11 research outputs found
ΠΠΏΡΡ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ ΡΡΠ΅ΡΠΊΠΎΠΆΠ½ΠΎΠ³ΠΎ ΠΎΠ±Ρ ΠΎΠ΄Π° ΠΏΡΠ°Π²ΠΎΠ³ΠΎ ΠΆΠ΅Π»ΡΠ΄ΠΎΡΠΊΠ° Π² ΡΠ°Π½Π½Π΅ΠΌ ΠΏΠ΅ΡΠΈΠΎΠ΄Π΅ ΠΏΠΎΡΠ»Π΅ ΠΈΠΌΠΏΠ»Π°Π½ΡΠ°ΡΠΈΠΈ ΡΠΈΡΡΠ΅ΠΌΡ Π»Π΅Π²ΠΎΠΆΠ΅Π»ΡΠ΄ΠΎΡΠΊΠΎΠ²ΠΎΠ³ΠΎ ΠΎΠ±Ρ ΠΎΠ΄Π° (ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠ΅ Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΠ΅ ΠΈ ΠΎΠ±Π·ΠΎΡ Π»ΠΈΡΠ΅ΡΠ°ΡΡΡΡ)
Implantable left ventricular assist device (LVAD) is a state-of-the-art treatment for adults and children with end-stage heart failure. The early and late period after LVAD implantation can be severely complicated. Right ventricular failure (RVF) still remains a common complication after LVAD implantation. RVF is the cause of reduced post-implant survival. We suggest that an additional temporary or permanent right ventricular assist device (RVAD) is an effective treatment for LVAD-associated RVF. In this clinical case report, we describe the medical history of a pediatric patient (14 years old) with severe heart failure (PediMACS Level 1) against a background of dilated cardiomyopathy. The patient required peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) prior to urgent LVAD (HM3) implantation. In the early post-LVAD implantation (1 POD) period, the patient presented with hemodynamic and echocardiographic events of acute RVF that was resistant to drug therapy (inotropic/vasopressor support, iNO) and required mechanical circulatory support (MCS) with a preoperatively implanted VA-ECMO. In the LVAD-associated RVF scenario, VA-ECMO as a means of total cardiac bypass is a non-physiological MCS method and, therefore, undesirable. In this clinical situation, our solution was to use a paracorporeal centrifugal blood pump for temporary right heart support. A RVAD was assembled using percutaneous cannulation in two sites and a modification of the pre-existing VA-ECMO circuit. For RVAD, we used an ECMO cannula previously installed through the femoral vein (26 F) and added a reverse venous cannula (22 F) through the right internal jugular vein into the pulmonary trunk. To facilitate the passage of the return cannula into the pulmonary artery, we used a contralateral sheath (6 F, 40 cm) and an Amplatz Super Stiff guidewire under radiological control. The oxygenator was removed from the circuit on day 2 of RVAD. Central hemodynamics (reduction in right atrial pressure (RAP) to 10 mm Hg, increase in pulmonary capillary wedge pressure (PCWP) to 14 mm Hg), as well as right ventricular (RV) and left ventricular (LV) volume characteristics all improved. These observations allowed us to optimize the performance of the implantable LVAD (increase in flow rate to 4.2 l/min or 2.1 l/min/m2). The duration of paracorporeal RVAD after LVAD implantation was 7 days with an average flow rate of 2.3 Β± 0.2 l/min. Postoperative treatment in the intensive care unit (ICU) lasted for 15 days. The patient was discharged from the hospital on postoperative day 34.Π‘ΠΈΡΡΠ΅ΠΌΠ° ΠΈΠΌΠΏΠ»Π°Π½ΡΠΈΡΡΠ΅ΠΌΠΎΠ³ΠΎ Π»Π΅Π²ΠΎΠΆΠ΅Π»ΡΠ΄ΠΎΡΠΊΠΎΠ²ΠΎΠ³ΠΎ ΠΎΠ±Ρ
ΠΎΠ΄Π° (LVAD) - ΡΡΠΎ ΡΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΡΠΉ ΠΌΠ΅ΡΠΎΠ΄ Π»Π΅ΡΠ΅Π½ΠΈΡ Π²Π·ΡΠΎΡΠ»ΡΡ
ΠΈ Π΄Π΅ΡΠ΅ΠΉ Ρ ΡΠ΅ΡΠ΄Π΅ΡΠ½ΠΎΠΉ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΡΡΡΡ Π² ΡΠ΅ΡΠΌΠΈΠ½Π°Π»ΡΠ½ΠΎΠΉ ΡΡΠ°Π΄ΠΈΠΈ. Π Π°Π½Π½ΠΈΠ΅ ΠΈ ΠΏΠΎΠ·Π΄Π½ΠΈΠ΅ ΠΏΠ΅ΡΠΈΠΎΠ΄Ρ ΠΏΠΎΡΠ»Π΅ ΠΈΠΌΠΏΠ»Π°Π½ΡΠ°ΡΠΈΠΈ LVAD ΠΌΠΎΠ³ΡΡ ΡΠ΅ΡΡΠ΅Π·Π½ΠΎ ΠΎΡΠ»ΠΎΠΆΠ½ΡΡΡΡΡ. ΠΠΈΡΡΡΠ½ΠΊΡΠΈΡ ΠΏΡΠ°Π²ΠΎΠ³ΠΎ ΠΆΠ΅Π»ΡΠ΄ΠΎΡΠΊΠ° (Π11Π) ΠΏΠΎ-ΠΏΡΠ΅ΠΆΠ½Π΅ΠΌΡ ΠΎΡΡΠ°Π΅ΡΡΡ ΠΎΠ΄Π½ΠΈΠΌ ΠΈΠ· ΡΠ°ΠΌΡΡ
ΡΠ°ΡΡΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ LVAD ΠΈ ΠΏΡΠΈΡΠΈΠ½ΠΎΠΉ Π½ΠΈΠ·ΠΊΠΎΠΉ ΠΏΠΎΡΡΠΈΠΌΠΏΠ»Π°Π½ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΉ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΠΈ. ΠΡ ΠΏΡΠ΅Π΄ΠΏΠΎΠ»Π°Π³Π°Π΅ΠΌ, ΡΡΠΎ Π΄ΠΎΠΏΠΎΠ»Π½ΠΈΡΠ΅Π»ΡΠ½ΠΎΠ΅ Π²ΡΠ΅ΠΌΠ΅Π½Π½ΠΎΠ΅ ΠΈΠ»ΠΈ ΠΏΠΎΡΡΠΎΡΠ½Π½ΠΎΠ΅ Π²ΡΠΏΠΎΠΌΠΎΠ³Π°ΡΠ΅Π»ΡΠ½ΠΎΠ΅ ΡΡΡΡΠΎΠΉΡΡΠ²ΠΎ Π΄Π»Ρ ΠΏΡΠ°Π²ΠΎΠ³ΠΎ ΠΆΠ΅Π»ΡΠ΄ΠΎΡΠΊΠ° (RVAD) ΡΠ²Π»ΡΠ΅ΡΡΡ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΡΠΌ ΠΌΠ΅ΡΠΎΠ΄ΠΎΠΌ Π»Π΅ΡΠ΅Π½ΠΈΡ LVAD-Π°ΡΡΠΎΡΠΈΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ³ΠΎ ΠΠΠ. Π Π΄Π°Π½Π½ΠΎΠΌ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΌ ΡΠ»ΡΡΠ°Π΅ ΠΌΡ ΠΎΠΏΠΈΡΡΠ²Π°Π΅ΠΌ ΠΈΡΡΠΎΡΠΈΡ Π±ΠΎΠ»Π΅Π·Π½ΠΈ ΠΏΠ΅Π΄ΠΈΠ°ΡΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° (14 Π»Π΅Ρ) Ρ ΡΡΠΆΠ΅Π»ΠΎΠΉ ΡΠ΅ΡΠ΄Π΅ΡΠ½ΠΎΠΉ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎΡΡΡΡ (Pedimacs Level 1) Π½Π° ΡΠΎΠ½Π΅ Π΄ΠΈΠ»Π°ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΉ ΠΊΠ°ΡΠ΄ΠΈΠΎΠΌΠΈΠΎΠΏΠ°ΡΠΈΠΈ, ΠΊΠΎΡΠΎΡΠΎΠΌΡ ΠΏΠΎΡΡΠ΅Π±ΠΎΠ²Π°Π»Π°ΡΡ ΠΏΠ΅ΡΠΈΡΠ΅ΡΠΈΡΠ΅ΡΠΊΠ°Ρ ΠΠ ΠΠΠΠ ΠΏΠ΅ΡΠ΅Π΄ ΡΡΠΎΡΠ½ΠΎΠΉ ΠΈΠΌΠΏΠ»Π°Π½ΡΠ°ΡΠΈΠ΅ΠΉ LVAD (HM3). Π ΡΠ°Π½Π½Π΅ΠΌ ΠΏΠΎΡΡΠΈΠΌΠΏΠ»Π°Π½ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΌ (1 POD) ΠΏΠ΅ΡΠΈΠΎΠ΄Π΅ LVAD Ρ ΡΡΠΎΠ³ΠΎ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° Π½Π°Π±Π»ΡΠ΄Π°Π»ΠΈΡΡ Π³Π΅ΠΌΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΈ ΡΡ
ΠΎΠΊΠ°ΡΠ΄ΠΈΠΎΠ³ΡΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΡΠ²Π»Π΅Π½ΠΈΡ ΠΎΡΡΡΠΎ ΡΠ°Π·Π²ΠΈΠ²ΡΠ΅ΠΉΡΡ ΠΠΠ, ΡΠ΅Π·ΠΈΡΡΠ΅Π½ΡΠ½ΠΎΠΉ ΠΊ ΠΌΠ΅Π΄ΠΈΠΊΠ°ΠΌΠ΅Π½ΡΠΎΠ·Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ (ΠΈΠ½ΠΎΡΡΠΎΠΏΠ½Π°Ρ/ Π²Π°Π·ΠΎΠΏΡΠ΅ΡΡΠΎΡΠ½Π°Ρ ΠΏΠΎΠ΄Π΄Π΅ΡΠΆΠΊΠ°, iNO) ΠΈ ΠΏΠΎΡΡΠ΅Π±ΠΎΠ²Π°Π²ΡΠ΅ΠΉ ΠΌΠ΅Ρ
Π°Π½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΏΠΎΠ΄Π΄Π΅ΡΠΆΠΊΠΈ ΠΊΡΠΎΠ²ΠΎΠΎΠ±ΡΠ°ΡΠ΅Π½ΠΈΡ Ρ ΠΏΠΎΠΌΠΎΡΡΡ ΠΏΡΠ΅Π΄ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎ ΠΈΠΌΠΏΠ»Π°Π½ΡΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠ³ΠΎ ΠΠ ΠΠΠΠ. Π ΡΡΠ΅Π½Π°ΡΠΈΠΈ LVAD-Π°ΡΡΠΎΡΠΈΠΈΡΠΎΠ²Π°Π½Π½ΠΎΠΉ ΠΠΠ ΠΠ ΠΠΠΠ ΠΊΠ°ΠΊ ΡΡΠ΅Π΄ΡΡΠ²ΠΎ ΠΏΠΎΠ»Π½ΠΎΠ³ΠΎ ΡΡΠ½ΡΠΈΡΠΎΠ²Π°Π½ΠΈΡ ΡΠ΅ΡΠ΄ΡΠ° ΡΠ²Π»ΡΠ΅ΡΡΡ Π½Π΅ΡΠΈΠ·ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΌ ΠΌΠ΅ΡΠΎΠ΄ΠΎΠΌ ΠΠΠ, ΠΈ ΡΠ»Π΅Π΄ΠΎΠ²Π°ΡΠ΅Π»ΡΠ½ΠΎ, Π½Π΅ΠΆΠ΅Π»Π°ΡΠ΅Π»ΡΠ½ΡΠΌ. Π ΡΡΠΎΠΉ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠΈΡΡΠ°ΡΠΈΠΈ Π½Π°ΡΠΈΠΌ ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ΠΌ Π±ΡΠ»ΠΎ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ ΠΏΠ°ΡΠ°ΠΊΠΎΡΠΏΠΎΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΡΠ΅Π½ΡΡΠΎΠ±Π΅ΠΆΠ½ΠΎΠ³ΠΎ Π½Π°ΡΠΎΡΠ° Π΄Π»Ρ Π²ΡΠ΅ΠΌΠ΅Π½Π½ΠΎΠΉ ΠΏΠΎΠ΄Π΄Π΅ΡΠΆΠΊΠΈ ΠΏΡΠ°Π²ΡΡ
ΠΎΡΠ΄Π΅Π»ΠΎΠ² ΡΠ΅ΡΠ΄ΡΠ°. ΠΡΠΏΠΎΠΌΠΎΠ³Π°ΡΠ΅Π»ΡΠ½ΠΎΠ΅ ΡΡΡΡΠΎΠΉΡΡΠ²ΠΎ Π΄Π»Ρ ΠΏΡΠ°Π²ΠΎΠ³ΠΎ ΠΆΠ΅Π»ΡΠ΄ΠΎΡΠΊΠ° (RVAD) Π±ΡΠ»ΠΎ ΡΠΎΠ±ΡΠ°Π½ΠΎ Ρ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠ΅ΠΌ ΠΌΠ΅ΡΠΎΠ΄Π° ΡΡΠ΅ΡΠΊΠΎΠΆΠ½ΠΎΠΉ ΠΊΠ°Π½ΡΠ»ΡΡΠΈΠΈ Π² Π΄Π²ΡΡ
ΠΌΠ΅ΡΡΠ°Ρ
ΠΈ ΠΌΠΎΠ΄ΠΈΡΠΈΠΊΠ°ΡΠΈΠΈ ΡΠ°Π½Π΅Π΅ ΡΡΡΠ΅ΡΡΠ²ΠΎΠ²Π°Π²ΡΠ΅Π³ΠΎ ΠΊΠΎΠ½ΡΡΡΠ° ΠΠ ΠΠΠΠ. ΠΠ»Ρ RVAD ΠΌΡ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π»ΠΈ ΠΊΠ°Π½ΡΠ»Ρ ΠΠΠΠ, ΡΡΡΠ°Π½ΠΎΠ²Π»Π΅Π½Π½ΡΡ ΡΠ°Π½Π΅Π΅ ΡΠ΅ΡΠ΅Π· Π±Π΅Π΄ΡΠ΅Π½Π½ΡΡ Π²Π΅Π½Ρ (26 F), ΠΈ Π΄ΠΎΠ±Π°Π²ΠΈΠ»ΠΈ Π²ΠΎΠ·Π²ΡΠ°ΡΠ½ΡΡ Π²Π΅Π½ΠΎΠ·Π½ΡΡ ΠΊΠ°Π½ΡΠ»Ρ (22 F) ΡΠ΅ΡΠ΅Π· ΠΏΡΠ°Π²ΡΡ Π²Π½ΡΡΡΠ΅Π½Π½ΡΡ ΡΡΠ΅ΠΌΠ½ΡΡ Π²Π΅Π½Ρ Π² ΡΡΠ²ΠΎΠ» Π»Π΅Π³ΠΎΡΠ½ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠΈ. ΠΠ»Ρ ΠΎΠ±Π»Π΅Π³ΡΠ΅Π½ΠΈΡ ΠΏΡΠΎΡ
ΠΎΠΆΠ΄Π΅Π½ΠΈΡ Π²ΠΎΠ·Π²ΡΠ°ΡΠ½ΠΎΠΉ ΠΊΠ°Π½ΡΠ»ΠΈ Π² Π»Π΅Π³ΠΎΡΠ½ΡΡ Π°ΡΡΠ΅ΡΠΈΡ ΠΌΡ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π»ΠΈ ΠΊΠΎΠ½ΡΡΠ°Π»Π°ΡΠ΅ΡΠ°Π»ΡΠ½ΡΠΉ ΠΈΠ½ΡΡΠΎΠ΄ΡΡΡΠ΅Ρ (6 F, 40 ΡΠΌ) ΠΈ ΠΏΡΠΎΠ²ΠΎΠ΄Π½ΠΈΠΊ ΡΠΈΠΏΠ° Amplatz Super Stiff ΠΏΠΎΠ΄ ΡΠ΅Π½ΡΠ³Π΅Π½ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΌ ΠΊΠΎΠ½ΡΡΠΎΠ»Π΅ΠΌ. ΠΠΊΡΠΈΠ³Π΅Π½Π°ΡΠΎΡ Π±ΡΠ» ΡΠ΄Π°Π»Π΅Π½ ΠΈΠ· ΠΊΠΎΠ½ΡΡΡΠ° Π½Π° Π²ΡΠΎΡΡΠ΅ ΡΡΡΠΊΠΈ RVAD. ΠΠ° ΡΠΎΠ½Π΅ ΠΠΠ ΠΌΡ ΠΎΡΠΌΠ΅ΡΠΈΠ»ΠΈ ΡΠ»ΡΡΡΠ΅Π½ΠΈΠ΅ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ ΡΠ΅Π½ΡΡΠ°Π»ΡΠ½ΠΎΠΉ Π³Π΅ΠΌΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΠΊΠΈ (ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΠ΅ ΠΠΠ Π΄ΠΎ 10 ΠΌΠΌ ΡΡ. ΡΡ., ΡΠ²Π΅Π»ΠΈΡΠ΅Π½ΠΈΠ΅ ΠΠΠΠ Π΄ΠΎ 14 ΠΌΠΌ ΡΡ. ΡΡ.) ΠΈ ΠΎΠ±ΡΠ΅ΠΌΠ½ΡΡ
Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΡΡΠΈΠΊ ΠΠ ΠΈ ΠΠ, ΡΡΠΎ ΠΏΠΎΠ·Π²ΠΎΠ»ΠΈΠ»ΠΎ ΠΎΠΏΡΠΈΠΌΠΈΠ·ΠΈΡΠΎΠ²Π°ΡΡ ΡΡΠ½ΠΊΡΠΈΠΎΠ½ΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ ΠΈΠΠΠ (ΡΠ²Π΅Π»ΠΈΡΠ΅Π½ΠΈΠ΅ ΠΏΡΠΎΠΈΠ·Π²ΠΎΠ΄ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΠΈ Π΄ΠΎ 4,2 Π»/ΠΌΠΈΠ½, ΠΈΠ»ΠΈ 2,1 Π»/ ΠΌΠΈΠ½/ΠΌ2). ΠΡΠΎΠ΄ΠΎΠ»ΠΆΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ ΠΏΠ°ΡΠ°ΠΊΠΎΡΠΏΠΎΡΠ°Π»ΡΠ½ΠΎΠ³ΠΎ ΠΠΠ ΠΏΠΎΡΠ»Π΅ ΠΈΠΌΠΏΠ»Π°Π½ΡΠ°ΡΠΈΠΈ ΠΠΠ ΡΠΎΡΡΠ°Π²ΠΈΠ»Π° 7 ΡΡΡΠΎΠΊ ΠΏΡΠΈ ΡΡΡΠ΅Π΄Π½Π΅Π½Π½ΠΎΠΉ ΠΏΡΠΎΠΈΠ·Π²ΠΎΠ΄ΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΠΈ 2,3 Β± 0,2 Π»/ΠΌΠΈΠ½. ΠΠ΅ΡΠΈΠΎΠ΄ ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ Π² ΡΡΠ»ΠΎΠ²ΠΈΡΡ
ΠΠ ΠΠ’ ΡΠΎΡΡΠ°Π²ΠΈΠ» 15 ΡΡΡΠΎΠΊ. ΠΠ°ΡΠΈΠ΅Π½Ρ Π²ΡΠΏΠΈΡΠ°Π½ ΠΈΠ· ΡΡΠ°ΡΠΈΠΎΠ½Π°ΡΠ° Π½Π° 34-Π΅ ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΡΠ΅ ΡΡΡΠΊΠΈ
Π’ΡΠ°Π½ΡΠΏΠ»Π°Π½ΡΠ°ΡΠΈΡ Π»Π΅Π³ΠΊΠΈΡ ΠΏΡΠΈ ΠΏΠ΅ΡΠ²ΠΈΡΠ½ΠΎΠΉ Π»Π΅Π³ΠΎΡΠ½ΠΎΠΉ Π°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ Π³ΠΈΠΏΠ΅ΡΡΠ΅Π½Π·ΠΈΠΈ: ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠΈ ΠΏΠ΅ΡΠΈΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ ΠΏΠ΅ΡΠΈΠΎΠ΄Π°
Lung transplantation (LT) for idiopathic pulmonary arterial hypertension (IPAH) now is the only radical treatment of this disease.Aim: to analyze own experience of performing LT in patients with IPAH.Materials and methods. 8 adult IPAH patients, who underwent LT between 2014 and october 2018, were included. In 7 of 8 patients undergoing bilateral lung transplantation on intraoperative venoarterial extracorporeal membrane oxygenation (VA ECMO) with prolongation into the postoperative period.Results. VA ECMO support was prolonged into postoperative period 6 and 7 days respectively in 2 (25,0%) patients and 3 days in 6 (75,0%) patients. Hospital mortality in IPAH patients was 1.Conclusions. Own experience demonstrates that LT is an effective method of treatment in patients with IPAH. Hospital, 1- and 3-year survival rates for the patient collective were 87.5, 75.0 and 75.0% respectively.ΠΠ΅ΡΠ²ΠΈΡΠ½Π°Ρ Π»Π΅Π³ΠΎΡΠ½Π°Ρ Π°ΡΡΠ΅ΡΠΈΠ°Π»ΡΠ½Π°Ρ Π³ΠΈΠΏΠ΅ΡΡΠ΅Π½Π·ΠΈΡ (ΠΠΠΠ) β Π½Π΅ΠΎΠ±ΡΠ°ΡΠΈΠΌΠΎΠ΅ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠ΅, Π΅Π΄ΠΈΠ½ΡΡΠ²Π΅Π½Π½ΡΠΌ ΠΌΠ΅ΡΠΎΠ΄ΠΎΠΌ ΡΠ°Π΄ΠΈΠΊΠ°Π»ΡΠ½ΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΊΠΎΡΠΎΡΠΎΠ³ΠΎ ΡΠ²Π»ΡΠ΅ΡΡΡ ΡΡΠ°Π½ΡΠΏΠ»Π°Π½ΡΠ°ΡΠΈΡ Π»Π΅Π³ΠΊΠΈΡ
(Π’Π).Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ: Π°Π½Π°Π»ΠΈΠ· ΡΠΎΠ±ΡΡΠ²Π΅Π½Π½ΠΎΠ³ΠΎ ΠΎΠΏΡΡΠ° Π²ΡΠΏΠΎΠ»Π½Π΅Π½ΠΈΡ Π’Π Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΠΠΠ.ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. Π ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π²ΠΊΠ»ΡΡΠΈΠ»ΠΈ 8 Π²Π·ΡΠΎΡΠ»ΡΡ
ΡΠ΅ΡΠΈΠΏΠΈΠ΅Π½ΡΠΎΠ², ΠΊΠΎΡΠΎΡΡΠΌ Π±ΡΠ»Π° Π²ΡΠΏΠΎΠ»Π½Π΅Π½Π° Π’Π Π² ΠΏΠ΅ΡΠΈΠΎΠ΄ Ρ 2014-Π³ΠΎ ΠΏΠΎ ΠΎΠΊΡΡΠ±ΡΡ 2018 Π³. ΠΡΠ΅ΠΌ ΡΠ΅ΡΠΈΠΏΠΈΠ΅Π½ΡΠ°ΠΌ Π±ΡΠ»Π° Π²ΡΠΏΠΎΠ»Π½Π΅Π½Π° Π΄Π²ΡΡΡΠΎΡΠΎΠ½Π½ΡΡ ΠΏΠΎΡΠ»Π΅Π΄ΠΎΠ²Π°ΡΠ΅Π»ΡΠ½Π°Ρ ΡΡΠ°Π½ΡΠΏΠ»Π°Π½ΡΠ°ΡΠΈΡ Π»Π΅Π³ΠΊΠΈΡ
. Π£ 7 ΠΈΠ· 8 ΡΠ΅ΡΠΈΠΏΠΈΠ΅Π½ΡΠΎΠ² Π’Π ΠΎΡΡΡΠ΅ΡΡΠ²Π»ΡΠ»ΠΈ Π² ΡΡΠ»ΠΎΠ²ΠΈΡΡ
ΠΏΠ΅ΡΠΈΡΠ΅ΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΠΠ ΠΠΠΠ.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. Π ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΌ ΠΏΠ΅ΡΠΈΠΎΠ΄Π΅ ΠΏΠ΅ΡΠ²ΠΈΡΠ½Π°Ρ Π΄ΠΈΡΡΡΠ½ΠΊΡΠΈΡ 3-ΠΉ ΡΡΠ΅ΠΏΠ΅Π½ΠΈ ΠΏΠΎ ΠΊΠ»Π°ΡΡΠΈΡΠΈΠΊΠ°ΡΠΈΠΈ ISHLT ΡΠ°Π·Π²ΠΈΠ»Π°ΡΡ Ρ 2 (25,0%) ΠΈΠ· 8 ΡΠ΅ΡΠΈΠΏΠΈΠ΅Π½ΡΠΎΠ², ΠΊΠΎΡΠΎΡΠ°Ρ ΠΏΡΠΎΡΠ²ΠΈΠ»Π°ΡΡ Π½Π΅Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΡΡ ΠΏΡΠ΅ΠΊΡΠ°ΡΠ΅Π½ΠΈΡ ΠΠ ΠΠΠΠ. ΠΠ±ΡΠ°Ρ ΠΏΡΠΎΠ΄ΠΎΠ»ΠΆΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ ΠΏΡΠΈΠΌΠ΅Π½Π΅Π½ΠΈΡ ΠΠΠΠ Ρ ΡΡΠΈΡ
ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² (n = 2) ΡΠΎΡΡΠ°Π²ΠΈΠ»Π° 6 ΠΈ 7 ΡΡΡΠΎΠΊ. Π£ Π΄ΡΡΠ³ΠΈΡ
6 (75,0%) ΡΠ΅ΡΠΈΠΏΠΈΠ΅Π½ΡΠΎΠ² ΠΏΡΠΎΡΠ²Π»Π΅Π½ΠΈΡ ΡΠ°Π½Π½Π΅ΠΉ Π΄ΠΈΡΡΡΠ½ΠΊΡΠΈΠΈ ΠΏΠ΅ΡΠ΅ΡΠ°ΠΆΠ΅Π½Π½ΡΡ
Π»Π΅Π³ΠΊΠΈΡ
Π½Π΅ Π½ΠΎΡΠΈΠ»ΠΈ ΡΡΠΎΠ»Ρ Π½Π°ΠΏΡΡΠΆΠ΅Π½Π½ΠΎΠ³ΠΎ Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠ° (2-Ρ ΡΡΠ΅ΠΏΠ΅Π½Ρ ΠΏΠΎ ΠΊΠ»Π°ΡΡΠΈΡΠΈΠΊΠ°ΡΠΈΠΈ ISHLT), ΠΈ ΠΏΡΠΎΠ΄ΠΎΠ»ΠΆΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ ΠΏΠΎΡΠ»Π΅ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠΎΠ½Π½ΠΎΠΉ ΠΠ ΠΠΠΠ ΡΠΎΡΡΠ°Π²ΠΈΠ»Π° 3 ΡΡΡΠΎΠΊ. ΠΠΎΡΠΏΠΈΡΠ°Π»ΡΠ½Π°Ρ Π»Π΅ΡΠ°Π»ΡΠ½ΠΎΡΡΡ Ρ ΡΠ΅ΡΠΈΠΏΠΈΠ΅Π½ΡΠΎΠ² Π»Π΅Π³ΠΊΠΈΡ
, ΠΎΠΏΠ΅ΡΠΈΡΠΎΠ²Π°Π½Π½ΡΡ
ΠΏΠΎ ΠΏΠΎΠ²ΠΎΠ΄Ρ ΠΠΠ, ΡΠΎΡΡΠ°Π²ΠΈΠ»Π° 1 Π½Π°Π±Π»ΡΠ΄Π΅Π½ΠΈΠ΅.ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. Π‘ΠΎΠ±ΡΡΠ²Π΅Π½Π½ΡΠΉ ΠΎΠΏΡΡ Π΄Π΅ΠΌΠΎΠ½ΡΡΡΠΈΡΡΠ΅Ρ, ΡΡΠΎ Π’Π ΡΠ²Π»ΡΠ΅ΡΡΡ ΡΡΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΠΉ Π»Π΅ΡΠ΅Π±Π½ΠΎΠΉ ΠΌΠ΅ΡΠΎΠΉ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΠΠΠ Ρ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»ΡΠΌΠΈ Π³ΠΎΡΠΏΠΈΡΠ°Π»ΡΠ½ΠΎΠΉ, 1- ΠΈ 3-Π»Π΅ΡΠ½Π΅ΠΉ Π²ΡΠΆΠΈΠ²Π°Π΅ΠΌΠΎΡΡΠΈ ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²Π΅Π½Π½ΠΎ 87,5; 75,0 ΠΈ 75,0%
The Study Of Ob Stellar Associations With The Glazar
The results of observations of a dozen OB stellar associations made with the ultraviolet space telescope Glazar is presented. Key Words : OB stellar associations I. THE GLAZAR SPACE TELESCOPE AND OBSERVATIONS The Glazar space telescope (Tovmassian et al.1988) was functioning at the Mir Space Station from August 1987 to March 1989. It is a 40 cm Ritchey-Cretien wide field camera (1: ffi 3, 40 mm at the focal plane) operating at 1640 Awith a bandwidth of ΒΈ 250 A. The detector was a Multichannel Intensifier used with film sensitive to a visible light. The cassettes with exposed films have been brought to the Earth by the returning crews. The star trackers of the telescope with pointing accuracy of about 3 arc were not used, and it was determined with that of the whole Mir Space Station, and was equal to about 40 00 . Due to this the sensitivity of the telescope was less. The limiting stellar magnitude decreased from 9 m to ΒΈ11 m . Areas of a dozen OB stellar associations have be..
Lung transplantation for idiopathic pulmonary arterial hypertension: perioperational features
Lung transplantation (LT) for idiopathic pulmonary arterial hypertension (IPAH) now is the only radical treatment of this disease.Aim: to analyze own experience of performing LT in patients with IPAH.Materials and methods. 8 adult IPAH patients, who underwent LT between 2014 and october 2018, were included. In 7 of 8 patients undergoing bilateral lung transplantation on intraoperative venoarterial extracorporeal membrane oxygenation (VA ECMO) with prolongation into the postoperative period.Results. VA ECMO support was prolonged into postoperative period 6 and 7 days respectively in 2 (25,0%) patients and 3 days in 6 (75,0%) patients. Hospital mortality in IPAH patients was 1.Conclusions. Own experience demonstrates that LT is an effective method of treatment in patients with IPAH. Hospital, 1- and 3-year survival rates for the patient collective were 87.5, 75.0 and 75.0% respectively