Journal «Angiology and Vascular Surgery» • 

2004 • VOLUME 10 • №1

EFFECT OF AORTIC CLAMPING ON HEMODYNAMICS AT RECONSTRUCTION OF THE THORACOABDOMINAL AORTA

L.A. Bokeria, V.A. Lishchuk, A.A. Spiridonov, E.G. Tutov, D.Sh. Gazizova,
V.S. Arakelyan, L.V. Sazykina, E.M. Nasyrov, R.S. Ovchinnikov
Department of Surgical Treatment of Aorta and Great Arteries Diseases,
Laboratory of Monitoring and Mathematic Simulation,
A.N. Bakulev Scientific center of Cardiovascular Surgery,
Russian Academy of Medical Sciences,
Moscow, Russia

This paper describes an experience with monitoring and computerized follow up of the hemodynamic status in 60 patients at and right after reconstruction of the thoracoabdominal aorta. In addition to the routine control, measurements were made of the pressure in the large vessels and cavities of the heart, duration of each heart contraction and CI. The following parameters were computed automatically: the status of the ventricles for each heart contraction, resistance of the greater end pulmonary circulation, elasticity of the arterial, venous, pulmonary arterial and pulmonary venous reservoirs, also for each cardiac cycle. At the generally accepted monitoring the hemodynamic responses to the surgeon's manipulations on the aorta appear smoothed or are not visualized at all. The control of each heart contraction reveals the responses to application of the clamp and its removal from the aorta, with their hemodynamic significance being not questionable. Aortic clamping and clamp removal from the aorta are associated with the generalized response of the regulatory systems of the body. The slow and thoroghly controlled aortic clamping and graded, controlled blood flow restoration due to clamp removal as well as the use of sodium nitroprusside (trimetafan or isofluran are preferable) allow to avoid an abrupt stroke load of the left ventricle of the heart and, respectively, the generalized response of the regulatory systems of the body.

KEY WORDS: thoracoabdominal aorta, clamping, monitoring, cycle analysis, hemodynamics, regulation.

P. 135

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