<abstract xmlns="http://www.w3.org/1999/xhtml"><p> Chronic thromboembolic pulmonary hypertension (CTEPH) occurs in 1 to 4% after acute pulmonary embolism. CTEPH can be cured by pulmonary endarterectomy (PEA), which is approved golden standard in chronic condition. There were performed three cases of PEA in Latvian Cardiology Centre during 2013-2014. General anaesthesia under cardiopulmonary bypass (CPB) with deep hypothermic circulatory arrests was provided. The core issue is correct patient selection (in terms of central PA obstruction by thrombus) as well as pulmonary circulation recovery capacity. Neuroprotection was provided by deep hypothermia, topical cooling of the head, Trendelenburg position, mild hypocapnia, Hb 9-10 g/L and pharmacological agents. For screening postoperative cognitive function the mini mental state examination (MMSE) was used before and after the surgery. Postoperative pulmonary vascular resistance index decreased by 56.3% (right ventricular systolic pressure decreased from 93.3 ± 25.7 to 44.5 ± 11.2 mmHg). Before the surgery three patients had NYHA functional class III or IV, at the time of discharge - I or II. In one case moderate (MMSE 18) cognitive disorders was observed at discharge from the ICU. No one died neither in the hospital nor within 30 days of discharge. The surgery improved RV function and pulmonary perfusion with no considerable organ failure, except mild cognitive disorders.</p></abstract>

Chronic thromboembolic pulmonary hypertension (CTEPH) occurs in 1 to 4% after acute pulmonary embolism. CTEPH can be cured by pulmonary endarterectomy (PEA), which is approved golden standard in chronic condition. There were performed three cases of PEA in Latvian Cardiology Centre during 2013-2014. General anaesthesia under cardiopulmonary bypass (CPB) with deep hypothermic circulatory arrests was provided. The core issue is correct patient selection (in terms of central PA obstruction by thrombus) as well as pulmonary circulation recovery capacity. Neuroprotection was provided by deep hypothermia, topical cooling of the head, Trendelenburg position, mild hypocapnia, Hb 9-10 g/L and pharmacological agents. For screening postoperative cognitive function the mini mental state examination (MMSE) was used before and after the surgery. Postoperative pulmonary vascular resistance index decreased by 56.3% (right ventricular systolic pressure decreased from 93.3 ± 25.7 to 44.5 ± 11.2 mmHg). Before the surgery three patients had NYHA functional class III or IV, at the time of discharge - I or II. In one case moderate (MMSE 18) cognitive disorders was observed at discharge from the ICU. No one died neither in the hospital nor within 30 days of discharge. The surgery improved RV function and pulmonary perfusion with no considerable organ failure, except mild cognitive disorders.

Anaesthesia Management with Deep Hypothermia and Circulatory Arrest During Surgery for Chronic Thromboembolic Pulmonary Hypertension / Anestēzija Pie Plaušu Artēruas Endarterektomijas Dziļā Hipotermuā Ar Cirkulācijas Apiurēšanu

Latvian Cardiology Centre, Pauls Stradiņš Clinical University Hospital, Pilsoņu iela 13, Rīga, LV-1002, LATVIA

Rīga Stradiņš University, Dzirciema iela 16, Rīga, LV-1007, LATVIA

Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences.

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Chronic thromboembolic pulmonary hypertension (CTEPH) occurs in 1 to 4% after acute pulmonary embolism. CTEPH can be cured by pulmonary endarterectomy (PEA),...

Anaesthesia Management with Deep Hypothermia and Circulatory Arrest During Surgery for Chronic Thromboembolic Pulmonary Hypertension / Anestēzija Pie Plaušu Artēruas Endarterektomijas Dziļā Hipotermuā Ar Cirkulācijas Apiurēšanu

Publicado en línea: 30 dic 2014

Páginas: 232 - 236

Recibido: 02 nov 2014

DOI: https://doi.org/10.2478/prolas-2014-0029

© by Roberts Leibuss

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.