[Right ventricular dysfunction after left ventricular assist device implantation]. / Dysfunkce pravé komory po implantaci levostranné mechanické srdecní podpory.

OBJECTIVE: The frequency of long-term left ventricular assist device (LVAD) implantation is increasing. Acute right ventricular dysfunction or right ventricular failure after LVAD implantation has important influence on morbidity and mortality. The aim of our study was to assess the management of right ventricular dysfunction after LVAD implantation. METHODS: The study group comprised 21 patients with implanted HeartMate II LVAD since December, 2006 to April, 2009. We evaluated in retrospective fashion baseline parameters of cardiovascular and other organ systems before LVAD implantation, applied pharmacological and mechanical support for the right ventricle, and important clinical outcomes to the end ofJune, 2009. RESULTS: LVAD was implanted in 18 men and 3 women with mean age of 48.7 +/- 11.2 years. The most frequent diagnosis was dilatational cardiomyopathy (9 patients; 42.9%), and the most frequent indication for implantation was bridge-to-transplantation (19 patients; 90.4%). Pharmacological support of the right ventricle after LVAD implantation comprised dobutamine (21 patients; 100%), milrinone (21 patients; 100%), isoproterenol (1 patient; 4.8%), and levosimendan (5 patients; 23.8%). In 2 (9.5%) cases there was a need for repeated application of levosimendan during postoperative course. Inhalational nitric oxide was used in 14 (66.7%) patients. Despite extensive pharmacological support, 3 (14.3%) patients needed right ventricular assist device (RVAD) implantation. Most patients (9; 42.8%) survived to heart transplantation; in one (4.8%) case LVAD was successfuly explanted; 6 (28.6%) patients is living with LVAD; 5 (23.8%) patients died during LVAD support. CONCLUSION: After LVAD implantation there is a need for aggressive pharmacological, and in some cases mechanical, support of the right ventricular function to provide adequate blood flow to LVAD in order to minimize morbidity and mortality.

The effect of the ultrashort beta-blocker esmolol on cardiac function recovery: an experimental study.

OBJECTIVE: This is an experimental work designed to determine, using the isolated perfused rat heart, the effect of the ultra-short acting beta-blocker esmolol on cardiac arrest and cardiac function recovery following esmolol withdrawal. METHODS: Changes in heart rate, coronary flow, diastolic pressure and the rate pressure product were evaluated on the isolated heart (Langendorff model). Esmolol concentrations of 125, 250, and 500 mg/l were tested. In another experiment using esmolol concentration of 250 mg/l, cardiac function recovery was assessed after 20- and 45-min arrest. RESULTS: While concentrations of 250 and 500 mg/l are necessary to produce cardiac arrest, the concentration of 500 mg/l does not result in full cardiac function recovery following esmolol withdrawal. After the highest concentration of esmolol, coronary flow, heart rate and the rate-pressure product recovered to about 80, 70 and 60% of the initial control values, respectively. When comparing 20- and 45-min arrests we found cardiac function normalization occurs later after 45-min arrest. CONCLUSION: The induction of cardiac arrest by esmolol is optimal at a concentration of 250 mg/l. A concentration of 125 mg/l does not result in cardiac arrest and produces bradycardia only, a concentration of 500 mg/l may be dangerous on account of persisting undesirable effects on the rat heart.

An alternative to cardioplegia.

A new method of cardioplegia using an ultrashort beta 1-selective blocker is described. The method is especially useful in reoperation in patients with a patent internal mammary artery. Four patients have been operated on using this method.

[Anesthesia using high doses of fentanyl in cardiac surgery]. / Anestézie vysokými dávkami fentanylu v kardiochirurgii.

The authors describe their own experience with anaesthesia using large doses of fentanyl in patients operated on account of ischaemic heart disease and acquired valvular defects. Considerable stability of the circulation and careful monitoring of cardiorespiratory parameters along with aimed influencing of serious deviations is the basis of success of this procedure, which makes it possible to perform cardiosurgery in high risk patients. The authors try to improve the described method further by using some modern procedures.