vtioВестник трансплантологии и искусственных органовRussian Journal of Transplantology and Artificial Organs1995-1191Academician V.I.Shumakov National Medical Research Center of Transplantology and Artificial Organs", Ministry of Health of the Russian Federation10.15825/1995-1191-2014-4-101-105vtio-479Research ArticleКлинические наблюденияClinical CasesЭФФЕКТИВНАЯ МЕДИКАМЕНТОЗНАЯ КОРРЕКЦИЯ ОСТРОЙ ПРАВОЖЕЛУДОЧКОВОЙ НЕДОСТАТОЧНОСТИ У РЕЦИПИЕНТА С ПОГРАНИЧНОЙ ЛЕГОЧНОЙ ГИПЕРТЕНЗИЕЙ ПОСЛЕ ОРТОТОПИЧЕСКОЙ ТРАНСПЛАНТАЦИИ СЕРДЦАSUCCESSFUL MEDICATION THERAPY OF ACUTE RIGHT VENTRICLE INSUFFICIENCY IN RECIPIENT WITH SIGNIFICANT PULMONARY HYPERTENSION AFTER HEART TRANSPLANTATIONЧернявскийА. М.ChernyavskiyA. M.ДоронинД. В.DoroninD. V.ФомичевА. В.FomichevA. V.

630055, г. Новосибирск, ул. Речкуновская, 15. Тел. 8 (913) 487-29-65

630055, Novosibirsk, Rechkunovskaya st., 15. Tel. 8 (913) 487-29-65

a_fomichev@list.ruДерягинМ. Н.DeryaginM. N.Центр хирургии аорты, коронарных и периферических артерий ФГБУ «Новосибирский НИИ патологии кровообращения имени акад. Е.Н. Мешалкина» МЗ РФ, Новосибирск, Российская ФедерацияРоссияCentre of aorta and coronary arteries surgery Federal state institution «Novosibirsk Research Institute of Circulation Pathology named by academician Meshalkin, Ministry of Health of the Russian Federation», Russian FederationRussian FederationОтделение реанимации и интенсивной терапии взрослых ФГБУ «Новосибирский НИИ патологии кровообращения имени акад. Е.Н. Мешалкина» МЗ РФ, Новосибирск, Российская ФедерацияРоссияDepartment of intensive care (in adult patients) Federal state institution «Novosibirsk Research Institute of Circulation Pathology named by academician Meshalkin, Ministry of Health of the Russian Federation», Russian FederationRussian Federation201415012015164101105Copyright © Чернявский А.М., Доронин Д.В., Фомичев А.В., Дерягин М.Н., 20142014Чернявский А.М., Доронин Д.В., Фомичев А.В., Дерягин М.Н.Chernyavskiy A.M., Doronin D.V., Fomichev A.V., Deryagin M.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.transpl.ru/vtio/article/view/479

Острая правожелудочковая недостаточность, в ранних сроках после ортотопической трансплантации сердца является грозным осложнением и зачастую может приводить к фатальному исходу. Особенно актуальным это является у пациентов с высоким сопротивлением сосудов малого круга. Препараты для снижения легочного сосудистого сопротивления (ЛСС) показали свою эффективность преимущественно для лечения первичной легочной гипертензии. Больному К. 23 лет с пограничной легочной гипертензией (среднее давление в легочной артерии 60 мм рт. ст., ЛСС – 6 ед. Вуда) выполнена ортотопическая трансплантация сердца. В раннем послеоперационном периоде у пациента развилась острая правожелудочковая недостаточность. Больному проводилась многокомпонентная инотропная поддержка. С целью снижения сопротивления малого круга кровообращения больной получал силденафил (в суточной дозе 50 мг) в сочетании с ингаляциями вентависа (в дозе 5 мкг каждые 3 часа) и приемом траклира (базинтан) (в дозе 125 мг в сутки). На фоне проводимой комплексной терапии отмечалось купирование проявлений правожелудочковой недостаточности, нормализация биохимических показателей. По результатам инвазивного мониторинга давление в легочной артерии снизилось до 30 мм рт. ст., сопротивление малого круга кровообращения к моменту выписки составило 1,1 ед. Вуда. По данным эхокардиографии (ЭхоКГ) выявлено уменьшение конечного диастолического объема правого желудочка КДО ПЖ с 70 до 62 мл и увеличение ФВ ПЖ с 47,7 до 62% через 2 мес. Наше клиническое наблюдение демонстрирует высокую эффективность лечения острой правожелудочковой недостаточности инотропными средствами в сочетании с препаратами, снижающими сопротивление малого круга кровообращения.

Acute right ventricular failure in the early period after orthotopic heart transplantation is a severe complication and can often lead to a fatal outcome. This is especially important in patients with high pulmonary arteries resistance. Drug therapy has shown effectiveness only for the treatment of primary pulmonary hypertension. Patient K., 23 years old with signifi cant pulmonary hypertension (mean pulmonary artery pressure of 60 mm Hg, PVR – 6 Wood units) underwent orthotopic heart transplantation. Acute right ventricular failure occurred at early postoperative period which required multicomponent inotropic support. In order to reduce resistance of the pulmonary circulation the patient received sildenafi l (daily dose 50 mg) in combination with inhaled Ventavis (5 mcg a dose every 3 hours) and receipt of Tracleer (bosentan) (at a dose of 125 mg per day). Complex drug therapy resulted in reduction of right ventricular failure, normalization of biochemical parameters. Invasive pulmonary artery pressure decreased to 30 mm Hg and pulmonary vascular resistance was 1.1 Wood units at the moment of discharge. We also revealed right ventricle end-diastolic volume reduction from 70 ml to 62 ml and ejection fraction of the right ventricle (RV EF) increased from 47,7% to 62% in 2 months. Our clinical observation demonstrates the high effi ciency of acute right heart failure complex therapy including inotropic agents in combination with drugs that reduce the pulmonary vascular resistance.

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The authors declare that there are no conflicts of interest present.