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.
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.
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.
SUBSTANCE: method involves determining hemodynamic characteristics of blood circulation in vascular anastomosis area in standard zones distal and proximal with respect to the vascular anastomosis by means of ultrasonic dopplerography during the first 6 months, after vascular plastic operation being applied. Dynamic changes in the characteristics are interpreted in terms of full-valued vascular anastomosis condition.
EFFECT: high accuracy of diagnosis; high accuracy of ultrasonic blood circulation condition criteria.
11 dwg, 2 tbl
SUBSTANCE: method involves carrying out cardiotocographic examination taking into account day rhythmostasis and following data analysis. Diagnostically significant cardiotocographic characteristics like basal rhythm, accelerations, acceleration durations, motor fetus activity and integral fetus state characteristic are determined. Non-conjugated estriol/progesterone coefficient is calculated with day rhythmostasis taken into account. Maternal and fetal blood circulation hemodynamic values synchronization coefficient is determined. Diagnostically significant characteristics values typical for fetus hypoxia are determined. When carrying out cardiotocographic examination, basal rhythm (strokes/min) is equal to 156±2.9 at 12 o'clock and 159±3.7 at 20 o'clock; accelerations (strokes/min) 3.0±0.2 at 12 o'clock and 2.2±0.3 at 20 o'clock; acceleration durations (s) 14.2±0.7 at 12 o'clock and 13.6±1.2 at 20 o'clock; motor fetus activity (during 10 min) 2.0±0.4 at 12 o'clock and 1.7±0.3 at 20 o'clock; integral fetus state characteristic 1.25±0.15 at 12 o'clock and 1.37±0.22 at 20 o'clock. When determining noncojugated estriol/progesterone coefficient: 0.57±0.05 at 8 o'clock and 0.67±0.06 at 20 o'clock. When determining maternal and fetal blood circulation hemodynamic values synchronization coefficient: 2.35±0.19 before 37 pregnancy weeks date and 2.78±0.18 after 37 pregnancy weeks date. The values corresponding to the above referenced ones, functional fetus state change and chronic fetal hypoxia are to be diagnosed.
EFFECT: high accuracy of diagnosis.
FIELD: medicine, oncology.
SUBSTANCE: before the onset and 10-14 d after the end of chemotherapy course it is necessary to carry out chromatic Doppler mapping to evaluate maximal tumor rate of circulation, and at its decreased value being 25% lower against initial data one should establish process stabilization, and at its increase being 25% higher against the initial data - process progressing should be stated upon. The innovation enables to objectively evaluate efficiency of chemotherapy at applying safe, simple ultrasound trial for the purpose to specify subsequent therapeutic tactics.
EFFECT: higher efficiency and accuracy of detection.
8 dwg, 3 ex
SUBSTANCE: one performs ultrasonic echo-dopplerometric investigation of regional blood flow in prostate before and after treatment to determine quantitative parameters. When pulsation index is reduced from 1.39±0.12 before treatment to 1.10±0.09 after treatment and venous blood flow velocity increases, respectively, from 3,91±0.36 to 5,22±0.47, treatment is regarded effective and completed.
EFFECT: increased accuracy of estimation.
SUBSTANCE: method involves determining microcirculation indices in rest state by applying Doppler laser flowmetry method and capillary blood circulation reserve indices in occlusion sample under cuff pressure being 30 mm of mercury column as high as the systolic patient blood pressure during 3 min. Cardiorespiratory disorders development is predicted in postoperative period, The microcirculation indices being greater than 6.0 perfusion units in combination with capillary blood circulation reserve indices being greater than 300% or microcirculation indices being below than 4.5 perfusion units in combination with capillary blood circulation reserve indices being greater than 200%.
EFFECT: high accuracy of prognosis.
SUBSTANCE: method involves carrying out visual and rectal examination. Peripheral blood circulation speed is measured in rectovaginal partition blood vessels. Rectovaginal partition folds are detected and increase in its thickness. Levators separation exceeding 20 mm is determined. Fibrous degeneration of rectovaginal partition is detected. Reduced blood circulation speed in levators is detected. Anterior rectocele is diagnosed. Values are measured by introducing ultrasonic transducer into the rectum. One of versions assumes introduction of hygienic intravaginal tampon into the vagina.
EFFECT: high reliability of diagnosis.
2 cl, 8 dwg
SUBSTANCE: method involves examining retina light sensitivity degree using computer-aided perimetry approach within 60° bandwidth from fixation point. Direct orbital muscle thickness and retrobulbar space volume is additionally determined by applying ultrasonic b-scanning method. Linear blood circulation speed and resistance index are also determined in the central retinal artery and posterior short ciliary arteries. Macular or general light sensitivity reduction 25% and more relative to age-specific norm being observed together with 50% growth and more in direct orbital muscle thickness, retrobulbar space volume growth by more than 35% in combination with linear blood circulation speed reduction in the central retinal artery and posterior short ciliary arteries by 40% and more and increasing resistance index by 20% and more relative to physiologic norm, optic nerve abnormality is diagnosed at early disease stages.
EFFECT: high reliability of diagnosis.
SUBSTANCE: method involves diagnosing gestosis severity degree with clinical signs and blood circulation being studied. Ultrasonic examination with Doppler color mapping is carried out in female patients manifesting fuzzy clinical symptoms. Intrarenal artery resistance index is determined. The value being within 0.62-0.65%, mild gestosis is to be diagnosed. The value being within 0.66-0.69%, moderate severity degree gestosis is to be diagnosed. The intrarenal artery resistance index being equal to or greater than 0.7%, severe gestosis cases are to be diagnosed.
EFFECT: high accuracy of diagnosis; noninvasive diagnosis method.
SUBSTANCE: method involves making lumbar puncture and measuring liquor pressure, taking pleocytosis into account, making ultrasonic transcranial Doppler flowmetric examination of brain, determining linear blood circulation speed on interior carotid artery and posterior cerebral artery, detecting intracranial venous discharge disorders through orbital and vertebral veins. Regression coefficient is calculated from a formula
where X1 is patient age (in years); X2 is the pleocytosis in the first lumbar sample (in cells number per 1 mcl of liquor); X3 is the meningitis symptoms duration (in days); X4 is the focal symptoms availability (1- yes, 0- no); X5 is the general cerebral symptoms duration (in days); X6 is the liquor pressure when taking the first lumbar puncture (in mm of mercury column); X7 is the linear blood circulation speed in interior carotid artery (in Hz/s); X8 is the linear blood circulation speed in posterior cerebral artery (in Hz/s); X9 is the intracranial venous discharge disorders based on ultrasonic transcranial Doppler flowmetric examination data; retrograde discharge through orbital veins, increased one through vertebral veins and others (1- yes, 0- no). Value of y≤0.5, unfavorable outcome is to be predicted with cerebroasthenic, asthenoneurotic and hypertension syndromes being formed. If y>0.5, favorable infectious process outcome is to be predicted.
EFFECT: high accuracy of diagnosis.
FIELD: medicine, ophthalmology.
SUBSTANCE: the present innovation deals with methods for diagnostics of vascular pathology of optic nerve (ischemic opticopathies) and, also, predicting vascular pathology of optic nerve lesion and counterlateral eyeball. One should perform dopplerographic registration of circulatory parameters: peak systolic velocity PSV cm/sec and end diastolic velocity EDV cm/sec on the 2nd, 3d min both before and at the background of functional loading: dealing with lifting legs up to 90° in area of internal carotid artery, central retinal artery and ciliary artery. Moreover, calculation of resistant index RI c. u. should be performed by the following formula (PSV cm/sec - EDV cm/sec)/PSV cm/sec and reactivity index RY c.u. by the following formula PSV cm/sec after loading/PSV cm/sec before loading. At RI value being above 0.7 and RY value being below 1.0 one should detect deterioration of visual functions and the absence of circulatory reserves in tested eye and counterlateral one. At RI value being below 0.7 and RY value being above 1.0 it is possible to detect the maintenance of visual functions and circulatory reserves in tested and counterlateral eyes. The innovation enables to accelerate and simplify the trial and carry out it with available physical loading for a patient without applying any additional appliances and medicinal preparations.
EFFECT: higher efficiency and accuracy of diagnostics and prediction.
6 dwg, 3 ex, 2 tbl
SUBSTANCE: method involves carrying out ultrasonic scanning examination of subclavian artery over its whole extent in physiological arm position with arterial blood pressure being measured in the middle one third of the arm. Next, when applying compression tests, blood circulation parameters variations are recorded in distal segment of the subclavian artery with arterial blood pressure being concurrently measured. Three degrees of superior thorax aperture syndrome severity are diagnosed depending on reduction of linear blood circulation velocity and arterial blood pressure compared to their initial values. Mild one takes place when linear blood circulation velocity reduction reaches 40% and arterial blood pressure 20% of initial level, moderate one when linear blood circulation velocity reduction reaches 70% and arterial blood pressure 50% and heavy one when linear blood circulation velocity reduction is greater than 70% of initial level and arterial blood pressure is greater than 50% to the extent of no blood circulation manifestation being observed in the subclavian artery.
EFFECT: high accuracy of diagnosis.
FIELD: medicine, urology.
SUBSTANCE: one should conduct subcutaneous prevocational tuberculin test and, additionally, both before the test and 48 h later it is necessary to perform the mapping of prostatic vessels and at decreased values of hemodynamics one should diagnose tuberculosis. The information obtained should be documented due to printing dopplerograms.
EFFECT: more reliable and objective information.
1 ex, 1 tbl
FIELD: medicine; medical engineering.
SUBSTANCE: method involves applying ultrasonic Doppler echolocation techniques for scanning blood circulation at selected area of cardiovascular system, determining blood circulation velocity vector projections and calculating blood circulation speed. Echolocation is carried out by using at least three non-complanar probing ultrasonic rays set at angles relative to selected area of cardiovascular system in the range of 0-±80°. Selected blood circulation area orientation angles are measured relative to scanning ultrasonic rays and Doppler frequency shifts in each measuring channel are determined. Blood circulation speed is calculated as where ω0i is the radiation frequency of ultrasonic oscillation in ray I, Δωi is the Doppler frequency shifts in measuring channel i, V is the ultrasonic wave propagation speed in the medium, ϑk is the blood circulation speed in selected area, ϑki is the blood circulation velocity projection to scanning ray i, a,b,c,h,k,n11,n12,n13 are the coefficients depending on ultrasonic rays orientation. The device has measuring unit having ultrasonic transducers and electronic unit having switch, high frequency oscillator, calculating unit, indication and control unit. The measuring unit is manufactured as bracelet which segments are connected to each other by means of adjustable hinges and has gages for measuring lateral segment orientation angles relative to the central segment and gages for measuring ultrasonic transducer orientation angles relative to the i-th segment where i = 1,2,3, connected to calculating unit, switch, indication and control unit connected to high frequency oscillator, ultrasonic transducers of the measuring unit are connected via the switch to the high frequency oscillator.
EFFECT: high accuracy of measurements; wide range of functional applications.
2 cl, 2 dwg
SUBSTANCE: method involves measuring forced exhalation volume per 1 s. Systolic pressure in pulmonary artery and ratio of maximum blood circulation speeds through tricuspid valve into diastole. Prediction is carried out on basis of value calculated from mathematical formula including measured and calculated parameters.
EFFECT: enhanced effectiveness of prediction.
SUBSTANCE: method involves measuring forced exhalation volume per 1 s (FEV1) in l, full right ventricle evacuation time (RVE) in ms and angiotensin II value (AII) in ng/l. Discriminant relationship is built as D=0.504·RVE+3.038·FEV1 - 2.0·AII. D being less than 83.88, pulmonary hypertension occurrence is predicted within 1 year. D being equal to or greater than 83.88, no pulmonary hypertension is predicted to occur.
EFFECT: enhanced accuracy of prediction.
FIELD: medicine, nephrology.
SUBSTANCE: one should detect circulation rate characteristics and vessel's diameter due to dopplerography, moreover, on should measure vessel's diameter directly in area of anastomosis, as for circulation rate characteristics they should be determined in constant-wave Doppler mode in area of circulation's maximal rate. Moreover, one should measure anastomosis' cross-sectional area and heart rate, moreover, one should calculate circulatory volume through anastomosis by the following formula: V(ml/min) = A VTI HR, where A - anastomosis' cross-sectional area (sq. cm), VTI - integral of circulatory linear rate through anastomosis (cm), HR - heart rate.
EFFECT: higher accuracy of detection.
4 ex, 1 tbl
SUBSTANCE: method involves determining linear blood circulation speed above and below diaphragm using dopplerography approach. State severity class is determined as healthy, recovering and heavy from measured linear velocities ratio. Applied therapy effectiveness is determined on the measured linear velocities ratio exiting beyond the scope of severity class range, when analyzing patient state dynamics.
EFFECT: high accuracy in estimating patient health state.
FIELD: medicine, hepatology.
SUBSTANCE: one should detect splenic length in mm (X1) and circulation in portal vein, moreover, additionally, on should detect volumetric circulation in splenic vein in cu. cm/min. (X2), the index for the ratio of volumetric circulation in splenic vein to the area of longitudinal splenic section (X3), circulatory direction in left-hand gastric vein (X4) by establishing its direction towards the liver to be 1, from the liver to be 2, diameter of splenic artery in cm (X5) and transhepatic portal volumetric circulation in cu. cm/min. (X6), then one should calculate discriminant function Z = 15.9850 - 0.0187X1 + 0.2006X3 - 1.9025X4 - 19.0493X5 - 0.0025X6, where Z - the criterion for predicting "healthy-sick" state; then it is necessary to detect the group with hepatic diseases by the value of Z ≤ 1.621 to calculate for them discriminant function Y = 9.7396 - 0.0279X1 - 0.0018X2 + 0.1873X3 - 4.9174X4, where Y - the criterion to predict "patients with chronic hepatitis - patients with cirrhosis" state and at Y > 1.239 one should diagnose chronic hepatitis, at Y ≤ 1.239 - cirrhosis.
EFFECT: higher efficiency of diagnostics.
FIELD: medicine, cardiology, endocrinology, gynecology.
SUBSTANCE: one should detect informational-valuable signs of patient's state, such as either the presence or absence of hypertonic disease and uterine extirpation together with adnexa, the value of body weight index, predominance of disorders according to modified menopausal index (MMI)such as autonomic, metabolic-endocrine or psycho-emotional ones, the type of metabolic structures of blood serum, moreover, it is necessary to echocardiographically detect stroke volume, cardiac index and systemic vascular resistance (SVR), at ultrasound testing one should detect maximal linear rate of circulation (LRC max) by medial cerebral artery and thyroid alterations, rheovasographically one should detect specific circulation (SC) of shins, at testing laser doppler flowmetry one should detect microcirculation index, biochemically it is necessary to detect the value of beta-adrenoreactivity, cholesterol level and that of B-lipoproteides, crystallographically - the presence of serotonin and dopamine crystals, due to immunoenzymatic assay on should detect the values by Table 1 and then after obtaining the values of diagnostic coefficients of every parameter it is necessary to summarize them and obtain diagnostic index (DI), at its value being below 10 one should state no alteration, at its value 10-10 - undetermined state, at its value being 21-30 - the 2nd severity degree of disorders, and at DI value being above 31 one should state the 3d severity degree of disorders available.
EFFECT: higher accuracy of evaluation.
5 ex, 2 tbl
FIELD: medicine, obstetrics, gynecology.
SUBSTANCE: one should study circulation in one of fetal renal arteries during the second half of third trimester of pregnancy. At increased resistance index from 0.81 and higher and, correspondingly, systolodiastolic ratio - from 5.1 and higher - one should fix the presence of fetal hypoxia and the necessity for urgent correction of this state. The suggested method increases the number diagnostic preparations and enables to increase the significance of predicting the state of neonatals.
EFFECT: higher accuracy of evaluation and prediction.
5 dwg, 5 ex, 1 tbl