[Treatment of reperfusion renal lesion after surgical management of chronic post-embolic pulmonary hypertension by means of extracorporeal membrane oxygenation (ECMO)].

Thromboendarterectomy from the branches of the pulmonary artery is a conventionally accepted approach to treatment for pulmonary hypertension in chronic pulmonary embolism. A frequently encountered complication associated with this operation is the development in the postoperative period of the reperfusion syndrome as a potential cause of fatal respiratory failure. Taking into consideration that the reperfusion syndrome is a reversible process, waiting measures of support may save the patient's life. The present article deals with a case report concerning successive surgical management of a female patient suffering from chronic recurrent pulmonary thromboembolism accompanied by high pulmonary hypertension complicated by severe respiratory insufficiency in the early postoperative period, thus requiring long-term use of veno-venous extracorporeal membrane oxygenation (ECMO). The clinical case described in the article shows that veno-venous ECMO may be employed to save patients presenting with reperfusion syndrome following thromboendarterectomy from the branches of the pulmonary artery. The method of connecting ECMO namely in the veno-venous option in this particular case was determined by fact that the patient had no cardiac insufficiency. Numerous studies conducted hitherto have also confirmed that using ECMO in the veno-venous variant is accompanied and followed by a lower incidence rate of complications as compared with that of the veno-arterial variant. The results of our case report strongly suggest that timely use of ECMO in the composition of rehabilitation measures during restoration of the compromised lungs may become an effective strategy aimed at improving survival of patients after successful thromboendarterectomy from the pulmonary artery branches.

[Cardiorespiratory abnormalities and cerebral oxygen supply in chronic thromboembolic pulmonary hypertension].

Aim of the study was assessment of severity of cardiorespiratory abnormalities and cerebral oxygen supply in patients with chronic thromboembolic pulmonary hypertension (CTEPH). We examined 56 patients with diagnosis of chronic pulmonary thromboembolism and duration of the disease 3 (1.5-4.1) years. According to data of pulmonary angiography pulmonary artery pressure was 78 (58-92) mm Hg, pulmonary vascular resistance - 618 (450-935) dyne/sec/cm-5, Miller index - 25 (22-27). Further investigation revealed changes of anatomo-functional parameters of the heart and parameters of pulmonary ventilation. These changes were associated with insufficient oxygen supply to the brain and lowering of tolerance to hypoxia. Results of this study should be taken into consideration when brain protective measures are provided during surgical treatment of CTEPH.

[Dynamics of lung perfusion after pulmonary thromboendarterectomy in patients with chronic postembolic pulmonary hypertension].

Perfusion scintigraphy of the lungs is used as screening in order to confirm thrombormbolic genesis of pulmonary hypertension. Meanwhile, perfusion scintigraphy is a non-invasive and objective method of assessing haemocirculation in the pulmonary tissue. Using the quantitative method of calculation of the perfusion deficit, one may judge about efficiency of the treatment performed and to assess the dynamics of the state of the micro- circulatory bed of the lung. We examined a total of 53 patients presenting with chronic postembolic pulmonary hypertension, who underwent pulmonary thromboendarterectomy. Pulmonary tissue blood flow was assessed by means of perfusion scintigraphy prior to operation, and in the early postoperative (3 weeks after operation) and remote (6 months and more) periods. Analysing the values of perfusion deficit in patients depending on the pulmonary hypertension degree we revealed close correlation dependence between the perfusion deficit and pulmonary hypertension, i. e., increased pressure in the pulmonary artery was accompanied by a decreased defect of lung perfusion according to the findings of perfusion scintigraphy. Analyzing the findings of perfusion scintigraphy in patients presenting with chronic postembolic pulmonary hypertension prior to surgery, in the immediate and remote postoperative periods in all groups showed a statistically significant decrease in the perfusion deficit. It was demonstrated that the method of perfusion pulmonary scintigraphy reliably reflects the alterations in the pulmonary tissue perfusion after lung pulmonary thromboendarterectomy, thereby reflecting efficiency of surgical treatment. With the initially pronounces pulmonary hypertension, improvement of lung perfusion obtained at the hospital stage also continues in the remote period.