ABSTRACT
Congestive heart failure with intact or moderately lowered left ventricular pump function is caused in some patients by mitral regurgitation. Consequences are dilation of the left atrium, pulmonary hypertension, tricuspid regurgitation, thromboembolic complications, rhythm disturbances, elevated risk of sudden death. Efficacy of drug treatment, electroimpulse therapy is little and surgery is the method of choice. One of alternatives is cardiac autotransplantation. A successful experience of application of this technique is presented. Cardiac autotransplantation was carried out in a female patient with moderately lowered left ventricular contractile function, extreme degree of mitral and tricuspid regurgitation, atriomegaly, atrial fibrillation and pronounced signs of congestive heart failure.
Subject(s)
Heart Failure/surgery , Heart Transplantation , Female , Heart Failure/diagnostic imaging , Heart Failure/etiology , Humans , Middle Aged , Mitral Valve Insufficiency/complications , Radiography , Transplantation, Autologous , Treatment OutcomeABSTRACT
Congestive heart failure with preserved or moderately lowered left ventricular pump function in some patients is caused by mitral regurgitation. Its consequences are left atrial dilation, pulmonary hypertension, tricuspid regurgitation, thromboembolic complications, disturbances of rhythm with elevated risk of sudden death. As efficacy of drug treatment and electroimpulse therapy is small surgery is the method of choice and one of alternatives - autotransplantation of the heart. Here we present a successful experience of application of this technique in a patient with moderately lowered left ventricular function, extreme degree of mitral and tricuspid regurgitation, atriomegaly, atrial fibrillation, and pronounced manifestations of congestive heart failure.
Subject(s)
Heart Failure/surgery , Heart Transplantation/methods , Female , Follow-Up Studies , Heart Failure/diagnostic imaging , Heart Failure/physiopathology , Humans , Severity of Illness Index , Tomography, X-Ray Computed , Transplantation, Autologous , Ventricular Function, Left/physiologySubject(s)
Aortic Valve Insufficiency/surgery , Cardiomyopathy, Dilated/surgery , Heart Atria , Heart Failure/surgery , Heart Transplantation/methods , Mitral Valve Insufficiency/surgery , Stroke Volume/physiology , Aortic Valve Insufficiency/complications , Aortic Valve Insufficiency/physiopathology , Cardiomyopathy, Dilated/complications , Cardiomyopathy, Dilated/physiopathology , Echocardiography , Electrocardiography, Ambulatory , Female , Follow-Up Studies , Heart Atria/diagnostic imaging , Heart Atria/physiopathology , Heart Failure/etiology , Heart Failure/physiopathology , Humans , Middle Aged , Mitral Valve Insufficiency/complications , Mitral Valve Insufficiency/physiopathology , Severity of Illness Index , Tomography, X-Ray Computed , Transplantation, AutologousABSTRACT
Changes in hemodynamics and blood oxygen transport function were studied during coronary bypass surgery (CBS) on the working heart under anesthesia with propofol and fentanyl. In patients operated on the working heart, the course of the basic stage of an operation was characterized by a moderate reduction in cardiac index and stroke volume due to the cardiac changes and immobilization, which resulted in cardiac compression and venous return deterioration. These impairments did not lead to worse oxygen-transportfunction and they were completely eliminated in the rehabilitative period. Analyzing the results of studies of troponin-T and creatinine kinase-MB showed that the procedure of coronary bypass surgery without using EKK had a less damaging effect on the myocardium. Analyzing the course of an early postoperative period indicated that the use of perfusionless technology substantially reduced needs for inotropic support, the time of artificial ventilation, and the length of stay at an intensive care unit.
Subject(s)
Coronary Artery Bypass , Heart/physiopathology , Aged , Cardiopulmonary Bypass , Female , Hemodynamics , Humans , Male , Middle Aged , Oxygen/blood , Oxygen ConsumptionABSTRACT
Operations were performed on 183 patients with infective endocarditis and injury of the valve apparatus of the heart. Duration of the disease was from 5 weeks to 9 years. Insufficiency of circulation of the III-IV functional class was noted in 92% of the patients. High activity of the infective process observed in 30% of the patients by the moment of operation did not influence the results of surgical treatment. Postoperative lethality was 7.6%.
Subject(s)
Cardiac Surgical Procedures/methods , Endocarditis, Bacterial/surgery , Adolescent , Adult , Aged , Child , Chronic Disease , Endocarditis, Bacterial/physiopathology , Equipment Design , Female , Heart Valve Prosthesis Implantation/instrumentation , Hemodynamics/physiology , Humans , Male , Middle Aged , Myocardial Revascularization/instrumentation , Outcome Assessment, Health Care , Postoperative Complications/mortality , Retrospective Studies , Severity of Illness Index , Survival RateABSTRACT
The authors share the observations from their cardiosurgical practice showing that one of the causes of sudden death or of rapid worsening of the state of patients with implanted bicuspid artificial valves might be their dysfunction resulting both from breakage of the hinged mechanisms of the valve with its dislocation and migration and from the disturbed mobility of the valve cusp due to a thrombus formed in the atrium. The observations show that the "ideal" construction of the valve is to be created.
