RU2560076C1 - Method for administering protaminesulphate after third stage of haemodynamic correction of congenital heart defects in patients with functional single ventricle - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to cardiology, and can be used to assist the haemodynamic correction of congenital heart defects in the patients with a functional single ventricle. To this effect, after the patient is disconnected from a cardiopulmonary bypass and decannulated, an infusion line is introduced to perform a hemofiltration and a modified ultrafiltration. Thereafter, protamine sulphate is administered.

EFFECT: method provides the effective heparin inactivation and the reduced risk of haemorrhage by administering protamine sulphate into the systemic circulation directly, bypassing the pulmonary circulation.

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Description

The invention relates to medicine, namely to cardiovascular surgery.

All operations that take place with cardiopulmonary bypass (IK) require the administration of heparin at the time of cannulation and the onset of IK; at the stage of decanulation, in order to inactivate heparin and reduce the risk of bleeding in the postoperative period, protamine sulfate must be administered. After the third stage of hemodynamic correction of the total cavapulmonary compound protamine sulfate, the patient is injected puncture through the wall of a single atrium.

The disadvantage of this method is that the wall of the single atrium is injured, and also when protamine sulfate is introduced into the pulmonary circulation through the peripheral venous port, it activates with the formation of microthromboembolas [1, 2, 3, 4], and then further enters the large circle of blood circulation.

An adequate prototype was not found in the analyzed literature.

The aim of the invention is to increase the safety of surgery and the prevention of intraoperative and postoperative complications, reducing surgical trauma.

The present invention relates to the third stage of the surgical correction of congenital heart defects (CHD) with a functionally single ventricle of the heart. Considering the hemodynamics in patients after the “Fontaine procedure”, a method for introducing protamine sulfate into an infusion line installed in a single atrium is proposed, as a result of protamine sulfate it enters immediately into the pulmonary circulation, bypassing the pulmonary circulation, there is no additional surgical injury.

The goal is achieved by a technical solution, which is a method of administering protamine sulfate after hemodynamic correction of congenital heart defects with a functionally unique ventricle of the heart, for which hemofiltration and modified ultrafiltration are performed, and then the introduction of protamine sulfate into the same infusion line into a single atrium. New in the proposed method is that protamine sulfate is injected not standardly into one of the venous peripheral ports, but directly into a single atrium, thus bypassing the pulmonary circulation.

New features allow you to achieve the following technical result:

- this route of administration bypasses the pulmonary circulation, thus eliminating the possibility of isolated cases of pulmonary edema and reduces the risk of increased pressure in the pulmonary vessels;

- prevents the formation of microthromboembolas;

- eliminates the likelihood of trauma to the system valve of the single ventricle of the heart with direct administration of protamine sulfate.

The essential features characterizing the invention, showed in the claimed combination of new properties that are not explicitly derived from the prior art in this field and are not obvious to a specialist.

An identical set of features was not found in the study of patent and medical literature.

This invention can be used in practical health care to improve the quality of treatment, increase the safety of operations by reducing intra- and postoperative complications.

Based on the foregoing, the proposed method should be considered appropriate to the conditions of patentability of the invention “Novelty”, “Inventive step”, “Industrial applicability”.

The proposed method will be clear from the following description and the drawings attached to it.

In fig. 1 shows a diagram of a method for administering protamine sulfate after the third stage of hemodynamic correction of congenital heart defects with a functionally single ventricle of the heart.

An anastomosis between the single atrium and the lateral wall of the Gore-tex linear prosthesis, side-by-side, anastomosis between the Gore-tex linear prosthesis and the right end-to-side pulmonary artery (general view of the operation of the third stage hemodynamic correction), the route of administration of protamine sulfate into the single atrium;

1 - anastomosis between the inferior vena cava and the linear prosthesis "Gore-tex" on the type of "end to end";

2 - anastomosis between a single atrium and the lateral wall of the linear prosthesis "Gore-tex" on the type of "side to side";

3 - anastomosis between the linear prosthesis "Gore-tex" and the right pulmonary artery of the type "end to side";

4 - the place of introduction of protamine sulfate "directly" and the place of installation of the infusion line into a single atrium;

5 - infusion line into a single atrium.

The method is as follows. Perform standard (median repeated sternotomy) access to the heart and major vessels. Before the cannulation step, heparin sulfate is administered. By a standard technique, an heart-lung machine is connected. At the end of the main stage of the operation, blood circulation circles are disconnected. All venous blood is directed to the right and left pulmonary arteries. The heart releases only into a large circle of blood circulation. This is the main feature of the child’s hemodynamics after Fontaine’s operation. An infusion line is installed for hemofiltration + modified ultrafiltration, through which protamine sulfate is also introduced.

Clinical example. Patient I., 3.5 years. Diagnosis: congenital heart disease. Two-leaf left ventricle of the heart. Pulmonary stenosis. Atrial septal defect. Condition after bi-directional cavapulmonary anastomosis at the age of 7 months. The diagnosis was made on the basis of ultrasound examination of the heart, sounding of the heart cavities. Access - median resternotomy. A cardiopulmonary bypass using a standard technique. Pinched aorta, cardioplegia. The inferior vena cava is cut off. An end-to-end anastomosis is applied between the Gore-tex linear prosthesis and the inferior vena cava 1 (Fig. 1). A fenestration with a diameter of 4 mm was formed in the lateral wall of the Gore-tex prosthesis 1.5 cm above the proximal anastomosis from the side adjacent to the right atrium, removed to the line of the alleged anastomosis between the single atrium and the lateral wall of the Gore-tex prosthesis in the outer fenestration area an extracardiac prosthesis sheath, an anastomosis is placed around the fenestration (along the line of the removed external sheath) between the right atrium (the mouth of the inferior vena cava) and the lateral wall of the Gore-tex linear prosthesis, side-to-side. The right pulmonary artery is longitudinally dissected from the bottom (opposite the previously applied bi-directional cavapulmonary anastomosis) for 2.5 cm, an anastomosis is placed between the Gore-tex linear prosthesis and the right pulmonary artery of the end-to-side type. The heart-lung machine is stopped. Decanulation. In a single atrium, an infusion line is established through which the administration of protamine sulfate, hemofiltration and modified ultrafiltration are performed. The blood flow through the prosthesis and bidirectional cavapulmonary anastomosis is satisfactory (according to transesophageal ultrasound). Hemostasis. An epicardial electrode is hemmed to the ventricle for the implementation of a temporary EX. A “Preclude” patch is hemmed to the edges of the dissected pericardium. Osteosynthesis of the sternum by wire ligatures. Layer wound closure with drainage of the pericardium and anterior mediastinum with a single drainage. Kutasept. Aseptic dressing. The postoperative period was uneventful. According to the ultrasound examination of the flow through the trunk of the aircraft, there is no cavapulmonary anastomosis and anastomosis of the linear prosthesis with the right pulmonary artery functioning satisfactorily. After 2 hours, the patient was extubated, on the 3rd day transferred from the intensive care unit. On day 14, the patient was discharged from the hospital.

The method proposed by the authors was applied in 14 patients. Complications when using this method during surgery in the early and long-term postoperative periods were not observed.

Thus, the application of the proposed method can effectively complete the third stage of hemodynamic correction with a functionally single ventricle of the heart with the lowest rates of surgical risk.

List of used literature.

1. Constantin Mavrodis. Pediatric Cardiac Surgery: Second ed. / Constantin Mavrodis, Carl L. Backer. - Mosby-Year Book, Inc. 1994 .-- C. 379-412.

2. Richard A. Jonas. Comprehensive Surgical Management of Congenital Heart Disease / Richard A. Jonas, James DiNardo, Peter C. Laussen, Robert Howe, Robert LaPierre, Gregory Matte. - Oxford University Press Inc. 2004 .-- C. 185-525.

3. Surgery for Congenital heart defects / [edited by] J. Stark, M. de Leval, illustrated by Michael Coutney - 2-nd ed. / W.B. Saunders Company 1994. - C. 712.

4. Noncardiogenic pulmonary edema immediately following rapid protamine administration. Brooks JC. Intensive Care, Veterans Affairs Medical Center, Gainesville, FL 32608, USA.

Claims (1)

The method of introducing protamine sulfate after the third stage of hemodynamic correction of congenital heart defects in patients with a functionally single ventricle of the heart, characterized in that after turning off the cardiopulmonary bypass and decanulation, an infusion line is established in the atrium, hemofiltration and modified ultrafiltration are performed, and then protamine sulfate is administered.

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