[Right ventricular insufficiency in patients in the early periods after orthotopic transplantation of donor heart]. / Pravozheludochkovaia nedostatochnost' u patsientov v rannie sroki posle ortotopicheskoi transplantatsii donorskogo serdtsa.

The function of transplanted heart in the early postoperative period is analyzed in 20 patients operated on at the Research Center of Surgery of the Russian Academy of Medical Sciences. Cardiac function was assessed by a complex of hemodynamic parameters, among which were the ratio between the ventricular stroke index and end diastolic pressure in the ventricle. Right-ventricular dysfunction of varying severity was detected in all the patients in the immediate postoperative period. Three variants of right-ventricular insufficiency were singled out: isolated right-ventricular insufficiency with increased (20%) and normal (45%) total vascular resistance and right-ventricular insufficiency combined with left-ventricular insufficiency (35%). Isolated right-ventricular insufficiency could be, as a rule, treated by combined intensive care including sympathomimetics and vasodilators. A combination of right-ventricular and left-ventricular insufficiency, which may be caused by incompatability between the sizes of the donor and recipient, as well as hypoxic and metabolic cardiac injury in donor body, is prognostically infavorable, for it requires intensive inotropic therapy and is associated with a high mortality.

[The use of ultra-high doses of insulin for the treatment of severe heart failure during cardiosurgical interventions]. / Ispol'zovanie sverkhvysokikh doz insulina dlia lecheniia tiazheloi serdechnoi nedostatochnosti vo vremia kardiokhirurgicheskikh vmeshatel'stv.

The experience is reviewed on the use of superhigh insulin doses 1200 to 3800 U (31.4 +/- 5.3 U/kg) for the treatment of acute heart failure in 17 patients subjected to open heart surgery. Symptoms of heart failure refractory to catecholamines and vasodilators were accompanied by marked hyperglycemia (23.1 +/- 4.3 mmol/l). It was impossible to discontinue assisted circulation. In 82.3% of patients myocardial contractility upon insulin administration improved considerably, which led to discontinuation of assisted circulation with moderate inotropic support. Possible mechanisms ensuring the efficacy of massive insulin therapy in patients with acute heart failure are discussed.

[The effect of the graft contraction rate on the intraoperative hemodynamics in orthotopic heart transplantation]. / Vliianie chastoty sokrashchenii transplantata na intraoperatsionnuiu gemodinamiky pri ortotopicheskoi transplantatsii serdtsa.

Intraoperative hemodynamics has been studied during orthotopic heart transplantation (OHT) in 36 recipients, aged 14 to 56 years, with spontaneous contractions of the graft. It has been established that patients with HR greater than 110 beats per min were in most cases characterized by normal central venous pressure (CVP) and venous blood oxygenation parameters. In lower HR, CVP is considerably higher and the indexes characteristic of the adequacy of cardiac output to body oxygen requirements are deteriorated. Right after OHT there is a reverse dependence between HR and CVP, with the lowest CVP values corresponding to HR intervals 101-120 and 121-140 per min. It has been concluded that tachycardia in the intraoperative period ensures a more effective function of the transplanted heart.

[Anesthesiologic management of clinical orthotopic liver transplantation]. / Anesteziologicheskoe obespechenie ortotopicheskoi transplantatsii pecheni v klinike.

The first clinical experience of anesthesiological management during 6 orthotopic liver transplantations (5 primary operations and 1 retransplantation) in 2 males and 3 females, aged 20 to 52 years, is presented. The method of general anesthesia is described--the use of veno-venous bypass without systemic heparinization and rapid infusion system. Hemodynamic, temperature, metabolic and coagulologic homeostasis disturbances are analysed at different stages of orthotopic liver transplantation, especially upon reperfusion of the donor organ. The tactics of infusion-transfusion therapy, as well as correction of electrolyte disturbances and blood coagulation disorders are being discussed. Different intraoperative complications are characterized. It is concluded that anesthesiological management of liver transplantations is one of the most complex problems of modern anesthesiology which takes joint effort of a large team of specialists: surgeons, anesthesiologists, perfusiologists, transfusiologists, and laboratory assistants specializing in different areas.