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Prognostic factors of surgical treatment of chronic thromboembolic pulmonary hypertension
Nižnanský, Matúš ; Lindner, Jaroslav (advisor) ; Rohn, Vilém (referee) ; Pudil, Radek (referee)
Chronic thromboembolic pulmonary hypertension (CTEPH) is a disease characterized by increased pulmonary artery pressure. It is caused by intraluminal thrombi organisation, stenoses and occlusions of pulmonary artery and its branches and peripheral vascular remodeling. It is a chronic complication of acute pulmonary embolism. The obstruction of pulmonary artery branches increases pulmonary vascular resistance (PVR) and this leads to the right ventricular overload and right-sided heart failure. The treatment of choice is surgical pulmonary endarterectomy (PEA), a procedure that is performed in deep hypothermic cardiac arrest. Patients with peripheral type of CTEPH, who are not indicated for operation and also patients with residual pulmonary hypertension after PEA can be indicated for specific vasodilatation therapy. In indicated cases the treatment may involve the balloon pulmonary angioplasty or lung transplantation. Despite the high effectivity of PEA, there is a number of patients, whose pulmonary arterial pressure remains high and this plays a key role in postoperative mortality and morbidity. Incidence of residual pulmonary hypertension is according to literature between 16 and 51%. This leads to a pursuit of finding possible tools to predict residual pulmonary hypertension after PEA. The aim of...
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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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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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Cyanoacrylate in treatment of great and small saphenous vein.
Novotný, Karel ; Pafko, Pavel (advisor) ; Lindner, Jaroslav (referee) ; Šebesta, Pavel (referee)
Introduction: Cyanoacrylate gluing technique is the least strenuous treatment of varicose trunks which does not necessitate tumescent anaesthesia and post procedural stocking compression. In response to the long-term unavailability of commercial kits with N-butyl-2-cyanoacrylate (Histoacryl) in the Czech Republic, we used a modified technique, which is based on the technique of endovascular treatment of AV malformations in the brain and uses a mixture of cyanoacrylate and Lipiodol to clog. We evaluated the success of the method, complications and clinical improvement of chronic venous insufficiency. Parts of the work are histological findings of collected samples of veins at various time intervals. In an in vitro experiment, we compared the bond strength of a bonded shear to a tear device. The adhesive mix values used were compared with those of commercially available adhesives for this purpose. Patients and methods: Fifty-six limbs in 49 patients suffering from great saphenous vein or small saphenous vein insufficiency in combination with symptomatic chronic venous insufficiency and complicating comorbidities were treated with a modified endovascular cyanoacrylate glue application technique. A histopathological examination was conducted on vein samples from six. In each patient a sample of the...
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Current Possibilities in Use of a Centrifugal Pump in the Cardiac Sugery
Mlejnský, František ; Lindner, Jaroslav (advisor) ; Lonský, Vladimír (referee) ; Vaněk, Tomáš (referee)
Current Possibilities in Use of a Centrifugal Pump in the Cardiac Sugery Abstract Currently, the most commonly used technical solution for pumping blood during extracorporeal circulation during cardiac surgery, as well as for some types of ECMO (extracorporeal membrane oxygenation) are either a roller pump or centrifugal pump. Due to its advantages the centrifugal pump is mainly used for prolonged extracorporeal circulation in cardiac surgery and as a heart and / or lung support system. In current literature there is a lack of compelling scientific evidence that would clearly support its use in a routine cardiac surgery. The aim of our study was to compare both types of currently used blood pumps in longer cardiac procedures with deep hypothermic circulation arrest. In a randomized clinical study we had selected a group of patients that underwent a pulmonary endarterectomy (PEA) in order to demonstrate the positive effects of the centrifugal pump on the postoperative inflammatory reactions. There were no statistically significant differences between these two pumps when other clinical and laboratory parameters were observed. Based on the hypothesis that significant temperature changes during cardiac procedure with a deep hypothermia can affect sealing pressure of the endotracheal tube cuff, we performed a...
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Impact of hereditary thrombophilia and acquired thrombophilia on incidence of postoperative venous thromboembolism.
Ulrych, Jan ; Kvasnička, Jan (advisor) ; Penka, Miroslav (referee) ; Lindner, Jaroslav (referee)
In Introduction, the author of this dissertation deals with postoperative venous thromboembolism (VTE), hereditary and acquired risk factors, prophylaxis regimens and recent recommendation of VTE prevention in surgery. In Practical part of this work the author assesses the risk of VTE in surgical patients according to risk assessment model. Genetic testing is carried out in all patients to determine the incidence of hereditary thrombophilia and coagulation markers are measured in 28-days postoperative period. Prevalence of VTE in 1-year postoperative period is observed. The results are analysed in group of patients with benign disease (hernia and gallstone disease) and group of patients with malignancy (colorectal cancer and pancreatic cancer) separately. The objective of this work is to determine the incidence of the most frequent thrombophilic mutations (factor V Leiden mutation and protrombin G20210A mutation) and assess the impact of hereditary thrombophilia on incidence of postoperative venous thromboembolism in general surgery. Validation of venous thrombosis risk assessment model recommended by Czech Society for Thrombosis and Hemostasis is further objective.
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Cyanoacrylate in treatment of great and small saphenous vein.
Novotný, Karel ; Pafko, Pavel (advisor) ; Lindner, Jaroslav (referee) ; Šebesta, Pavel (referee)
Introduction: Cyanoacrylate gluing technique is the least strenuous treatment of varicose trunks which does not necessitate tumescent anaesthesia and post procedural stocking compression. In response to the long-term unavailability of commercial kits with N-butyl-2-cyanoacrylate (Histoacryl) in the Czech Republic, we used a modified technique, which is based on the technique of endovascular treatment of AV malformations in the brain and uses a mixture of cyanoacrylate and Lipiodol to clog. We evaluated the success of the method, complications and clinical improvement of chronic venous insufficiency. Parts of the work are histological findings of collected samples of veins at various time intervals. In an in vitro experiment, we compared the bond strength of a bonded shear to a tear device. The adhesive mix values used were compared with those of commercially available adhesives for this purpose. Patients and methods: Fifty-six limbs in 49 patients suffering from great saphenous vein or small saphenous vein insufficiency in combination with symptomatic chronic venous insufficiency and complicating comorbidities were treated with a modified endovascular cyanoacrylate glue application technique. A histopathological examination was conducted on vein samples from six. In each patient a sample of the...
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Impact of hereditary thrombophilia and acquired thrombophilia on incidence of postoperative venous thromboembolism.
Ulrych, Jan ; Kvasnička, Jan (advisor) ; Penka, Miroslav (referee) ; Lindner, Jaroslav (referee)
In Introduction, the author of this dissertation deals with postoperative venous thromboembolism (VTE), hereditary and acquired risk factors, prophylaxis regimens and recent recommendation of VTE prevention in surgery. In Practical part of this work the author assesses the risk of VTE in surgical patients according to risk assessment model. Genetic testing is carried out in all patients to determine the incidence of hereditary thrombophilia and coagulation markers are measured in 28-days postoperative period. Prevalence of VTE in 1-year postoperative period is observed. The results are analysed in group of patients with benign disease (hernia and gallstone disease) and group of patients with malignancy (colorectal cancer and pancreatic cancer) separately. The objective of this work is to determine the incidence of the most frequent thrombophilic mutations (factor V Leiden mutation and protrombin G20210A mutation) and assess the impact of hereditary thrombophilia on incidence of postoperative venous thromboembolism in general surgery. Validation of venous thrombosis risk assessment model recommended by Czech Society for Thrombosis and Hemostasis is further objective.
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Current Possibilities in Use of a Centrifugal Pump in the Cardiac Sugery
Mlejnský, František ; Lindner, Jaroslav (advisor) ; Lonský, Vladimír (referee) ; Vaněk, Tomáš (referee)
Current Possibilities in Use of a Centrifugal Pump in the Cardiac Sugery Abstract Currently, the most commonly used technical solution for pumping blood during extracorporeal circulation during cardiac surgery, as well as for some types of ECMO (extracorporeal membrane oxygenation) are either a roller pump or centrifugal pump. Due to its advantages the centrifugal pump is mainly used for prolonged extracorporeal circulation in cardiac surgery and as a heart and / or lung support system. In current literature there is a lack of compelling scientific evidence that would clearly support its use in a routine cardiac surgery. The aim of our study was to compare both types of currently used blood pumps in longer cardiac procedures with deep hypothermic circulation arrest. In a randomized clinical study we had selected a group of patients that underwent a pulmonary endarterectomy (PEA) in order to demonstrate the positive effects of the centrifugal pump on the postoperative inflammatory reactions. There were no statistically significant differences between these two pumps when other clinical and laboratory parameters were observed. Based on the hypothesis that significant temperature changes during cardiac procedure with a deep hypothermia can affect sealing pressure of the endotracheal tube cuff, we performed a...
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