Method for temporary support of myocardial perfusion in patients with involved trunk of left coronary artery

FIELD: medicine.

SUBSTANCE: femoral artery is punctured on the right to place an introducer therein. The radial artery is punctured to connect a roller pump for arterial blood sampling. The subclavian or internal jugular vein is punctured to approach the coronary sinus to place a retro perfusion balloon. The retro perfusion balloon is inserted into a proximal segment of the great or middle cardiac vein. The balloon is inflated, and retro perfusion is performed at 20 ml/min accompanying the balloon angioplasty and/or stent implantation. The balloon is blown off after an antegrade blood flow is recovered.

EFFECT: method enables reducing a risk of intraoperative and postoperative complications, reducing a risk of haemorrhages, thromboses and ischemia of an extremity by puncturing the radial artery.

2 ex

 

The invention relates to the field of medicine, namely to surgery, in particular to cardiovascular surgery, and can be used in interventional Cardioangiology for temporary selective support coronary perfusion of the myocardium of the left ventricle during endovascular correction of atherosclerotic lesions of the left coronary arteries in patients with chronic and acute disorders of coronary circulation.

In the last decade, coronary heart disease (CHD) is the leading major cause of mortality in almost all regions and countries of the world [Kononov A.V., Kostanov I. Yu., Kuznetsova I. E., aligishieva Z. A., Abildinova A. J., Tsereteli N. In., Kolodynski A. G., D. G. Gromov, O. E. Sukhorukov, D. G. Iosseliani Stenting of the left main coronary artery in patients with various forms of coronary heart disease: early and sredneetazhnye results // international journal of interventional Cardioangiology. - M.: - 2013. - No. 32, pp. 19-26].

One of the most severe coronary heart disease patients are patients with lesions of the left main coronary artery (LCA), most of which have a marked impairment of function of the myocardium of the left ventricle and reduced ejection fraction, and therefore have a high risk of fatal cardiac events [A. Dacosta, Tady B. Favre J. P. et al. Left main coronary artery disease // Arch. Mai. Coeur. Vaiss. - 1994. - Vol.87, No. 9 - P. 1225-1232]. Despite the constant improvement of methods of endovascular correction of the stem lesions, intraoperative mortality in this type of intervention may reach 4.3% [Cammeau P., P. Barragan, Roquebert R. et al. Left main coronary stenting: long-term follow-up. Am J Cardiol 2004; 94:Suppl 6A:3E.16], which makes urgent the search for new more effective treatments.

Currently the use of support systems of the coronary circulation in endovascular intervention is becoming more common in high risk patients, which include patients with lesions of the left main coronary artery in combination with a low ejection fraction of the left ventricle.

Known methods of surgical treatment of ischemic heart disease (RU patent No. 2192791, MGI AV 17/00, publ. from 20.11.2002 g, us patent No. 2192792, IPC AV 17/00, publ. 20. 11. 2002), which impose constant coronarography shunt or anastomosis. However, open heart surgery is more dangerous, traumatic, requires the use of additional anesthetic and cardiac benefits.

A method of treating myocardial infarction (RU patent No. 2355325, IPC AV 17/00, publ. of 20.05.2009), where a patient is immersed in a total state of mild hypothermia. Application of General hypothermia involves �rovedine surgery open heart, often with the use of extracorporeal circulation, which in itself makes impractical the application of endovascular coronary equipment.

The disadvantages of the known method include the use of additional anesthesia for anesthesia of the patient. Anesthesia of the patient, carried out for the General use of moderate hypothermia, eliminates the possibility of intraoperative communication between the doctor and the patient, and therefore makes it impossible to evaluate the subjective state of the patient. In addition, the introduction of intracoronary autologous blood chilled can contribute to the occurrence of pronounced koronarospazm that leads to myocardial ischemia and the development of arrhythmic complications (including ventricular fibrillation).

The known method of intra-aortic balloon contrapuntally (Bokeria L. A., Alekyan B. G., Colomo A., Buziashvili Y. I. Interventional methods of treatment of coronary heart disease. - M.: Publishing house of scientific. A. N. Bakulev RAMS. - 2002. - 417). Method intra-aortic balloon contrapuntally widely used as a method to support circulation, which is based on the use of inflatable balloon (32 to 40 ml), connected to an external control panel. Cylinder set distal to the left subclavian artery. Synchronize�created with the heart rate the balloon is inflated with helium at the moment of diastole (when the full closure of the aortic valve), that creates increased pressure in the ascending aorta, and therefore increases the perfusion pressure in the coronary arteries. Deflation of the balloon occurs in early systole, at the time of opening of the aortic valve.

The advantage of the known method is that by increasing diastolic pressure in the aorta increases perfusion pressure in the coronary arteries and, as consequence, decreases the need for hospitalization of oxygen; the ejection fraction of the left ventricle is increased by 20% -39%; ease of installation (due to anatomical reasons in applying this method, only 10% of patients have difficulties).

The disadvantages of this method are: lack of effectiveness of the method in unsteady heart rhythm; the inefficiency of the method with the "overlap" of the inner lumen of trunk of a balloon catheter and when performing angioplasty with stenting due to the inability of the antegrade blood pool of the left coronary artery.

A prototype of the invention is selected known temporary support myocardial perfusion in patients with lesions of the left main coronary artery involving the puncture of the femoral artery with the installation of the Introducer, the connection through the artery of the peristaltic pump draws the arterial blood and is p�quench access to the coronary sinus (Bokeria L. A., Alekyan B. G., Colomo A., Buziashvili Y. I. Interventional methods of treatment of coronary heart disease. - M.: Publishing house of scientific. A. N. Bakulev RAMS. - 2002. - 417).

The known method is as follows. For the purpose of conducting balloon angioplasty and/or stenting perform puncture of the femoral artery on the right. In the lumen of the artery establish a standard 7F Introducer, wherein the distal end of the Introducer is in the projection of the external iliac artery. Perform the puncture of the left femoral artery and into the lumen of the artery establish long 8F Introducer, the distal end of which is installed in the projection of the terminal aorta. Perform puncture of the subclavian or internal jugular vein to the right or left to access the coronary sinus and into the lumen of the vein establish long 9F Introducer sheath with the installation of the distal end of the Introducer into the right atrium. Using subclavian venous and/or jugular 9F Introducer sheath at the mouth of the coronary sinus is delivering a system by which conduct Trekhprudny retroperfusion balloon catheter 7-8F in the middle or distal main cardiac vein coronary venous sinus. Set retroperfusion catheter in the mid and distal coronary sinus, the balloon is placed at the end of the catheter, RA�duvets to complete overlap of the lumen of the main cardiac vein. To clarify the provisions of venography catheter is introduced through the insertion through the internal lumen of the catheter with contrast medium. The balloon is deflated, and one of the gleams of the catheter is connected to the retroperfusion system. The second lumen of the cylinder is connected to the sensor invasive pressure to control the pressure in the coronary sinus during the session of retroparty. The third lumen of the catheter is required for retrograde perfusion of autokraft and intravenous injection of a solution of heparin (10000 IU intravenously).

Retroperfusion system on the principle of controlstar: a device that produces inflating retroperfusion balloon during diastole of the heart (used for inflating gas is helium and/or carbon dioxide) and blows the balloon during systole to preserve the venous drainage of the sinus. During inflating of the balloon in diastole blood autochrome flows retrograde to the myocardium via the coronary veins and venules. During diastole of the heart through the lumen of the cylinder roller perfusion pump drives blood autochrome with a maximum speed of up to 250 ml/min (the minimum perfusion rate of 25 ml/min; the maximum is 250 ml/min). During systole of the heart roller pump stops. During synchronized with diastole of retrophone pressure in the sinus is ~80-90 mm Hg.CT., but can� be increased to higher values. For collection of arterial blood roller peristaltic pump consisting of retroperfusion system is connected to an arterial Introducer set in the terminal aorta through the left femoral artery. For controlled inflation and deflation of retroperfusion balloon retroperfusion system synchronized with the patient's ECG (R wave). When conducting retrophone Introducer installed in the right common femoral artery is used as a port for conducting x-ray instrumentation to the coronary arteries of the heart. The method synchronized with diastole of retrophone coronary sinus is in the process of the temporary overlap of the lumen of the left main coronary artery during catheter balloon angioplasty or stenting. Conducting synchronized with diastole of retrophone coronary sinus is also possible in the case of acute occlusion of the trunk during or after the course of angioplasty and stenting.

Application of the known method reduces myocardial ischemia in the process of overlapping of the antegrade blood pool of the left coronary artery in the process of angioplasty and stenting of the left main coronary artery (LM) and proximal segment of the anterior interventricular branch (lad), contributing to the possibility�spine for a long period of overlap of the lumen of the left main coronary artery lad and in the case of stenting "hard" calcified stenosis and/or correction of bifurcation lesions front of the pool, which requires more time for implantation of stents. The advantages of the known method include the possibility of improving myocardial function of the left ventricle in acute occlusions of the left main coronary artery and/or proximal segment of the lad, which allows to avoid the development of acute myocardial infarction.

However, the known method has the following disadvantages.

1) the Installation of a long Introducer 25 cm in length is often difficult because of possible deviation and/or expressed atherosclerotic disease of the iliac-femoral arterial segment. In addition, the installation 8F Introducer may result in problems with hemostasis at the time of its removal (after the operation) and, therefore, risk of bleeding, the formation of giant hematomas, false aneurysms at the obligatory use of desegregates and anticoagulant therapy.

2) inserting into the lumen of the left subclavian and internal jugular vein subclavian and/or jugular long Introducer (length 25 cm, diameter - 9F) complicates venous hemostasis after removal of the Introducer with the compulsory use of desegregates and anticoagulant therapy.

3) Introducing into the lumen of the coronary sinus trehprofilnoe retroperfusion balloon catheter (type Swan-Ganz) 7-8F is unfounded - the shaft of the rigid cylinder, the cylinder�th large catheter, less controlled. In the process of conducting such a balloon catheter is a violation of the outflow of venous blood from the coronary sinus and increases the risk of trauma to the wall of the sinus in the conduct of retroperfusion balloon catheter.

4) use of the retroperfusion system that synchronizes the inflation of the perfusion balloon and the retroperfusion of autologous blood with the diastole of the heart (diastole - balloon inflation and retroperfusion, in systole - blowing cylinder without atroparvus), is unfounded, since the series of permanent inflation and deflate of the cylinder at the end of the retroperfusion catheter causing damage to the wall of the coronary sinus. Moreover, even a temporary overlap of the lumen of the main cardiac vein may contribute to the development of arrhythmic complications and violation of the outflow of venous blood, which causes ischemic changes of the myocardium. One should not forget that in the known method the maximum speed of retroparty with inflation of the balloon can reach 250 ml/min, making it unsafe for the coronary veins and can lead to rupture of the coronary veins of the heart, as well as hyperbaric damage venules of the myocardium and, consequently, the lack of restoration of function of areas of the heart muscle, perfused retrograde.

The objective of the proposed image�etenia is to provide a method of temporary support myocardial perfusion in patients with lesions of the left main coronary artery, possible to reduce the risk of intraoperative and postoperative complications.

The problem is solved in that in the known method of temporary support myocardial perfusion when performing balloon angioplasty and/or stenting in patients with lesions of the left main coronary artery involving the puncture of the femoral artery on the right with the installation in it of the Introducer, the puncture of the artery with the installation in it of the Introducer to connect the peristaltic pump draws arterial blood, the puncture of the subclavian or internal jugular vein for access to the coronary sinus with the subsequent installation of retroperfusion balloon peristaltic pump is connected via the radial artery retroperfusion balloon is introduced into the proximal Department of a large or middle cardiac vein, then inflate the balloon and hold the retroperfusion at a speed of 20 ml/min during balloon angioplasty and/or stent implantation, the balloon is deflated after the restoration of antegrade blood flow.

The present invention meets the criterion of "novelty" and "inventive step", because in the process of conducting patent information research did not reveal sources of scientific-technical and patent information to be novelty of the present invention, as well as those�on-demand solutions, containing the essential features of the proposed method.

The proposed method allows using to obtain the following technical effect.

The proposed method allows to reduce the risk of intraoperative and postoperative complications. Conducting retrograde perfusion at a low speed of 20 ml/min preserves the integrity of the wall perfuziruemah of Vienna, does not violate outflow of blood from the coronary sinus. Retroperfusion balloon, which is during the overlap of the antegrade blood flow through the coronary arteries in the inflated state, does not violate retrograde outflow, which reduces the risk of intraoperative myocardial infarction. Perform the puncture of the radial artery reduces the risk of bleeding, thrombosis and limb ischemia. Puncture of the radial artery has easy access and low risk of bruising. The proposed method allows to increase the effectiveness of the temporary maintenance of blood supply to the myocardium on the anterolateral wall of the left ventricle. The proposed method is as follows: Perform puncture of the femoral artery on the right with the installation of Introducer 7F for endovascular access to the coronary arteries for the purpose of conducting balloon angioplasty and/or stenting, distal end of Introducer is the projection of the external iliac artery. �apolnet puncture of the radial artery for arterial fence autologous blood roller peristaltic pump and set the standard radial Introducer 5 F, the distal end of which is in the radial artery of the patient. Perform puncture of the subclavian and internal jugular vein for access to the coronary sinus with the subsequent installation of a specialized delivery system for delivery to the sinus retroperfusion balloon 6F (type Swan-Ganz). In this case, the length of the distribution system at least 25 cm, outer diameter - 8 F, the distal end systems are further bent at an angle of 45°. The delivery system is placed in the mouth of the coronary sinus. By delivery system, using a standard coronary guidewire in the proximal Department of a large or middle cardiac vein spend retroperfusion balloon type Swan-Ganz with an outer diameter of 6 F. balloon at the tip of the catheter is inflated to aid in coronary venography, and then through the lumen of the catheter is injected with a contrast agent.

Perform contrast venography to clarify the position of the catheter. The balloon is deflated and the one lumen of the catheter is connected to roller perfusion pump for retrophone autologous blood and intravenous injection of a solution of heparin 10000 UNITS.

The second lumen of the cylinder is connected to the syringe to allow the inflation (inflating) to complete overlap of the lumen of a large or middle cardiac vein. The diameter of the great cardiac vein varies in the range of 3-5 mm.

At that time�GDSs retroperfusion container is installed in the proximal large or middle cardiac vein, hyped to complete overlap of the lumen of the vein, start the session retrophone. Roller peristaltic pump draws blood autochrome from the radial artery (through the radial Introducer) and pumps it to selectively catheterized large or middle cardiac vein at a rate of 20 ml/min.

For inflating the balloon used anticoagulant is heparin.

Balloon inflation is not synchronized with diastole. The balloon is inflated and produce a retroperfusion only during balloon angioplasty or stent implantation (by overlapping of the left main coronary artery) and deflated immediately after the restoration of antegrade flow in the left main coronary artery. The maximum perfusion rate of 20 ml/min During systole of the heart roller perfusion pump is not stopped and perfusion of the heart continue. The pressure in the sinus during retrophone should not reach 80 mm Hg.CT., however, in some cases, it may be higher. To prevent the formation of blood clots in the process of perfusion arterial autologous blood in the contour associated with a peristaltic roller pump, additionally joins the heparin solution at the rate of 5 UNITS per 1 kg of body weight. The proposed method is not synchronized with the patient's ECG.

The proposed method is performed only in the long process of the temporary overlap of the lumen of the left main coronary arter�I.

Examples of specific performance are given in the extracts from the case history No. 5327.

Patient Z., aged 68, was admitted to the intensive care unit and intensive care SBME BUT "City clinical hospital №5" G. N. Novgorod clinic with acute chest pain, recurrent in his left hand. Diagnosis at admission: myocardial ischemia, anterior Q-wave myocardial infarction, circulatory - NB. Initial ischemic changes according to electrocardiography (ECG): "peredneperegorodochnoj-apical-lateral process" - elevation VI (1 mm), depression V3-V6 (2 mm). Initial echocardiographic changes: ejection fraction (EF) 44%, the index of violations of local contractility (INLS) 1,37.

The patient was immediately taken to the Department of endovascular methods of diagnosis and treatment for percutaneous coronary intervention. The "door-to-balloon was 6 hours since the onset of pain that led to this hospitalization. When performing selective coronary angiography revealed the following changes: a massive thrombus in the distal part of the left main coronary artery (LCA) with overlapping gaps anterior descending artery (GENE) and circumflex artery (OA) to 90% of the inner diameter. Given the critical klinicheskogo lesions of the LMCA, the PNA and OA, it was decided to start by retroperfusion�support blood supply of the anterior wall of the left ventricle. For retrophone myocardial installed radial Introducer 5F in the region of the radial artery on his right arm, made a puncture and catheterization of the left subclavian vein guideway system 6F for catheterization of the coronary sinus. After catheterization of the coronary sinus retroperfusion balloon catheter held in the proximal division of the great cardiac vein. Performed venography venous pathology is not revealed. Deflation of a balloon catheter, a retroperfusion control the location of the cylinder. The connected system for retrophone of the myocardium.

Coronary guide wires sequentially held in the distal PA and OA. Balloon catheters sequentially conducted through the conductors in the left main coronary artery with the capture of the estuarine segments of the PNA and OA. Started balloon dilatation with the simultaneous inclusion of systems for retrophone of the myocardium. Retroperfusion of the myocardium of the left ventricle was evaluated by means of pumping blood autologous blood roller peristaltic pump (fence over the radial artery) into the lumen of the great cardiac vein: the maximum flow velocity in the retroperfusion system 20 ml / min, the maximum pressure in the retroperfusion system 80 mm Hg.PT. The system of blood coagulation in the extracorporeal circuit was implemented Sol. Heparini at a speed of 80 units. per hour. Made prolonged dilation of vasoconstriction of the LMCA, the PNA and OA by the method of "kissing balloons" at a pressure of 12 ATM for 40 seconds. On the control angiogram of the lumen of the PA and OA sufficient for the stents. Delivering system and the stent is installed in the left main coronary artery with the capture of the ostial segment of the PNA. Careful positioning of the stent. Stent implantation according to the method pressed against the conductor at a pressure of 10 ATM. Proximal optimization of the left main coronary artery at a pressure of 16 ATM. Made the exchange of conductors. The balloon catheter is drawn through the cell of the stent in the proximal segment OA. Performed dilation of the cell of the stent at a pressure of 12 ATM. On the control angiogram: the lumen of the left main coronary artery, the PA and OA in the area of intervention is fully restored, dissection no, parietal thrombosis no.Retroperfusion completed, produced deflation retroperfusion of the cylinder, removal of the retroperfusion system. The surgery is finished. In the process of conducting retrophone: elevation of ST segment in lead VI is absent, a sharp decrease of ST-segment depression in precordial leads V3-V6 (up to 0.5 mm) compared with baseline values. Echocardiography during retroperfusion support: increase PV to 50% decrease in INLS to 1.16. Pain syndrome in the intervention process was stopped.

Clinical example No. 2. Historical� disease No. 7123. Patient P., aged 65, was admitted to the intensive care unit and intensive care SBME BUT "City clinical hospital №5" G. N. Novgorod clinic with pain under the left shoulder blade, severe dyspnea at rest. Diagnosis at admission: myocardial ischemia, PEAKS, re front is not Q-wave myocardial infarction, circulatory - NB. Initial ischemic ECG changes: ST-segment depression in lead VI (2 mm). Initial echocardiographic changes: ejection fraction (EF) 48%, index of a violation of local contractility (INLS) of 1.12. Systolic blood pressure is 120 mm Hg.PT.

The patient was immediately taken to the Department of endovascular methods of diagnosis and treatment for percutaneous coronary intervention. The "door-to-balloon was 10 hours from the moment of occurrence of the pain that led to this hospitalization. When performing selective coronary angiography revealed the following changes: a stenosis of 80% in the distal part of the left main coronary artery (LCA) with the transition to the mouth anterior descending artery (PNA). Coronary guidewire was made through the area of stenosis of the LMCA and the PNA in the distal of the PNA. Through the conductor to the area of stenosis performed balloon catheter is performed angioplasty of the stenosis. On the control coronarography - occlusive dissection in the proximal segment of the PNA. The recorded�, whereas a sharp drop in hemodynamics of the patient: elevation of ST segment in lead VI (4 mm), the fall in systolic blood pressure to 70 mm Hg.PT. Given the rapid development of the clinic cardiogenic shock, extra started inotropic support and myocardial retroperfusion support blood supply of the anterior wall of the left ventricle. For retrophone myocardial installed radial Introducer 5F in the region of the radial artery on his right arm, made a puncture and catheterization of the left subclavian vein guideway system 6F for catheterization of the coronary sinus. After catheterization of the coronary sinus retroperfusion balloon catheter held in the proximal division of the great cardiac vein. Performed venography venous pathology is not revealed. Deflation of a balloon catheter, a retroperfusion control the location of the cylinder. The connected system for retrophone of the myocardium. Retroperfusion of the myocardium of the left ventricle was evaluated by means of pumping blood autologous blood roller peristaltic pump (fence over the radial artery) into the lumen of the great cardiac vein: the maximum flow velocity in the retroperfusion system 20 ml / min, the maximum pressure in the retroperfusion system 80 mm Hg.PT. The system of blood coagulation in the extracorporeal circuit was implemented Sol. Heparini at a speed of 800 units per hour. When retrophone - stabilization of hemodynamics (systolic blood pressure - 100 mm Hg.St.), the decrease in ST-segment elevation of 0.5 mm. In coronary guidewire in the region of the occlusive dissection in the area of the stenosis of the LMCA and the PNA held delivering the system with the stent. The stent is implanted at a pressure of 16 ATM. On the control angiogram - the lumen of the left main coronary artery and the PNA in the intervention area is fully restored, dissection no, parietal thrombosis no. Retroperfusion completed, produced deflation retroperfusion of the cylinder, removal of the retroperfusion system. The surgery is finished. At the time of disconnection of atroparvus (at the end of operation): the ST segment in lead VI - isoline. Echocardiography during retroperfusion support: increase PV to 50% and save INLS 1,12 during cardiogenic shock and a sharp decline in myocardial contractility. Pain syndrome in the intervention process was stopped. Systolic blood pressure of 105 mm Hg.PT.

Method of temporary support myocardial perfusion when performing balloon angioplasty and/or stenting in patients with lesions of the left main coronary artery involving the puncture of the femoral artery with the installation in it of the Introducer, the puncture of the artery with the installation in it of the Introducer to connect the peristaltic pump draws arterial blood, the puncture of the subclavian or�morning jugular vein for access to the coronary sinus with the subsequent installation of retroperfusion balloon characterized in that peristaltically pump is connected via the radial artery retroperfusion balloon is introduced into the proximal Department of a large or middle cardiac vein, and then inflate the balloon and hold the retroperfusion at a speed of 20 ml/min during balloon angioplasty and/or stent implantation, the balloon is deflated after the restoration of antegrade blood flow.



 

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27 cl, 13 dwg

FIELD: medicine.

SUBSTANCE: medical devices and methods, more specifically to devices, systems and methods of treating sinusitis. A guide catheter for the directional insertion of one or more flexible devices into a patient's sinus and the aspiration by means of the guide catheter. According to the first version, the guide catheter comprises an elongated shaft of the catheter designed for insertion into a patient's nostril, and an assembled bushing connected to a proximal portion of the shaft. The shaft comprises a proximal portion, a curved distal portion more flexible as compared to the proximal portion, and a lumen extending longitudinally through the proximal and distal portions. The assembled bushing comprises an inner chamber fluid-connected to the lumen of the shaft, a backpressure valve integrated into the inner chamber, as aspiration port for connecting the aspiration mechanism to the bushing, and a vent hole. The valve has a hole used to form a hermetic sealing surround the device advanced through the valve. The lumen comprises a first inner diameter in the proximal portion of the shaft. The first inner diameter has a size sufficient to enable a proximal aspiration procedure through the shaft while the balloon catheter is found in the lumen of the proximal portion. According to the second version of the guide catheter, the lumen of the proximal portion of the shaft comprises the backpressure valve. An aspiration port extends along the proximal portion of the shaft in order to connect the aspiration mechanism to the guide catheter. The vent hole is formed along the proximal portion of the shaft. A sinus or sinus cavity surgical system comprises the above guide catheter according to the first version and the flexible device designed for insertion through the guide catheter into the sinus cavity to perform a sinus or sinus cavity surgery.

EFFECT: invention is simple and least injuring.

26 cl, 27 dwg

FIELD: medicine.

SUBSTANCE: invention refers to medicine. A catheter has a tubular body and a rotatable rod integrated into the tubular body cavity. A cutting element is connected to the rotatable rod and has a cutting edge. The cutting element and the rotatable rod are configured to move longitudinally inside the tubular body between the retracted position, wherein the cutting element is parallel to a long axis of the tubular body, and the cutting position, wherein the cutting element is deflected between the proximal and distal ends of the tubular body beyond an outer diameter of the tubular body. The cutting element is configured to cut the material from a vascular wall on the processed section as pushing the catheter in the distal direction through the processed section. The catheter comprises a collection chamber arranged in the proximal direction in relation to a cutting window.

EFFECT: structural improvement.

9 cl, 11 dwg

FIELD: medicine.

SUBSTANCE: artificial ventricle of the heart comprising a two-stage diaphragm pump and a cannula consisting of ventricular and aortal portions series connected to the pump; the pump consists of a membrane-divided gas cylinder, which is piped or canalled to a device providing pulsed gas feed alternated with vacuum generation; a pumped medium chamber is provided with a union to connect to the ventricular portion of the cannula; the ventricular portion represents a rigid tubular element perforated along the periphery of its diametric section configured between retainer washers in an inner wall of the tubular element of the cannula and displaced towards the retainer washer remote from the union of the diaphragm pump; a cylindrical cup is less high than a distance of the retainer washers and has a base hole; the base is provided in the inner portion of the tubular element of the cannula and movable between the retainer washers to open and close the perforations, while the aortal portion of the cannula is made of a soft silicone tube. Disclosed is a version of the artificial ventricle characterised by structural implementation.

EFFECT: invention enables the heart unloading to recover the myocardial function and to maintain blood pressure in the circulatory system.

10 cl, 3 dwg, 2 ex

FIELD: medicine.

SUBSTANCE: pump unit comprises a flow passage and inlet and outlet valves; a blood-flow surface has a time-version relief described by the relations of unsteady self-organising rotational blood flow. An energy source represents a patient's heart, while the flow passage is provided in the pericardial cavity and adjoins the heart in the anatomical position of the right ventricle and shaped after that. From the outside, the pump unit is closed with a pericardial layer a lack of which is filled with a synthetic flap of a biologically compatible synthetic material.

EFFECT: invention enables blood pumping without using external energy sources providing partial or complete recovery of individual normal blood circulation values.

1 ex, 1 tbl, 4 dwg

FIELD: medicine.

SUBSTANCE: invention relates to medical pumps and is intended for introduction into the blood circulation system of a mammal in order to support the heart in the blood circulation realisation. A catheter pump contains a hollow catheter, a drive rod, placed in a lumen of the hollow catheter, a drive shaft, connected to the distal end of the drive rod for bringing it into motion by means of the drive rod, proximal and distal cases, a group of threads, stretched between the proximal and distal cases, and a propeller, installed on the drive shaft between the proximal and distal cases. Distal and proximal bearings bear the drive shaft and are installed in the distal and proximal cases. A system of washing is intended for the liquid supply by the hollow catheter to the proximal bearing in order to wash and lubricate it. Means for washing and lubrication of the distal bearing is made in a form of channels for supply of liquid from the proximal bearing to the distal one.

EFFECT: technical result consists in an increased service term.

9 cl, 22 dwg

FIELD: medicine.

SUBSTANCE: method involves simulating gestosis in Wistar rats by the daily intraperitoneal introduction of L-nitro-arginine-methyl ester 25 mg/kg for 7 days from the 14th day of pregnancy. That is followed by a single simulation of a 10-minute remote ischemic episode on the hind limb on the 21st day of pregnancy by femoral artery clamping and reperfusion. Vascular tests follow 90 minutes later, and an endothelial dysfunction coefficient is calculated.

EFFECT: method enables studying the NO-independent protective mechanisms accompanying the endothelial dysfunction correction in the specific experimental environment.

1 ex

FIELD: medicine.

SUBSTANCE: group of inventions refers to medicine, specifically transplantology. Cells are removed from mammalian organs by perfusion. The cells are removed so that to preserve morphology of an extracellular matrix before cell removal. The cells are recovered in the prepared cell-free mammalian organs by the injection or the perfusion of the regenerative cells therein.

EFFECT: group of inventions enables preparing the organ for transplantation by the perfusion wherein the extracellular matrix has a smooth and undamaged external surface that enables further recovery of the organ and its normal function by the introduction of the regenerative cells at a higher degree of engraftment and an ability for differentiation.

2 dwg, 13 ex, 22 cl

FIELD: medicine.

SUBSTANCE: method involves simulating gestosis in Wistar rats by the daily intraperitoneal introduction of L-nitro-arginine-methyl ester 25 mg/kg for 14th to 20th day of pregnancy. The simulated pathology is corrected by distant preconditioning (DP) from the 10th to 20th day of pregnancy by 10-minute femoral artery clamping at the level of an upper one-third of thigh followed by tissue reperfusion.

EFFECT: method provides the effective endothelial dysfunction correction in pregnant women suffering gestosis ensured by a manifested anti-ischemic effect of DP in the specific experimental environment and the specified DP regimen.

1 ex

FIELD: medicine.

SUBSTANCE: method involves reproducing a gestosis model in Wistar rats by the daily intraperitoneal introduction of L-nitro-arginine-methyl ester 25 mg/kg for 14th to 20th day of pregnancy. The modelled pathology is corrected by the daily distant pre-conditioning from the 10th to 20th week of pregnancy. That is ensured by 10-minute cross-clamping of the femoral artery once a day by applying a cuff on an upper one-third of thigh followed by reperfusion.

EFFECT: improved placental microcirculation ensured by anti-ischemic protective action on the body and provided NO bioavailability with endothelial dysfunction correction.

1 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, specifically cardiosurgery, and may be used for treating thromboembolia of pulmonary artery. For this purpose a surgical intervention accompanied by artificial circulation involves mechanical thrombus removal from greater branches of the pulmonary artery. It is followed by exposing a left atrium and conducting a retrograde pulmonary perfusion by sequential perfusion of each of the four pulmonary veins for 4 minutes by a combination solution. The combination solution is prepared by mixing blood from a pump oxygenator and a protective solution in proportions 3:1. The protective solution consists of 0.9% sodium chloride 800 ml, dexamethasone 16 ml, actovegin 400 ml and 15% mannitol 100 ml. The perfusion procedure is conducted at volumetric speed 200-250 ml/min and perfusion pressure 20 mm Hg. Thromboemboles are removed from peripheral parts of the pulmonary artery by aspiration of blood stream from the incised pulmonary artery. The procedure is terminated with hermetically closed wound of the pulmonary artery. A left atrium cavity is closed with recovering cardiac activity, and the incisional wound is closed in layers.

EFFECT: method provides considerably reduced death rate and risk of postoperative complications in the case patients, as well as provided effective removal of small thromboembols from the peripheral parts of the pulmonary artery and prevented developing air embolism of the pulmonary artery.

1 tbl, 1 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely cardiosurgery, and may accompany endarterectomy with using extracorporeal circulation. That is ensured by the intracoronary introduction of heparin dissolved in normal saline in proportions 1:1 in dose 50-100 mg in a deendothelised area during pharmacological asystole.

EFFECT: method provides improved effect of said surgery ensured by the higher concentration of heparin absorbed on a vascular wall.

2 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: group of inventions relates to clinical cardiology and cardiovascular surgery. Method consists in carrying out diagnostics of individual condition of patient's blood circulation system, measuring field of blood flow rates in heart chambers and main vessels, comparison of measured parameters with physiological norm, determination of parameters, which form twisted blood flow, modelling individual twisted blood flow in diagnosed system of blood circulation, and streamlined surfaces and guiding elements of flow channels of reconstructed system of blood circulation are given forms, which corresponding to lines of flow of restored normally twisted blood flow in accordance with given ratios. Described are devices for method realisation: vascular prosthesis, cannula, prosthesis of heart valve, pump for blood pumping, twisting device.

EFFECT: exclusion of stagnant zones and reduction of risk of blood clot formation, blood trauma and hyperplasia of blood canal.

21 cl, 20 dwg

FIELD: medicine.

SUBSTANCE: invention refers to medical equipment and can be used for the replacement of involved natural human cardiac valves. A frame for a biological cardiac valve prosthesis comprises a tubular insert 2, which bears a flexible element 5 having flexible supports 6, each of which comprises two flexible beams 7. Each flexible beam 7 is provided with a loop-shaped element 16 positioned on heads 8 of the flexible beams 7 and coupling support stands 9 and bridges 13 mounted between two support stands 9 of the flexible element 5 from different flexible supports 6; each loop-shaped element 16 is provided with a seating surface 17 facing the vertical plane 11 passing through the central axis 12 of the frame; the support stands are mounted in relation to the above vertical plane 11; the seating surface 17 lies in a plane extending in parallel through the central axis of the frame with the support stands 9 being mounted symmetrically in relation to the vertical plane 11. The seating surfaces 17 of two flexible beams 7 from the same flexible support 6 are configured symmetrically in relation to the plane 11 passing through the central axis 12 of the frame.

EFFECT: increasing the reliability by reducing a rate of potential cusp cutting-through by fastening threads.

3 cl, 5 dwg

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