the routine cyto-logical techniques and compared the latter’s results with those of EPC. The data were statistically processed, by employing the Statistica 6.0 programs; p Kozlov I. A., Poptsov V. N. Combined Therapy with Nitric Oxide and Surfactant-BL for Acute Respiratory Distress Syndrome After Operations Using Extracorporeal Circulation ….15 Abstract Выбрать Показать The present study was undertaken to comparatively evaluate the efficacy of inhalational nitric oxide alone and in combination with surfactant-BL in the complex therapy for acute respiratory distress syndrome (ARDS) after surgery under extracorporeal circulation (EC). The study included 53 patients aged 21 to 76 years. It has revealed that in ARDS that complicates operations under EC, the use of surfactant-BL during therapy with inhalational nitric oxide enhances the latter’s effects on arterial oxygenation, accelerates the regression of pulmonary oxygenizing dysfunction, and reduces the duration of artificial ventilation and the length of stay in an intensive care unit
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