Changes in Hemodynamics of Greater and Lesser Circulation in Scoliotic Disease

Abstract

Objective. Complex estimation of pulmonary and systemic circulation in patients with various degree of scoliotic disease severity and duration. Material and Methods.We observed 210 patients at the age of 14 to 38 years with I–IV grade scoliosis. Sex ratio (male/female) was 1:6. All patients were divided in two groups according to the age: Group 1 – patients of 14–18 years old, with the average disease duration being 8.3 ± 3.6 year; Group 2 – 19–38 years old, with the average disease duration – 24.6 ± 1.9 years. Control group cosisted of 60 individuals without scoliotic deformities, heart and pulmonary diseases, and was comparable in age and sex. All groups underwent complex examination including standard Dopplerechocardiography. Results. Echocardiography demonstrated changes in systolic function of the left ventricle in patients with scoliosis which is naturally accompanied by central hemodynamics impairment. Hyperkinetic type of hemodynamics was revealed in patients with mild scoliosis and hypokinetic type – in patients with severe one. The study revealed pulmonary hypertension, rise of average blood pressure, increase in peripheral and lung vascular resistance in adolescents with clinically apparent scoliotic deformities. Impairment of central hemodynamics and pulmonary blood flow in adult patients with severe scoliosis were less pronounced. Conclusion. Impairment of systemic and pulmonary circulation has been revealed in patients with thoracic scoliosis, which is more pronounced in adolescents with severe and rapidly progressing forms of the disease. They suffer from early derangement of adaptation mechanism and progressing decrease in stroke and minute cardiac output, in spite of increase in cardiac beat rate; decrease in average hemodynamic pressure and rise of resistance in lesser and greater circulation.

Anesthesia for surgery in a patient with Knist's dysplasia for severe scoliotic deformity

“…1. Оперативное лечение сколиотической деформации позвоночника позволяет снизить прогрессирование и не допустить в дальнейшем ухудшение функции дыхательной и сердечно-сосудистой систем, тем самым увеличить продолжительность жизни [3][4][5].…”

“…Для тяжелых кифосколиотических форм изменения позвоночника характерны выраженные нарушения в функции внешнего дыхания, снижение жизненной емкости легких, минутного объема дыхания [3]. Снижение легочной эластичности, анатомическое смещение сердца, перегиб крупных сосудов с дислокацией трахеи и бронхов могут стать причиной повышения давления в системе малого круга кровообращения, что, в свою очередь, приводит к развитию правожелудочковой недостаточности [4,5]. Нарушение сократительной способности сердечной мышцы, а также в проводящей системе могут приводить к опасным сбоям ритма сердца и прогрессированию тотальной сердечной недостаточности [3].…”