#46
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Коль скоро я привел фото, дам и клиническую историю случая (по английски - извините, лень переводить):
Patient C. is a 34 year-old female, admitted for delivery. 5 minutes after her waters broke, she developed cardiac arrest. ACLS protocol was started, and the patient was emergently taken to the OR for C-section. 15 minutes after arrest, baby was delivered. TEE was performed in the OR, and demonstrated marked enlargement and severe hypokinesis of the right ventricle, and a large mobile mass, going from right atrium to the left atrium through the PFO Because of high risk of systemic emboli in this case, patient was urgently taken to the cardiac OR, where she was placed on cardiopulmonary bypass, and underwent right atriotomy with extraction of the embolus (Figure 1C) from both atria, with subsequent inspection of proximal pulmonary arteries, which didn’t reveal any clots. Subsequent pathologic examination revealed squamous epithelium in the embolus, consistent with diagnosis of amniotic fluid embolization. Patient made uneventful recovery with no neurologic sequelae, and with complete normalization of cardiac function. Though cardiac surgery was performed for extraction of the paradoxical embolus-in-transit, it is possible that cardiopulmonary bypass facilitated recovery of the patient. Фото самого тромбоэмбола: |
#47
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Цитата:
Правильное название вышеупомянутого устройства мне не известно. Выпускает его Arrow или Portex. Представляет собой Сван, под баллонном, которого крепится складывающаяся корзиночка. Когда баллон заплывает в ЛА, корзиночка принудительно открывается оператором и обтурирует легочный ствол. Единственный раз в жизни я ставил подобное устройство лет 5 тому назад. В принципе ничего хитрого. |
#48
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Фильмы я выложил, еще вчера. М.б. стоит их класть на you tube, но так качество выше. Прелесть случая д-ра Майского в невероятной быстроте событий: реанимация, кесарево сечение, кардиохирургия. Этот амниотический тромб ведь выделяет вазоактивные вещества, от этого и произошла острая перегрузка ПЖ объемом. Выживает при такой тромбоэмболии примерно 15%, так ведь, д-р Майский?
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#49
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Фильм красоты необычайной. Спасибо за инфо про девайс - буду узнавать.
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#50
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Про наш случай - да, выжить при этом осложнении - большое везение. Вот кратенькая справка, если кому-то интересно:
Amniotic fluid embolism is a rare obstetric catastrophe, occurring in one per 8.000-to 80.000 pregnancies; only 15% of patients remain alive and without major neurologic sequelae (1). The pathophysiology of AFE may resemble anaphylaxis or septic shock (1). Typically, hypotension, respiratory failure, disseminated intravascular coagulation and neurologic symptoms are observed. Few available reports of TEE, performed shortly after embolization, universally report marked RV failure (3,4,5). This response appears to be caused not solely by the pulmonary embolism, but also by the vasoconstriction produced by vasoactive substances released when amniotic fluid enters into the pulmonary circulation (6,7,8). This may be the reason why treatment of severe hemodynamic reaction to this type of embolism with cardiopulmonary bypass enjoyed certain success (2), by providing the time needed for elimination of vasoactive substances and recovery of cardiac function. 1.Clark SL, Hankins GDV, Dudley DA, Dildy GA, Porter TF. Amniotic fluid embolism: Analysis of the national registry. Am J Obstet Gynecol 1995;172:1158–69. 2.Esposito RA, Grossi EA, Coppa G, Giangola G, Ferri DP, Angelides EM, Andriakos P. Successful treatment of post partum shock caused by amniotic fluid embolism with cardiopulmonary bypass and pulmonary artery thromboembolectomy. Am J Obstet Gynecol 1990;163:572–4. 3.Shechtman M, Ziser A, Markovits R, Rozenberg B. Amniotic fluid embolism: early findings of transesophageal echocardiography. Anesth Analg 1999;89:1456–1458. 4. Rufforny-Doudenko I, Sipp C, Shehata BM. Pathologic quiz case. A 30-year-old woman with severe disseminated intravascular coagulation during delivery. Arch Pathol Lab Med 2002;126:869 –870. 5. Porata S, Leibowitzb D, Milwidskya A, Valskya D.V, Yagela S, Anteby E.Y. Transient intracardiac thrombi in amniotic fluid embolism BJOG 2004;111:506–510 6. Reis RL, Pierce WS, Behrendt DM. Haemodynamic effects of amniotic fluid embolism. Surg Gynecol Obstet 1969;129:45– 48. 7. Rodgers BM, Staroscik RN, Reis RL. Effects of amniotic fluid on cardiac contractility and vascular resistance. Am J Physiol 1971; 220:1979– 1982. 8. Hankins GD, Snyder RR, Clark SL, Schwartz L, Patterson WR, Butzin CA. Acute haemodynamic and respiratory effects of amniotic fluid embolism in the pregnant goat model. Am J Obstet Gynecol 1993;168:1113– 1129; discussion 1129–1130. |
#51
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audovichenko одобрил(а): Вот это красота!!! Дмитрий, мультик Вы рисовали сами? Огромнейший респект!
Нет. Моя только идея. Мульт создал некто Александр - наш добрый товарищ. |