[Impact of ventilation in the cardiac index and systolic index in surgery of the abdominal aorta].
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The authors have analyzed immediate results of restorative vascular operations on 408 patients with occlusive injuries of the aorto-iliac segment. An improvement of the surgical technique, active surgical tactics of management of complications, newly developed complex of prophylactic measures for the recent 10 years have resulted in 2.5 times less amount of postoperative thromboses, 3.5 times less amount of suppurations, bleedings (1.8 times), amputations of extremities (3.1 times). Total lethality was 1.9 times less.
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Analysis of morphological and developmental features of arteries forming the terminal portion of the aorta was performed. These are the external iliac, umbilical, median sacral, ovarian, caudal mesenteric and lumbar arteries. In the earliest fetuses slow rate of development of the branches of aorta is stated. However, beginning from 13th week ot gestation the rate increases causing considerable developmental and individual variability of the vessels. At the end of the fetal period and in newborns a decrease in the rate of the development of the terminal portion of the aorta is typical for the species and sex except individual variability of its secondary branches.
Various methods have been used for the diagnosis of congenital fetal arrhythmias. Currently, M-mode echocardiography is the most widely used method. However, good tracings are often difficult to obtain because of unfavorable fetal positions, resulting in long durations of examination. In early gestation, the fetal heart is often too small for clear M-mode echocardiography. Doppler velocity waveforms of the fetal inferior vena cava represent the right atrial activity, whereas those of the aorta reflect ventricular contraction. Because of the proximity of the vessels, it is easy to obtain simultaneous recording in opposite channels of Doppler waveforms from both vessels. A visual relationship between the atrial and ventricular contractions may be clearly established and a diagnosis may be made. The findings of simultaneous pulsed Doppler velocimetry of the fetal aorta and inferior vena cava were assessed in different types of congenital fetal arrhythmia: congenital heart block, premature atrial ectopic contractions, premature ventricular ectopic contractions, and supraventricular tachycardia. The correct diagnosis was made as early as 13 weeks' gestation, showing the application of this method in early pregnancy.
The use of reconstructive operation in combination with lumbar sympathectomy for the treatment of obliterative lesion of the vessels of the aortoiliofemoral segment permits to reduce the incidence of development of the early postoperative vascular thrombosis and late reocclusion. A good patency of vascular transplants after combined operation was noted in 62% of cases, after isolated reconstruction--in 38%.
A comprehensive clinicoangiographic and functional examination was made of 180 patients with combined coronary and vascular abnormalities. With this, a diagnostic algorithm was developed, which determined the authors' approach to evaluation of the severity of patients and the choice of surgical policy. A total of 150 patients were operated on, the total mortality being 7.3%. The examination of operative and hospital mortality rates in patients with combined abnormalities showed that pre-aortocoronary bypass surgery before a reconstructive vascular operation in patients with severe coronary diseases made it possible to avoid serious coronary events in the following postoperative period.
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The case history is presented of a patient admitted with a Salmonella infection and the development of a mycotic aortic aneurysm within two weeks. The patient could be successfully treated by resection of the aneurysm, primary prosthetic in-situ grafting and antibiotics.