[TRANSPORT OF OXYGEN DURING GEOMETRICAL RECONSTRUCTION OF THE LEFT VENTRICLE IN CONJUNCTION WITH CORONARY ARTERY BYPASS GRAFTING AND USING OF HIGH THORACIC EPIDURAL ANESTHESIA AS A MAJOR COMPONENT OF GENERAL ANAESTHESIA].

UNLABELLED: The purpose of the study is to examine the perioperative dynamics of strategic blood oxygen transport indicators: delivery (DO2), consumption (VO2), the coefficient of oxygen uptake (CUO2) and their composition, as well as the dynamics of blood lactate indicators in patients with ischaemic heart disease (IHD) who underwent surgery under cardiopulmonary bypass with high thoracic epidural anaesthesia (HTEA) as the main component of anesthesia. MATERIALS AND METHODS: Research was conducted in 30 patients with a critical degree of operational risk, during the correction of post-infarction heart aneurysmn using the V. Dor method in combination with coronary artery bypass grafting. RESULTS: The strategic blood oxygen transport indicators (delivery, consumption and the oxygen uptake coefficient) showed a statistically significant decrease compared to the physiological norm and to the initial data at two points of the research: the intubation of the trachea and during cardiopulmonary bypass. The system components of oxygen were influenced at problematic stages by the dynamics of SvO2 (increase), AVD (decrease), hemodilution withe fall of the HIb- in the process of JR in the persence of superficial hypothermia. The maintenance of optimal CA in the context of HTEA, combined with a balanced volemic load and a minimized cardiotonic support ensured the stabilisation of strategic blood oxygen transport indicators aithe postperfusion stage and during the immediate postoperative period CONCLUSION: The article is dedicated to the study of strategic blood oxygen transport indicators and their components during the operation of geometric reconstruc-tion of the left ventricle combined with coronary artery-bypass using cardiopulmonary bypass and with high thoracic epidural anesthesia as the main component of general anaesthesia. The analysis has covered the stagewise delivery dynamics, consumption and the oxygen uptake coefficient at II stages of the operation and of the immediate postoperative period. The study has ident (fled the causes qf reduced oxygen transport during the preperfu- sion and postperfusion periods, under IR and during the immediate postoperative period. Values of CA, SvO2, AVD, Hb, hemnodilution, T qf the body in oxygen transport indicator dynamics have been proven. A way of maintaining oxygen transport indicators close to the physiological norm in the immediate postoperative period has been justified.

[DISORDERS OF LUNG FUNCTION IN THE EARLY POSTOPERATIVE PERIOD IN PATIENTS OPERATED ON THE ASCENDING AORTA WITH THE EXPANSION OF INTERVENTION ON THE AORTIC ARCH].

Precapillary artery--arterial (bronchial artery--pulmonay artery) anastomoses, come into play in cases where the locking artery open and alveoli washed arterialized blood. Normally, these anastomoses are closed. Intrapulmonary shunts carry blood supply acinar hinder extraordinary circumstances (chronic pulmonary embolism, surgery, occurring in cardiopulmonary bypass, when the flaw of blood through the Iungs is suspended for the duration of cardiopulmonary bypass). Patients operated on the ascending aorta with the expansion of intervention on the nortic arch during the correction of pathology carry blood supply only the central nervous system. All other organs and systems at this time were protected by mild hypothermia. However, during circulatory arrest, required for correction of pathology acinar damage as a result of hypoxia, probably because there is no blood flow in the pulmonary artery and there is no blood flow in the bronchial arteries. Last, in the ordinary course of artificial circulation, capable due to arterio-arterial pulmonary anastomoses prevent hypoxic damage to acinar, not lead to persistent hypoxemia in the immediate postoperative period in these patients, as a result of violations of lung diffusion capacity.

[Relations between several parameters of respiratory mechanics after radical correction of congenital heart defects]. / Sviaz' mezhdu nekotorymi pokazateliami mekhaniki dykhaniia posle radikal'noi korrektsii vrozhdennykh porokov serdtsa.

The results of this study are at variance with highly prevalent opinion that an increase in Vinsp leads to a parallel growth of Cst. A different degree of relationship between Vinsp and Cst was observed in the studied groups (from 0.33 to 0.92). These relationships in children with congenital heart disease are determined by the state of pulmonary circulation and lung parenchyma before surgery and after correction and depend on the form of the defect and patient's age. Such a variety of values is due to specificity of changes in the lungs depending on the pathomorphology of congenital heart disease and progress of these changes with age.

[New conditions for evaluating static compliance]. / Novye usloviia opredeleniia staticheskoi podatlivosti (Cst).

Static compliance (Cst), time course and clinical and diagnostic significance of relationship between Cst and Vinsp were studied in 97 patients with congenital heart diseases aged over 3 years after open-heart surgery for correction of the defect during uneventful immediate postoperative period. Three groups of patients were distinguished: 1) patients operated on for Fallot's tetralogy without a previous aortopulmonary anastomosis (TF-1); 2) patients with Fallot's tetralogy with a previous systemic pulmonary anastomosis (TF-2); 3) patients operated on for atrioventricular septal defects and incomplete atrioventricular communication. Age subgroups of 3-5, 6-8, 9-11, and 12-15 years were singled out in each group. The proposed modified method for measuring Cst in children aged over 3 years operated on for congenital heart disease more accurately and reliably characterized the status of lung parenchyma. As a result, the correlation (r) between Cst and Vinsp in all nosological groups and age subgroups was much higher than was previously reported.

[The mechanical properties of the lungs in patients with congenital heart defects in the immediate postoperative period]. / Mekhanicheskie svoistva legkikh u bol'nykh s vrozhdennymi porokami serdtsa v blizhaishem posleoperatsionnom periode.

Static compliance and inspiratory resistance were assessed in 218 patients aged over 3 years after open-heart surgery for correction of congenital heart disease during the immediate postoperative period without complications. Cst in the immediate postoperative period in patients with Fallot's tetralogy, intraventricular septum defect, intraatrial septum defect, and incomplete form of atrioventricular communication was higher than in patients operated on for Fallot's tetralogy with a previous systemic-pulmonary anastomosis and pulmonary artery atresia, whereas Rinsp was virtually the same in all groups. Age-specific differences were noted. The data are recommended for use as reference values in stress.

[The use of a pressure-support ventilation regimen in the recovery of spontaneous respiration after heart operations]. / Ispol'zovanie rezhima ventiliatsii podderzhkoi davleniem pri vosstanovlenii spontannogo dykhaniia posle operatsii na serdtse.

Pressure-support ventilation (PSV) with supporting pressure (SP) levels 20, 15, 13, 10, and 8 mm H2O was used in 111 patients with congenital heart disease after open-heart surgery during transfer to spontaneous respiration. PSV was associated with a significant decrease of respiratory rate and increase of respiratory volume (RV) at high SP levels. Respiration in the PSV mode permits the patient to control the inspiration flow, duration of inspiration phase, and RV, thus improving the patient-device synchronization. Cardiac index (CI) was changing with decrease of SP from 20-15 to 13 mm H2O in patients with different diseases during high SP PSV. This is caused by changed pulmonary circulation (transfer to intraacinar type) which increased the negative correlation between CI and chosen SP. In addition, CI depends not only on RV, but on the status of lung parenchyma as well.

[The cardiac index dynamics of patients after the radical correction of tetralogy of Fallot depending on the level of the pressure-support ventilation (PSV) regimen]. / Dinamika serdechnogo indeksa u bol'nykh posle radikal'noi korrektsii tetraday Fallo v zavisimosti ot urovnia podderzhivaiushchego davleniia rezhima ventiliatsii PSV.

Seventeen patients were examined, reoperated on for correction of Fallot's tetralogy on the open heart after a previous aortopulmonary anastomosis. Pressure support ventilation (PSV) was used in all patients during transfer to spontaneous pressure, making use of different levels of pressure support (20, 15, 13, 10, and 8 mm H2O). Decrease of pressure support from 20-15 mm H2O to 13 mm H2O resulted in a sharp increase of cardiac index. We explain this phenomenon by a drastic increase of the respiratory volume during the use of high PSV levels (20-15 mm H2O), surpassing 1.5-2 times the physiological and age-specific norm; this leads to a sharp increase of the mean intrathoracic pressure, disturbing the cardiovascular function.