SU1395298A1 - Method of allotransplantation of the second heart in unit with one lung - Google Patents

Abstract

This invention relates to reconstructive cardiac surgery and transplantology. The purpose of the invention is to provide secondary blood circulation. The harvested to the immer is transferred to the pleural cavity of the removed lung. A transplant of a heart in a block with one lung in the Zion chamber. Transplantation begins with anastomosis of the bronchus of the donor with the end of the bronchus of the remote lung recipient end-to-end. Anastomosis of the left atria of the graft and the heart of the recipient. Aortic anastomosis is applied by type, end to side between the end of the aortic graft and the anterior-lateral wall of the aortic arch of the recipient. The coronary blood flow in the heart of the graft is restored. The recipient's inferior vena cava is crossed, anastomosis is applied end-to-end between the stump of the crossed vena cava and the free branch of the bifurcation prosthesis and between the trunk of the prosthesis with the caudal end of the vena cava of the graft heart. (L

Description

co; o ate

rsD

from 00

The invention relates to medicine, in particular to re-instrumental cardiac surgery and transplantation, and concerns methods of secondary blood circulation and oxygenation of the blood in the case of uncorrective circulatory and respiratory combined decompensation of the body.

The purpose of the invention is to provide an auxiliary co-circulation by overlapping the aorta-aortic anastomosis in a side-to-side manner between the end of the graft aortic transplant at an angle of 35-45 and the anterior-lateral wall of the ascending aorta of the recipient. Anastomosis systemic venous inflows to a bifurcation of the inferior vena recipient veins formed by the bifurcation of the prosthesis blood vessels or segment terminal part of the abdomen of the donor aorta to the bifurcation and the ends of the iliac arteries type end-to-end between the stumps Nizhny No caval veins of both hearts and ends brangai bifurcation insert and the distal end of the hollow vein of the recipient, crossed at a distance of 4-6 m from the right atrium of the recipient; the tracheobronchial anastomosis is applied between the ends of the stump of the main bronchus of the remote lung recipient and the main bronchus of the lung transplant by the conventional method,

The method is implemented as follows.

The operation of transplantation of the second heart in the block with one lung to the place of the removed one lung redipient is performed in three successive stages, of which the first two are performed on the heart donor and on the isolated cardiopulmonary transplant, and the third stage is performed on the recipient cardiopulmonary bypass conditions. The operation on the donor is to remove the cardiopulmonary complex in a single unit. The operation is performed from the median longitudinal sternotomy access. Percard is dissected widely in the longitudinal direction and a wide dissection of all main vessels of the heart and the tracheobronkial zone is performed. Intersect between the two ligatures unpaired vein. Extremely distally, they tie up the upper half-vein in the mouth. Then the n-h-hv yu clamp on the bottom

Q 5 0 5 About

dlg

five

0

five

The vena cava is as close as possible to the diaphragm and intersects at the border with the right atrium. Lastly, the aorta is occluded. The trachea is cut off over the bifurcation, the aorta is cut distally from the clamp and the transplant.

 The tat is quickly transferred to the immersion chamber for deep cooling. the operation step is performed on the graft in vitro, under immersion hypothermia conditions. Removal of one lung and trachea; at the level of the bifurcation, the right branch of the pulmonary artery is retracted or redone, all pulmonary veins are crossed and then along the mouth of the pulmonary veins in the wall of the left atrium on the side of the remote lung they form a common opening by intersecting the tissue bridges between the mouths of the veins. The end of the dissected inferior vena cava is anastomotized end-to-end in type with one of the branches of the bifurcation prosthesis of blood vessels.

The operation on the recipient is performed from the wide lateral thoracotomy in the fourth intercostal space or from the median longitudinal sternotomy. On the side of transplantation, a wide pericardiotomy is performed parallel and anterior to the phrenic nerve, which, together with the pericardial flap, is retracted into the posterior fossa. Then transpericardial pulmoectomy is performed; cross between two ligatures a pulmonary artery. The main bronchus together with the maximally preserved peri is covered with bronchial tissue at the level of the upper lobe bronchus. Proximally to the ventricular collector, proximally from the mouths of the pulmonary veins, a clamp of the Satinsky type is applied, the veins are cut off and the lung is removed. The partitions between the mouths of the pulmonary veins are connected with a cut into one common hole. A transplant harvested in an immersion chamber is transferred to the pleural cavity of the removed lung - the heart is in a block with one lung. The transplantation begins with anastomosis of the bronchus of the donor with the end of the bronchus of the remote lung recipient end-type end. Following this, the left atria of the transplant and the heart of the recipient are anastomosed with a continuous eversion suture. Then, an aortic anastomosis of the end-to-side type is inserted between the aortic condom of the graft and the corresponding dimensions with a hole in the anterior-lateral wall of the aortic arch of the recipient in the zone of the latter's transition to the ascending or descending part at an acute angle. After completion of the aortic anastomosis operation, the occlusive clips are removed and the heart transplant is restored to the coronary blood flow. The final stage of transplantation is performed on the background of the restoration of the electrical and mechanical activity of the myocardium of the transplanted heart. Between the two clips cross the inferior vena cava of the recipient and the type of end in

g

The end is superimposed by anastomoses between the stump of the crossed vena cava and the remaining free squandering bifurcation prosthesis, between the trunk of the prosthesis and the caudal end of the vena cava of the heart graft.

Claims (1)

Claims of the method of allotransplantation of a second heart in a block with one lung in place of a remote lung of a recipient by applying arterial, venous and tracheobronchial anastomoses, characterized in that, in order to ensure a constant assisted blood circulation, hydroxy genation in patients with myocardial weakness of the recipient, along the contour of the transplanted heart, impose an anastomosis between the aorta of the graft and the ascending aortic recipient type end in side at an acute angle, and the lower vein The recipient is crossed and the anastomosis of the venous inflow is performed using a bifurcation prosthesis, the stem of the prosthesis with the distal segment of the vena cava, and its branch with the cult of the inferior vena cava of both hearts.