Modern advances in cardiac surgery in patients with congenital or acquired heart defects in cardiopulmonary bypass are largely associated with the development and use of effective means of protecting the myocardium. The main purpose of cardiac surgery is to improve or maintain the work of the heart. The purpose of our work was to study the state of intracardiac and central hemodynamics in patients with mitral valve insufficiency during surgical correction using crystalloid cardioplegia in the perioperative period. Material and methods. We examined 40 patients with mitral valve insufficiency admitted for surgical correction of the defect. Patients underwent therapy and surgery (mitral valve replacement) in accordance with the local protocol of intraoperative cardioprotection using crystalloid cardioplegia (Bernshteider solution). Results and discussion. Patients were fixed at the end of сardiopulmonary bypass, before being transferred to (intensive care unit) ICU, after leaving ICU the end systolic, end diastolic and stroke index of the left ventricle, left ventricular ejection fraction, cardiac index, systolic pressure in the pulmonary artery and global longitudinal myocardial strain. These indicators were obtained using the apparatus "Aplio XG SSA-770A" (Toshiba, Japan) by sectoral sensors with a radiation frequency of 2.5 to 5.0 MHz. and the apparatus "Vivid iq" ("GE", USA). From statistical research methods, the calculation of the reliability criterion - t ("Student's criterion") and correlation analysis with the calculation of the Pearson correlation coefficient were used. The left ventricular ejection fraction at the exit from the cardiopulmonary bypass decreased to 50.7 ± 5.2% (p = 0.09 compared with the initial level). Then it increased insignificantly: to 51.7 ± 5.0% before transferring to intensive care unit and to 52.4 ± 5.8% (p> 0.7 compared to baseline) after transferring from intensive care unit. The global longitudinal myocardial strain module after correction of the defect and withdrawal from cardiopulmonary bypass significantly decreased from 8.4 ± 0.8% to 7.3 ± 0.7% (p <0.001) and then did not significantly change statistically until the end of the study being transferred from intensive care unit 7.7 ± 1.1% (p <0.005 compared with baseline). Systolic pressure in the pulmonary artery after correction of the defect and after leaving the cardiopulmonary bypass decreased significantly and reliably to 35.8 ± 3.0 mm Hg. Art. (p <0.0001) and then not significantly changed (35.3 ± 2.8 mm Hg. before transferring to intensive care unit and 35.1 ± 2.7 mm Hg. before transferring from intensive care unit). Conclusions. Thus, surgical correction of mitral valve insufficiency with the use of cardioplegic cardiac arrest was accompanied by the greatest changes in global longitudinal myocardial strain, systolic pressure in the pulmonary artery and left ventricular ejection fraction at the exit stage of cardiopulmonary bypass, and the tendency to normalization was observed only from the systolic pressure in the pulmonary artery, whereas the module of global longitudinal myocardial strain and left ventricular ejection fraction decreased. Despite this, the integral indicator of the circulatory system - cardiac index - was below 2.5 l / min ∙ m2 in only 5 (12.5 ± 5.2%) patients, while not being below 2.2 l / min ∙ m2, which was due to a compensatory increase in heart rate (maximum - up to 96 min 1) and the appointment of sympathomimetic therapy.
Keywords: intracardiac and central hemodynamics, mitral valve insufficiency, crystalloid cardioplegia, mitral valve replacement, cardiopulmonary bypass
Full text: PDF (Rus) 307K