SU1409234A1 - Method of investigating the functional ability of myocardium in case of through defect of the heart - Google Patents

Abstract

This invention relates to cardiac surgery. The purpose of the invention is to increase the information content of the method. On the section of the wall of the heart, subject to plastic, hem patch. U-shaped seams are applied to one free edge of the patch, which do not tighten. Under the patch, perforation of the wall and cutting out the required myocardial section is performed. U-shaped sutures are tightened and tied up. The method allows studying the functional ability of the myocardium in case of end-to-end defect of the heart.

Description

This invention relates to medicine, in particular to cardiac surgery.

The purpose of the invention is to increase the information content of the method by studying the NIL dynamics of defect regeneration and thromboresistance of the patch with preservation of the intracardiac blood flow.

The method is carried out as follows.

A patch of artificial material of the required size is hemmed onto the outer portion of the wall of the heart to be plastic, so that one of its edges remains free. One or two U-shaped seams are put on the free edge of the patch. Special cutters are introduced to perforate the wall and cut out the necessary myocardial section of any given area. The tool is removed. U-shaped seams are tightened and fastened.

PRI m e RO Dog mongrel, male, weight 20 kgo Premedication: 30 minutes before the operation, 20 ml of 1% p-ra morphine (10 mg / kg), 0.8 ml O, 1% was intramuscularly injected p-ra atropine sulfate (0.04 mg / kg), 2.0 ml of 1% p-ra dimedrol and 2.0 ml of seduxen. When a drowsiness or adynamia appears, the dog is put into the operating room, laid on the operating room. table and fixed in position on the left side Electrocardiograph electrodes Electrocardiogram monitoring and electrocardiography are connected. On the ECG sinus rhythm with a frequency of 136 beats. per minute, rhythmic; ECG within the norm. The area of operation is carefully shaved. Under local anesthesia with a 0.5% solution of Novocain, the femoral artery and vein are separated and catheterized. The arteries are connected to the monitor Aortic blood pressure monitor. Periodic control of CVP (in the inferior vena cava). Aortic blood pressure is stable at 120/60 mm Hg. CVP stable 70 mm aq. Article Intravenous to the dog is injected 10 thousand units, heparin (500 units / kg). Induction into anesthesia was carried out by intravenous administration of 200 mg of a 2.5% solution of hexenal (Yu mg / kg) and 2.0 ml of seduxen. Depressive breathing is achieved; .and. Intubation of the trachea with a single lumen tube number 16 with an inflatable cuff. Artificial

ventilation of the lungs with a PO-6 respirator with a flow of oxygen of 4–6 l / min and a respiratory rate of 25–30 per minute. The base anesthesia was carried out by intravenous drip infusion of 400 mg of 2.5% p-ra hexenal (20 mg / kg) and JOO mg of ketalar (5 mg / kg); fractionally, at the most traumatic stages of the operation, 0.05% p-tannyl solution of 2.0 ml was administered (total 10.0 ml). Lateral thoracotomy along the 1st intercostal space on the left. When opening the pleural cavity air is light, adhesions, no fluid. Opened and pericardially held. Heart of normal size and shape. Heart rate 138 beats per minute, ECG unchanged, BP in aorta 124/68 mm rost (cf. 92) CVP 72 mm aq. Measurements were made of pressure in the cavity of the heart and flowmetry on the pulmonary artery. The pressure in the left atrium 5/3. (cf., 4) mm Hg., in the left ventricle 124/00 (. sp.61) mm Hg, in the right atrium - 4/2 (cf.) mm pTOST., right ventricle 28/00 mm. (CP13) The flow through the pulmonary artery was 4140 ml / min. An overlapping oval-shaped patch and fluoronlavsan (braided) were applied to the outer wall of the right ventricle of the heart and the pulmonary artery using two 4/0 continuous atraumatic sutures using a patch of 2.5x3, 5 cm. The lower edge of the patch facing the surgeon is 1.3 cm free. On this free lower edge of the patch, in the area of the output path of the right ventricle of the heart, one U-shaped atraumatic suture was inserted with a 4/0 prolen thread, which did not tighten. Through the free lower edge of the patch between the L-shaped seam, special nippers were inserted under the patch perforation of the wall of the right ventricle and ejection of a part of the wall of the output waste of the right ventricle, fibrous ring of the pulmonary artery with a leaf and wall of the pulmonary artery The tool is removed, U-shaped schov is engaged. There is no bleeding. A myocardial and pulmonary artery defect with dimensions of 2.0x3.0 cm is formed. Heart rate is 134 beats per minute, sinus rhythm, there are no measurements on the ECG. Blood pressure in the aorta 122/64

cf 90) mm of the CVT of 70 mm water The measurement of the pressure in the heart cavities and pulmonary artery flowmet about the pressure in the left atrium 5/3 (cf. 4) mm pTOSTo, left ventricle 120/00 MI-I, (cf. 62), atrial right 4/2 (cf.) mm pTOSTo, right ventricle 26/00 (cp12) mm pTOSTO. The blood flow through the pulmonary artery was 4168 ml / min. Heart rate was normal, the cavities of the heart were not enlarged. The patch was spread, oval-shaped Palpator through the patch is well defined by the created defect of the myocardium and the pulmonary artery. Injected into the pericardial cavity 2 million EDO penitsklli- on gro streptomycin and 1 of Hemostasis "Suturing rare pericardial sutures Layerwise suturing wound tightly about the chest wall discontinued supply of drugs intravenously administered 15.0 ml of 10% p-ra bemegrida. Resistant recovery of spontaneous breathing. Consciousness clear, Trachea extubation. On the ECG sinus rhythm, heart rate 136 beats. per minute, ECG unchanged, blood pressure in the aorta 120/70 mm rToSTo CVP 70 mm vodnos Femoral vessels were sequentially decanted and tied off Electrocardiograph electrodes were removed The dog was taken to the vivarium, blood loss was 100 minutes

Electrocardiographic monitoring and control and measurement of pressure and hemodynamic parameters were carried out at the Mingograf-28 minograph of Siemens-El.

Thus, the electrocardiogram and hemodynamic parameters remained stable both before the operation, and at all its stages and after it

Six months after the operation, reoperation was performed. Under the general anesthesia described with cannulation of the femoral arteries and veins and artificial breech of the lungs, a left-sided thoracotomy was performed with resection of the V rib. In the pleural cavity, single planar commissures that are dissected after electrocoagulation are not liquid. Easy air. Pericardium loose spa n in the area of plastics with a patch and the surrounding myocardium and the wall of the pulmonary artery. Acute and blunt way the pericardium is highlighted to be taken on the hand. Frequency ser0

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short cuts 130 beats. per minute, sinus rhythm on ECG, no pathological changes. HELL in the aorta 120/70 mm Hg. CVP 70 mm gd.st. The pressure in the heart cavity and pulmonary artery flowmetry were measured. The pressure in the left atrium is 5/3 (cf. 4) mm, -Hg, .. the left ventricle is 120/00 (cf. 58) mm. mercury., right atrium 4/2 (SR.Z) mm Hg, right ventricle 27/00 (Wed 13) mm Hg The pulmonary artery flow was 4160 m / min. Visually, all parts of the heart are ordinary sizes, contractions of the heart are normal. The patch with dimensions of 2.5x3.5 cm is spliced with the wall of the pulmonary artery and myocardium, along the edges of the patch, the schvy are clearly differentiated by a prolenic filament. The patch on the touch is dense, there is no calcination and no aneurysm. Palmatator through the patch clearly identifies the previously created defect (through) of the myocardium and pulmonary artery with dimensions of about 2.0x3.0 cm. A biopsy of the patch section and the wall of the medulla of the area of the previously created defect was produced. In the cavity of the pericardium and pleura introduced 2 million units, penicillin and 1 g of streptomycin. Hemostasis Closure of the pericardium with rare seams Layer-by-layer suturing of the surgical wound of the chest wall tightly. Discontinued supply of drugs. 20.0 ml of 10% bemegride solution are injected intravenously. Resistant recovery of spontaneous breathing. Consciousness is clear. Trachea extubation Hemodynamic parameters are stable, ECG is normal. Sequential decannularity and ligation of the femoral vessels. Electrocardiograph electrodes are disabled. The dog is delivered to the vivarium. Macroscopic examination of the patch (biopsy) and myocardium areas of the previously created through-defect revealed that the inner surface of the patch is smooth, although small blood clots are seen in places. During histological examination of a hematoxylin-stained eosin and a myocardium stained with a light microscope It was found that the patch sprouted with connective tissue, at the base of collagen fibers, in some places there were also cellular elements, mainly histiocytes and fibroblasts.

From the inner surface (on the bloodstream side, the patch is covered with a layer of organized fibrin {up to 0.4 cm thick) is lined with one layer of flattened endothelial cells. At the border of the patch - the myocardium, there is a thick layer of connective tissue, the fibers are mostly coarse collagenic, spread as in patch and myocardium. The surrounding myocardium in the area of the created defect is changed slightly, the occurrence of cardiosclerosis prevails, the cardiocytes of the usual structure with a pronounced striation

12 months after the first operation, under the general anesthesia described with cannulation of the femoral arteries and veins and artificial ventilation of the lungs, left-sided thoracotomil along the V intercostal space was made, the mass of adhesions in the pleural cavity, which were dissected after electrocoagulation, no fluid, light air. The pericardium is loosely spaded with a heart, in the area of plastic surgery, it is significant. The pericardium is pointed out by a sharp and obtuse one and held onto the handles. All parts of the heart are usually c; sizes, reductions are normal. The patch is intimately adherent to the wall of the pulmonary artery and the surrounding myocardium. The patch is dense, several foci of calcification are noted, there are no aneurysms. Palpation through the patch determines the previously created defect of the myocardium and pulmonary artery with dimensions of about 2.0x3.0 cm Heart rate 130 beats. per minute, ECG sinus rhythm, no pathology. ECG does not differ from the initial blood pressure in the aorta 120/70 mm Hg, CVP 70 mm water The pressure in the heart cavity and pulmonary artery flowmetry was measured. At the same time, the pressure in the left atrium is 5/3 (CPA) mm Hg “one hundred left ventricle 120/00 (CP58) mm Hg, Art., The right atrium 4/2 (cf. 3) mm Hg, right ventricle 28 / 00 (cf., 14) mm pToSTo. The blood flow through the pulmonary artery was 4169 ml / m. 10.0 ml of air was injected intracardiacly into the left ventricle. Cardiac arrest. Electrocardiogram electrodes are disconnected, trache is extubated, catheters are removed from the femoral vessels. Heart is removed and removed. Heart dissection was performed and dissection of its strips0

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tey During macroscopic radiation of a macropreparation, it was found that the previously created through-wall defect of the output path of the Right Ventricle and the pulmonary artery with dimensions of 1.8 x X 2.7 cMo The patch from the inside is mostly smooth, shiny, in places, mostly near the wall, organized blood clots, several small foci of calcification are noted. The patch is dense to the touch. Hypertrophy of the walls of the heart is not. Heart cavity in the normal range. The patch is firmly adhered to the myocardium and the wall of the pulmonary artery, its edges are clearly differentiated from the outside. During the histological examination of a 5–7 mg thickness of a hematoxylin-eosin and Van-Guison parasitic patches and the surrounding myocardium stained with a thickness of 5-7 mg, it was revealed that the fluorotone patch fabric -lsans largely sprouted coarse low-differentiated connective tissue. The number of cell elements is insignificant. The number of blood vessels, which are mainly concentrated on the border of the patch - myocardium, is also insignificant. From the side of the cavity of the right ventricle, the patch is covered with a thick layer of coarse, poorly differentiated connective tissue with areas of hyalnosis and calcification. Peripheral parts of myocardium retain their structure

Thus, the information content is improved by studying the dynamics of myocardial regeneration of the area of the created defect and the thromboresistance of the patch from the biomaterial.

Claims (1)

Invention Formula The method of studying the functional ability of the myocardium in the case of a through defect of the heart by perforating its wall with a flap overlap, which is such that, in order to increase the informativity of the method by studying the dynamics of the regeneration of the defect and thromboresistance of the patch with preservation of the intracardiac blood flow, the perforation of the heart wall is carried out defect by resection of the myocardium under a previously fixed patch of biotransplant or artificial material,