ABSTRACT
In 50 patients undergoing direct revascularization of the myocardium, an attempt was made to carry out transesophageal echocardiography. In 5 of them, visualization of the myocardium appeared unsatisfactory, 2 patients were excluded from the investigation in view of the fact that they were operated on in the acute phase of myocardial infarction. Among 43 patients who were entered into the investigation, the areas of abnormal local contractility of the myocardium (AILC) occurred during surgery in 14 (33%). In 3 patients, the newly occurring disorders of local contractility of the myocardium persisted till the end of the operation. In the remaining cases, the presence of the AILC was temporary. The sensitivity of the newly occurring stable AILC in the diagnosis of perioperative myocardial infarction and acute coronary death amounted to 75%, specificity was 100%.
Subject(s)
Coronary Disease/diagnostic imaging , Echocardiography/methods , Intraoperative Complications/diagnostic imaging , Myocardial Infarction/diagnostic imaging , Adult , Aged , Coronary Disease/physiopathology , Coronary Disease/surgery , Creatine Kinase/blood , Echocardiography/instrumentation , Esophagus , Female , Humans , Intraoperative Complications/physiopathology , Intraoperative Complications/surgery , Male , Middle Aged , Myocardial Infarction/physiopathology , Myocardial Infarction/surgery , Myocardial Revascularization , Postoperative Period , Transducers , Ventricular Function, Left/physiologyABSTRACT
Sympathomimetic agents: isoproterenol (novodrin), dopamine, noradrenalin, adrenalin were used in 137 patients with acute circulatory insufficiency. Their hemodynamic effects were assessed, using catheterization of heart chambers and radiocardiography, and studies of circulating blood oxygen transport, acid-base state and metabolic product levels. A differential approach to sympathomimetic treatment has been developed. Isoproterenol is primarily indicated in those cases where myocardial failure is combined with decreased heart rate, conductivity disorders and markedly increased total peripheral resistance. Dopamine is more justified in cases where increasing the heart rate is more desirable, and there are signs of renal failure and heart rhythm disorders. The possibility of dopamine-induced pulmonary hypertension and pO2 fall should not be dismissed. Correct choice of an agent or a combination of agents makes it possible to control the patient's condition through action on various hemodynamic mechanisms that determine the magnitude of cardiac output.