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Pulmonary hypertension
Chovanec, Milan ; Herget, Jan (advisor) ; Szárszoi, Ondrej (referee) ; Lindner, Jaroslav (referee)
4 Abstract Hypercapnia could be used in the treatment of critically ill patients with chronic hypoxia (cardio - pulmonary failure) as a prevention against the development of hypoxic pulmonary hypertension. This work showed the reason based on the observed difference between patients with chronic obstructive pulmonary disease and high altitude dwellers. Both groups have similar levels of oxygen saturation of haemoglobin, high altitude residents have no hypercapnia compared to patients with chronic obstructive pulmonary disease but hypercapnic sea level patients have less severe lung hypertension than mountain residents. Mortality of people with diagnosed pulmonary arterial hypertension is closely associated with right ventricle hemodynamic function (pulmonary arterial pressure, right atrial pressure and cardiac index). Recently, the therapy that has been used for pulmonary arterial hypertension has consisted of three main targets; firstly: endothelin receptor blockers, secondly: prostacycline and its analogues, thirdly: PDE-5 inhibitors in order to increase the concentration of endogenous NO and its mutual combination. Unfortunately, it is clear that the recent clinical therapy of pulmonary arterial hypertension is extremely expensive, with minimal or no effect on right ventricle hemodynamic function. In...
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The relation between the measurement of dilation of the pulmonary trunk and the measurment of peripheral pulmonary-vascular reshaping for patiens with CTEPH.
Paynová, Karolina ; Jansa, Pavel (advisor) ; Lindner, Jaroslav (referee)
Přírodovědecká fakulta Univerzity Karlovy Katedra antropologie a genetiky člověka Bc. Karolina Paynová Vztah míry dilatace plicnice k míře periferní plicní cévní remodelace u pacientů s chronickou tromboembolickou plicní hypertenzí. The relation between the measurement of pulmonary artery dilation and the measurement of peripheral pulmonary vascular remodeling for patients with CTEPH. Abstrakt anglicky Abstract in english Abstract Chronic tromboembolic pulmonary hypertension (CTEPH) is believed to result from acute pulmonary embole. It manifests itself in the growth of blood pressure in pulmonary circulation. This condition, if not treated, can lead to the failure of right heart. The treatment of CTEPH is the surgical pulmonary endarterectomy, which consists in enucleation of organized fibrotic thrombus with the part of the vascular arterial wall. The prerequisite for the successful surgery is the selection of suitable candidates, mostly the patients with the central location of disability and the absence of the peripheral vascular remodelation. The peripheral vascular remodelation is difficult to recognize by contemporary diagnostic methods. A recent study has shown that patients with hypertensive aneurysm of the pulmonary artery have the good life prognosis and the dilation of the pulmonary artery is the...
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Anesthesiological diffíeulties arising in the surgical treatment of chronic pulmonary hypertension
Kunstýř, Jan ; Lindner, Jaroslav (advisor) ; Vaněk, Tomáš (referee) ; Černá, Alena (referee)
Pulmonary hypertension is a serious syndrome with very unfavorable prognosis. It encompasses numerous diseases and the only one which is surgical ly treatable is chronic thromboembolic pulmonary hypertension. Pulmonary endarterectomy (PEA) is a curative method for select patients with surgically accessible thrombotic obstruction. It involves not only the operation itself, but also complicated diagnostics, preoperative preparation, and sophisticated postoperative intensive care. According to contemporary world reviews of professional literatuře, mortality rates following PEA, range from 5 to 24 percent. Better results with lower levels of mortality as well as morbidity are unambiguously proven in the centers with more experience where the highest numbers of such surgeries are undertaken. Good team work is an essential condition for a successíul PEA program and the anaesthetist is its indispensable member. Anaesthesia of patients with chronic right ventricle dysfunction undergoing cardiac surgery using extracorporeal circulation brings about several diffíeulties and we tried to deal with them in our work. This kind of operation was not available in the Czech Republic and the íirst goal of our work was to implement this surgical program in its complexity - including anaesthesia and intensive postoperative...
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Contribution to the Hemodynamic of Vascular Anastomosis
Grus, Tomáš ; Lindner, Jaroslav (advisor) ; Adamec, Miloš (referee) ; Veverková, Lenka (referee)
The primary objective of the research project was the optimization of geometry of the infrainguinal prosthetic bypass in the site of the distal end-to-side anastomosis. Due to the negative influence of hemodynamics, it is most frequently this location, which is responsible for the longterm failure of the graft. Our prospective angiographic study in patients as well as experimental and computational simulations indicate that flow type in the anastomosis and wall shear stress (WSS) in particular are the key factors that determine the location of neointimal hyperplasia and promote its progression. Maximum of such changes was located in the toe, heel, and bottom of the anastomosis, and these clinical findings correspond with the results from the simulations. We carried out several clinical experiments that suggest the importance of the angle of the distal anastomosis of an infrainguinal prosthetic bypass as a key factor in the development (both location and quantity) of neointimal hyperplasia 6 to 24 months following the procedure. The construction of the anastomosis at a more acute angle results in WSS values that are closer to physiological flow. This reduces both mechanical impairment of the endothelial cells and stimulation of the smooth muscle cells. From the researched set of anastomotic angles (25ř, 45ř,...
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Problems of Patiens with Hypertension before and after the Surgical Operation.
Krejčí, Lucie ; Mellanová, Alena (advisor) ; Lindner, Jaroslav (referee)
Thi s The s i s de al s wi th the i s su e of the p ulmo na r y h ype r t ens ion b e for e a nd a f t er th e pulmon ar y e n da r t er e ctomy. Th e th eo r et i c al p a r t t a rge t s the a f f e c t ion of the p ulmo na r y h ype r t ens ion, i t s di a gn os t i c s , c l a s s i f i c a t ion a nd cur e. Spe c i a l cha pt e r s ar e d ed i c a t ed to th e chr on i c thr omb oembol i c pu lmon ar y h ype r t ens ion an d the pu lmon ar y en da r t e r e c tomy. The r e s e ar ch pa r t of the The s i s inc ludes a shor t e ned c a s e r epor t an d a de s cr ipt ion o f the sp ec i f i c c a r e a bout pa t i e nt s a f t e r the pu lmona r y e nda r t e r e c tomy. We e va lua t e a s t a ndar d qu e s t io nn ar y SF - 36 a bo ut th e s t a t e of h e a l th in thi s p ar t , wh i ch t he pa t i en t s wi th the c hr oni c thr omb oembol i c pu lmon ar y h ype r t ens ion we r e int e r vi ewe d wi th, be for e an d a f t er th e s ur gi c al op e r a t io n, a nd the impr o vement wa s examine d. We a l s o in ve s t iga t e i f the pe r s ona l c ha r a c t e r i s t i c s o f the r e sp onde nt s , as the i r a ge or s e x, pl a ys a n imp or t a nt r ol e in the r e sp ons e. Th e pa t i ent s b e for e a s ur gi c a l o pe r at io n of the coro na r y a r t er i e s we r e a l so int e r vi...
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