Method for predicting ross' operation result

FIELD: medicine, functional diagnostics, cardiology.

SUBSTANCE: on isolating the trunk of pulmonary artery one should measure circulation in its wall with the help of a laser-doppler flowmeter to detect average value of microcirculation, root-mean-square and interval of deviation against average value. Then one should detect average value of microcirculation and the value for circulation decrease after replacing the trunk of pulmonary artery into aortic position. If average value of microcirculation in the wall of pulmonary artery in position of aortic valve has been decreased by the value either equal or below 1.282xσ, one should predict favorable result of operation, if the decrease occurred by more than 1.282xσ, one should predict unfavorable result of operation. The method broadens the number of diagnostic means applied in the field of cardiosurgery.

EFFECT: higher efficiency and accuracy of prediction.

2 ex

 

The invention relates to medicine, namely to methods for predicting outcomes of complex cardiac surgery and reconstructive operations.

There are several ways to implement the operation of the Ross. Some of them are marked with adverse outcomes, which ultimately negates the effect autotransplantation valve pulmonary artery in aortic position. Use as autoprotease only the valve of the pulmonary artery in a patient requires a high degree of responsibility in the appointment of such operation to the patient, as it can only be executed once. Not currently known methods which would reasonably could predict the successful outcome of such operations.

Existing methods of prediction based only on the ratio of the number of successful and failed operations performed in different cardiac clinics using different methods of operation of the Ross. The analysis of the outcomes of 118 operations Ross showed that four patients underwent a second operation to replace the pulmonary autograft, one patient had acute dilatation of autograft within two weeks after the operation, so that 8% of all patients required replacement of pulmonary autograft through 6 years after surgery (1).

It is known that shankarcharya and veins has its own sources of blood supply - vasa vasorum, which are located in adventitia vessel and penetrate the wall to the outer layers of the media. They form periarterial vascular network. Forming her arteries originate from the nearby small arteries (2).

In addition to the vasa vasorum, extending from the lateral arterial branches, some of them departs from small holes in an intim, i.e. directly from the lumen of the main vessel (3).

All structural and functional processes in the vascular wall, directly depend on the state of blood circulation in periarteriolar the bloodstream. Therefore, if the operation is complete, the disturbed microcirculation adventitia vessel and the outer layers of the media (middle vascular layer), or be blocked completely, the structural and functional consequences of this violation (or block) will be unfavorable. And the more deeply will the violation, the sooner will come the complications of the autograft - structural or functional. If disturbance of microcirculation in vasa vasorum are missing, or they are small, then the conclusion favorable prognosis of the outcome of the operation. If disturbance of microcirculation large, or it is blocked by blood clots or otherwise, then the conclusion about the high probability of adverse outcome of surgery.

There is a method of determining blood flow using userdefinable flowmeter (4).

The aim of the invention is to provide objective and accurate prediction of the outcome of cardiac surgery Ross by assessing the microcirculation vascular wall.

The method is as follows.

1. After separation of the trunk of the pulmonary artery (LA) and the ascending aorta produce a measurement of microcirculation in the outer layers of the vessel (adventitia and outer layers of the media) and find the average amount of blood flow to the pulmonary artery and σ1.

2. After moving the trunk LA in aortic position make repeated measurements of the microcirculation in the outer layers LA and find the average amount of blood flow.

3. To the obtained average values of measurement of microcirculation in the wall LA the following criteria are applied statistical comparison (5). To do this, select the interval of the deviation from the average value of ±1,282×σ, which gets 80% of all measurements, and calculate the value of this interval on the calculated value σ1for blood flow in the wall of the AIRCRAFT, measured to move the shaft LA, that is, in the first dimension. As the amount of blood flow in the wall of LA when this operation only decreases the value is used -1,282×σ1(minus 1,282×σ1). Interval ±σ includes 95.4% of all measurements.

4. Calculate the difference of the average blood flow in the wall of LA before and after the move and compare it with the value of the calculated interval 1,282×σ1

5. If the average values of the microcirculation in the wall of LA in the position of the aortic valve decreased by an amount equal to or less 1,282×σ1then it is concluded that the microcirculation is not broken, and the probability of a favorable outcome of the operation is high; if the reduction of microcirculation occurred more than 1,282×σthen concludes gross violation of microcirculation and the high probability of an unfavourable outcome of the operation.

Examples 1. Patient m-W, A.S., female, age 32 years, height is 157 cm weight 52,5 kg; diagnosis: Congenital heart disease, ventricular septal defect, aortic defect with a prevalence of insufficiency, pulmonary hypertension, circulatory insufficiency stage 1 (II FC); secondary infective endocarditis. Measured laserdevices.com flowmeters the blood flow in the wall of the LA before the operation (first measurement) amounted to 43.1 (67,8÷22,9) ml/ (100 g min), the number of measurements 1770, σ1=8,7; interval 1,282×σ1=11,1534; after surgery 32,7 (65,2÷16,1), the number of measurements 1770; σ=8,01. After surgery, the blood flow in the barrel wall LA, moved in aortic position, decreased by 10.4 ml/ (100 g min), (ΔCrowe=43,-32,7). The average value of the flow wall LA after surgery was inside the critical interval - ΔCrowe<1,282×σ1. Value σ taken from the results of the first measurement prior to travel.

On the basis of these comparisons it is concluded that the movement of the trunk LA in aortic position reduced blood flow in the wall of the LA, but did not exceed a critical value, and hence gives rise to a favorable prognosis of the outcome of the operation of the Ross.

2. Sick And LE, female, 54 years old, height 152 cm, weight 60 kg; diagnosis: Acquired valvular disease, aortic stenosis, calcification of the valve, a slight mitral valve insufficiency, circulatory insufficiency IIA, (SFC). Measured laserdevices.com flowmeters the blood flow in the barrel wall LA (first measurement) before surgery at 78.4(95,6-60) ml/ (100 g min), the number of measurements 1790, σ1=7,927; interval 1,282×σ1=10,1624; after the operation (second dimension) 64,1 (94,3÷33,14), the number of measurements 1534. After surgery, blood flow in the barrel wall LA, moved in aortic position, decreased by 14.3 ml/ (100 g min) (ΔCrowe=78,4-64,1). The mean value of blood flow to the borehole wall LA was outside the critical interval - ΔCrowe>1,282×σ1. On the basis of this comparison it is concluded that the movement of the trunk LA in aortic position prospect is led to a critical reduction in blood flow in the wall LA, and the outcome of the Ross operation may be adversely affected.

The proposed method allows to determine the likelihood of a favorable outcome of the Ross operation in each patient.

Literature

1. David T.E. et al. Dilatation of the pulmonary autograft after the Ross procedurell J.Thorac Cardiovasc. Surg. - 2000. - V.119. - P.210-220.

2. Great medical encyclopedia. Ed. 2-E. M.: encyclopedia, 1957 - Vol.2., str-682.

3. Papk W.W. The vasa vasorum of the fscendingaorta and pulmonaru thunk and - their cjronary - extracardiac relationships llAmer. Heart S. - 1970 - V.80 - N - P802.

4. Okuneva G.N., Cherniavsky AM, EVGENIY Kuznetsov and other Intraoperative assessment of myocardial blood flow in different parts of the heart method laseroptical plomeria in CHD patients before and after revascularization. Methods flowmetry. M., 1999, No. 3, p.15-19.

5. Mitropolsky, A. Technique of static calculations. - M.: Nauka, 1971, 576 S.

A method for predicting the outcome of the Ross operation, including the measurement of the microcirculation, characterized in that after separation of the trunk of the pulmonary artery in the wall measure the blood flow laserdevices.com flowmeters, determine the average value of the microcirculation, standard deviation and range of variation from the mean; then determine the average value of the microcirculation and the value of reduction of blood flow after moving the trunk of the pulmonary artery in aortic position, and if the average value of the microcirculation in the wall of agonoy artery in the position of the aortic valve decreased by an amount equal to or less than 1,282·σthen predicts favorable outcome of the operation, if the decrease was more than 1,282·σthen predict adverse outcome of the operation.



 

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