[Left ventricular dysfunctions after correction of aortic stenosis].

The purpose of the investigation was to study central hemodynamics and left ventricular function in low cardiac output after correction of aortic stenosis. The study included 34 patients (28 males and 6 females) aged 59. 7+/-1.5 years, surged with cardiopulmonary bypass (CPB). Low cardiac output was detected in all cases in the post-CPB period. Inotropic support with dopamine and/or dobutamine was effective in 47% of the patients (Group 1) and ineffective in 53% (Group 2). There were no statistically significant differences in cardiac index and pulmonary wedge pressure between the groups. Group 1 patients had ultrasound signs of left ventricular systolic dysfunction (low left ventricular ejection fraction and larger left ventricular systolic and diastolic areas in the transgastric position). Group 2 patients had ultrasound signs of left ventricular diastolic dysfunction (high left ventricular ejection fraction and smaller left ventricular systolic and diastolic areas). beta-blockers were used in 10 patients from Group 2. Central hemodynamics and left ventricular function normalized in all these cases. It is concluded that it is possible to recognize left ventricular dysfunctions in low cardiac output after aortic valve replacement with transesophageal echocardiography. Inotropic support is effective in only patients with left ventricular systolic dysfunction. Patients with left ventricular diastolic dysfunction should receive beta-blockers.

[The plasma level of an inactive moiety of B-type natriuretic peptide precursor as a predictor of cardiac function during operations under extracorporeal circulation].

Ventricular cardiomyocytes secrete brain natriuretuc peptide (BNP) and an inactive moiety of its precursor (nt-proBNP). It is recommended the blood level of the latter should be monitored to ascertain the severity of myocardial lesion. This investigation was undertaken to study the diagnostic and prognostic value of a substantial increase in blood nt-proBNP levels (600 pg/ml or more) in patients operated on under extracorporeal circulation. Thirty-eight patients operated on for coronary heart disease were examined. Before surgery, the plasma concentration of nt-proBNP had been determined by electrochemiluminescence (Elescys, Roche). According to plasma nt-proBNP levels, the patients were divided into 2 groups: 1) 24 patients with nt-proBNP levels of less than 600 pg/ml; 2) 14 patients with its levels of 600 pg/ml or more. Group 1 patients showed signs of diastolic dysfunction of the right ventricle: the lower ratio of its early to atrial filling linear velocity integrals and the increased end-diastolic volume index. In the postperfusion period, nt-proBNP is a significant independent predictor of left ventricular function. The patients with the baseline nt-proBNP levels of above 600 pg/ml were found to have decreases in ejection fraction of the left ventricle and in its pump ratio along with elevated pulmonary wedge pressure.

[Anesthetic management of the surgical correction of heart valve defects combined with myocardial revascularization]. / Anesteziologicheskoe obespechenie khirurgicheskoi korrektsii porokov klapanov serdtsa v sochetanii s revaskuliarizatsiei miokarda.

Thermodilution volumetry of the right ventricle (RV) in the course of combined operations has demonstrated significance of RV function and identified signs of its dysfunction when other parameters of hemodynamic monitoring were low informative. Of late, introduction of updated anesthetic modalities and intraoperative monitoring have noticeably improved surgical outcomes of combined lesions of the heart as shown by decreased hospital lethality.