Asunto(s)
Anestesia/métodos , Puente de Arteria Coronaria/efectos adversos , Enfermedad Coronaria/cirugía , Complicaciones Posoperatorias/etiología , Anciano , Anestesia/efectos adversos , Puente de Arteria Coronaria/rehabilitación , Enfermedad Coronaria/fisiopatología , Humanos , Persona de Mediana EdadRESUMEN
AIM: To assess value of single-photon emission computed tomography with (99m)Tc-sestamibi ((99m)Tc MIBI SPECT) for detection of post-infarction left ventricular aneurysm in patients with coronary artery disease. MATERIAL: Fifty nine patients were operated upon because of coronary heart disease. In 27 patients with post-infarction left ventricular aneurysm modified Dor operation (aneurysmectomy with endoventricular circular patch plasty reconstruction) was performed. In 24 patients with extended cardiosclerosis direct myocardial revascularization was conducted. RESULTS AND CONCLUSION: Comparison of (99m)Tc MIBI SPECT data obtained at rest and during dobutamine stress test revealed some diagnostic features characteristic of patients with left ventricular post-infarction aneurysm. Quantitative and qualitative assessment of viability of myocardium in basal and "borderline" zones influenced not only the volume of revascularization, it was important for preliminary determination of post-infarction left ventricular aneurysm resection level, selection of type of plasty, prognostication of complications in immediate and remote postoperative periods.
Asunto(s)
Aneurisma Cardíaco/diagnóstico por imagen , Infarto del Miocardio/complicaciones , Infarto del Miocardio/diagnóstico por imagen , Tomografía Computarizada de Emisión de Fotón Único , Agonistas Adrenérgicos beta , Dobutamina , Aneurisma Cardíaco/cirugía , Humanos , Masculino , Infarto del Miocardio/cirugía , Revascularización Miocárdica , Pronóstico , Tecnecio Tc 99m SestamibiRESUMEN
The paper provides evidence for the pathogenetic approach to treating acute lung lesion (ALL) and adult respiratory distress syndrome (ARDS). An algorithm of the use of Russian lung surfactant preparations: CT-HL and CT-BL has been developed. In involves earlier (the first days following the onset of respiratory failure) use of surfactant, its combined bolus intratracheal or intrabronchial administration in doses of 200-400 mg/m2, followed by continuous (5-day) aerosol inhalation in doses of 20-30 mg/h for children and 30-75 mg/h for adults until pronounced clinical and X-ray effects are shown. Fifty three patients were found to develop ALL and ARDS in the presence of severe pneumonia, postperfusion lung disorders, reperfusion syndrome, pulmonary embolism, long-term artificial ventilation, combined car accident injury and gunshot wounds of the chest, heroine intoxication, septic shock, sepsis, postoperative sequels in cancer patients, and after hepatic transplantation or massive aspiration of gastric contents. Fifty patients were overcome their critical status, 44 survived. The duration of artificial ventilation (AV) ranged from 1 to 6 days. Earlier use of the drugs made it possible to transfer patients to safe AV regimens and to eliminate ALL and ARDS rapidly and to significantly reduce mortality due to critical states.