[Use of extracorporeal membrane oxygenation for pulmonary haemorrhage after pulmonary endarterectomy]. / Primenenie ékstrakorporal'noi membrannoi oksigenatsii pri legochnom krovotechenii posle legochnoi éndarteréktomii.

Pulmonary haemorrhage is one of the most severe complications of pulmonary endarterectomy. To the most effective methods of combating this potentially fatal complication belongs extracorporeal membrane oxygenation (ECMO). In this article we describe a clinical case report regarding intraoperative use of central veno-arterial ECMO for pulmonary haemorrhage following thromboendarterectomy from the pulmonary arteries. According to the data of some authors, long-term ECMO support (for more than 4 days) may lead to such severe consequences as rethrombosis of pulmonary arteries and impairment of cerebral circulation. In our case we managed to avoid such complications, taking into consideration that the duration of ECMO amounted to 21 days. Resulting from the carried out comprehensive therapeutic measures by the time of discharge from hospital, a significant decrease in pulmonary artery pressure was achieved, with events of residual pulmonary hypertension.

[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.

[Treatment of a patient with a ruptured infectious aneurysm of the aortic arch].

Described in the article is a clinical case report concerning surgical treatment of a 65-year-old male patient presenting with a ruptured infectious aortic arch aneurysm. He was subjected to an operation consisting in prosthetic repair of the ascending portion of the aorta and aortic arch with a homograft under conditions of artificial circulation, deep hypothermia, and antegrade cerebral perfusion.

[Lipid peroxidation and cytochrome P-450-dependent metabolism of xenobiotics in patients with coronary heart disease and multiple organ failure].

The aim of the investigation was to study oxidative stress and hepatic monooxygenase function (HMF) in coronary heart disease (CHD) patients with multiple organ dysfunction (MOD) after myocardial revascularization. Twenty-seven CHD patients with signs of MOD and 38 patients with an uncomplicated postoperative period were examined. The intensity of MOD was rated by the SOFA scale; oxidative stress was estimated from the values of malondialdehyde, conjugate trienes, ceruplasmin, and catalase, and HMF was evaluated from antipyrine pharmacokinetic data. On postoperative day 1, the study group showed significant signs of MOD, as well as activated lipid peroxidation (LPO) and a 1.5-fold reduction in HMF. The control group displayed an insignificant HMF suppression under less marked oxidative stress. On days 3-4 after surgery, the total MOD index was noticeably lowered. Both groups exhibited a high LPO rate and enhanced HMF. On days 10-12 postoperatively, the severity of MOD corresponded to the previous period. There was a decrease in LPO activity in both groups. HMF was found to substantially reduce in the study group and to be in line with the baseline values in the control one. Correlation analysis revealed direct and inverse relationships of the indices of MOD with LPO rates and HMF. Therefore, MOD in patients with CHD is attended by increased oxidative stress and leads to a more significant HMF reduction as compared with those with an uncomplicated postoperative period. At the same time, LPO activation is one of the cardinal causes of HMF suppression. Reduced HMF may enhance the sensitivity of CHD patients to drug therapy.

[Experience with intra-aortic balloon pumping preventively used in patients with a low left ventricular ejection fraction, operated on under extracorporeal circulation].

One hundred and fifty-six patients with coronary heart disease and a low (less than 30%) left ventricular ejection fraction (EF), operated on under extracorporeal circulation and preventive intra-aortic balloon pumping (IABP) were examined. The latter was found to promote the maintenance of stable hemodynamic parameters during and after surgery. Postoperative acute heart failure developed in 101 (64.7%) patients. Mortality was 9.6% (15 patients), in 9 cases death occurred after acute heart failure. There were no intra- and postoperative cases of lower extremity ischemia. Thus, preventive IABP is a safe and effective procedure in patients with low myocardial contractility (EF less than 30%), operated on under extracorporeal circulation.

[Oxidative stress and hepatic monooxygenase function in patients with coronary heart disease before and after cardiac surgery].

The parameters of lipid peroxidation (LPO) and hepatic monooxygenase function (HMF) were studied in 92 patients with coronary heart disease (CHD). After termination of and within the first 24 hours after myocardial revascularization, the levels of malonic dialdehyde and conjugate trienes were found to show 45.6 and 62.1% increases, respectively. The half-life of antipyrine (AP T(1/2)) increased by 23.5%. Studies on postoperative days 3-4 and 10-12 revealed a reduction in LPO rates and normalized HMF. After off-pump surgery, LPO and HMF significantly unchanged. On the contrary, open heart surgery resulted in a noticeable activation of LPO and an almost 1.5-fold decrease in HMF. The increase in oxidative stress and the deceleration of hepatic microsomal oxidation were ascertained to be directly related to the duration of extracorporeal circulation and the time of myocardial ischemia. After surgery, the rate of LPO and the reduction of HMF were more considerable in patients with multiple organ dysfunctions, as compared with the uncomplicated postoperative period. Within the first 24 hours following surgery, AP T(1/2) increased by 83.4%, but on postoperative days 10 to 14, it remained to be decreased by almost 1.5 times as compared with the baseline. Thus, LPO activation is one of the leading mechanisms of decelerated hepatic xenobiotic biotransformation after myocardial revascularization. Diminished lower HMF enhances the sensitivity of CHD patients to drug therapy and requires a differential approach to its use.

[A case of surgical treatment of post-traumatic false arteriovenous aneurysm of the right kidney vessels]. / Sluchai khirurgicheskogo lecheniia posttravmaticheskoi lozhnoi arteriovenoznoi anevrizmy sosudov pravoi pochki.

This paper describes an experience gained with successful surgical correction of post-traumatic false aneurysm of the right kidney vessels in a 36-year-old patient operated on previously for knife wound and intrahepatic abscess. All-round examination (duplex scanning of the renal arteries, multispiral computed tomography, abdominal aortography, and ultrasonography of the kidneys) revealed a false aneurysm of the medium segment of the right kidney artery measuring 31x21x33 mm. The aneurysm was located downwards, to the rear and inwards from the artery, with marginal posteroinferior calcification drained to the venous collector (the right kidney vein) expanded to 36-40 mm. The preoperative diagnosis: a post- traumatic false arteriovenous aneurysm of the right kidney vessels; vasorenal hypertension; IIa stage circulatory insufficiency; chronic pyelonephritis, remission; hydronephrosis on the right; 0-I stage chronic renal insufficiency. In view of the failure of the attempts to accomplish endovascular intervention, progression of right ventricular heart insufficiency, the presence of vasorenal hypertension, and right kidney malfunction we performed operation which consisted in evacuation of the false arteriovenous aneurysm of the right kidney artery, plasty of the defect of the right kidney vein and of the defect of the right kidney artery by the aneurysmal wall. The postoperative period was uneventful. Control ultrasonography failed to discover arteriovenous shunting at the level of the right kidney arteries. Also, auscultation did not reveal any murmur in the projection of the renal vessels on the right and above the abdominal aorta. On the 14th postoperative day the patient was discharged from the clinic in a satisfactory condition. His laboratory and hemodynamic parameters were good.

[The study of cerebral oxygenation and central hemodynamics in patients with ischemic heart disease at rest and during physical effort.]. / Issledovaniia tserebral'noi oksigenatsii i tsentral'noi gemodinamiki u bol'nykh ishemicheskoi bolezn'iu serdtsa v pokoe i pri fizicheskoi nagruzke.

Cerebral oxygenation (rSO(2)) in the region of sagittal sinus and main hemodynamic parameters were measured in 112 patients with ischemic heart disease and class II-III angina. Four groups of patients were distinguished according to degree of rSO(2) lowering. Hemodynamics and oxygen transport function of the blood were proportionally related to degree of rSO(2) lowering. Normal rSO(2) (>70%) and degree lower (70-61%) was associated with predicted (desirable) cerebral blood flow. Lower rSO(2) values (60-50%) were accompanied with increased oxygen utilization (by 20-25%). Critical rSO(2) lowering (below 50%) was associated with>/=75% rise of oxygen utilization what was indicative of decreased brain blood flow and cerebral ischemia.