PERFUSION METHOD FOR TOTAL RECONSTRUCTIONS ON THE AORTIC ARCH

摘要

FIELD: medicine.;SUBSTANCE: invention relates to medicine, particularly to cardiovascular surgery. Perform a duplication of the arterial line with a diameter of 3/8'' with markings “body” and “head” by means of the corresponding Y-shaped adapter after the arterial filter-trap. Then install on the “head” line of the remote occluder and the pickfluometer sensor, taking into account the patient's temperature, hemodynamic parameters at the preperfusion stage, ultrasound dopplerography (UZDG) of the brachiocephalic trunk (BTS), the left common carotid artery (LSA) and the left axillary artery (LAA) with transcranial dopplerography of the middle cerebral arteries (TKDG CMA). Then, after the initiation of the artificial circulation (IC), repeat TKDG CMA. Results obtained with TKDG CMA at the preperfusion stage are compared with similar temperature and hemodynamic parameters. At the same time, the obtained figures are taken for TKDG reference values for the subsequent regulation of cerebral perfusion at all stages of IC. After dissecting the aortic arch below the LAA, during a short-term arrest, an aortic cannula is inserted to perform a parallel perfusion of the body during arc reconstructions, 24 Fr, which is a polyvinyl chloride tube with a rounded outlet end and an inflatable balloon cuff, up to 60 ml on one side, and a 3/8" straight connector for connection to the arterial line of the extracorporeal circuit on the other side. Section of the tube, located under the balloon-cuff, is equipped with a sleeve made of stainless steel, placed in the thickness of the tube wall to the cylinder of the inflation line with a two-way valve. This cannula is connected to the “body” main line and performs a parallel perfusion along both the “head” and “body”, with a preliminary alternating cannulation of the LSA and LAA and the connection of the cannula to the “head” branches of the 1/4 diameters'', with a controlled peak flow meter, changing the diameter of the lumen by means of a remote occluder, the velocity along the “head” line equal to the sum of the velocities of the currents along the BTS + LSA + LAA, obtained by measuring the UZDG of these vessels at the preperfusion stage. Perform TKDG SMA with further correction by an occluder, increasing or decreasing the lumen of the “head” line, flow BTS + LSA + LAA at a difference of the received and control rates on results TKDG CMA at all stages of IR at similar temperature and hemodynamic parameters of the patient at the initial stages of IC.;EFFECT: method allows to create a reliable visualization of the adequacy of antegrade perfusion of the brain, as well as to provide an accurate regulation of the perfusion of the visceral organs.;1 cl, 1 dwg, 1 ex