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ANATOMICAL ASPECTS OF CARDIAC TRANSPLANTATION
Ashuralieva Gulhumor Kahhorovna
Assistant, Department of "Anatomy and Clinical Anatomy",
Andijan State Medical Institute, Uzbekistan
Abstract:
This article is devoted to the study of the most important organ in the human div
- the heart, the study of its development, structure, topography, innervation, functions,
modern research methods. The relevance of the study is explained by the high incidence of
cardiovascular diseases in people. In addition, indications, contraindications, the technique
of performing a heart transplant operation and complications after it are given.
Kеywоrds:
heart, transplantation, cardiovascular system, surgery, anatomy, vessels.
INTRОDUСTIОN
Despite advances in pharmacotherapy of cardiovascular diseases, heart transplantation
remains the only treatment method for a number of patients with heart failure that improves
their prognosis and quality of life. The heart is the central organ of the cardiovascular system.
It is a four-chambered muscular organ consisting of the right and left ventricles and atria. It
has an irregular conical shape, slightly flattened in the anteroposterior direction. The human
heart is located in the chest cavity, in the center, with a slight shift to the left. On the outside,
it is surrounded by a membrane - the pericardium. Between the heart and the pericardium is
a fluid that moistens the heart and reduces friction during its contractions [2-4].
MАTЕRIАLS АND MЕTHОDS
The heart develops from two symmetrical rudiments, which then merge into one tube
(simple tubular heart), located in the neck. Due to the rapid growth of the tube in length, it
forms an S-shaped loop (sigmoid heart). From the venous section of the sigmoid heart, the
atria develop, and from the arterial section, the ventricles. The first contractions of the heart
begin at a very early stage of development, when the muscle tissue is barely visible [3-4].
The superior and inferior vena cava flow into the right atrium. At the point where these
veins flow, a wave of contraction of the heart muscle occurs, quickly covering both atria and
then passing to the ventricles. In addition to the great vena cava, the coronary sinus of the
heart also flows into the right atrium, through which venous blood flows from the walls of
the heart itself. The opening of the sinus is closed by a small fold (thebesian valve). Four
pulmonary veins flow into the left atrium. The largest artery in the div, the aorta, emerges
from the left ventricle. It first goes to the right and up, then, bending back and to the left, it
crosses over the left bronchus in the form of an arc. The pulmonary artery emerges from the
right ventricle; it first goes to the left and up, then turns to the right and divides into two
branches that go to both lungs [3].
RЕSULTS АND DISСUSSIОN
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The heart is in working order throughout a person’s life, does a huge amount of work and
needs abundant nutrition. Therefore, its blood supply is arranged in such a way that it fully
ensures the inflow and outflow of blood. The cardiac muscle receives blood before all other
organs through two coronary arteries, which branch off from the aortic bulb in the area of
its right and left sinuses. Even at rest, the abundantly developed network of coronary
vessels of the heart receives about 5-10% of all the blood ejected into the aorta. The right
coronary artery is directed along the transverse groove to the right toward the back half of
the heart. It supplies most of the right ventricle, the right atrium and part of the back surface
of the left heart. Its branch supplies the conduction system of the heart – the Aschoff-Tawar
node, the bundle of His. The left coronary artery divides into two branches and supplies
most of the left heart and the front part of the right ventricle. The coronary arteries divide
into a large number of branches, widely anastomosing with each other and scattering into a
very dense network of capillaries, penetrating everywhere, into all parts of the organ [1].
The heart has twice as many (thicker) capillaries than skeletal muscle. Venous blood flows
from the heart through numerous channels, the most significant of which is the coronary
sinus, which flows independently directly into the right atrium. All other veins collecting
blood from individual areas of the heart muscle also open directly into the heart cavity: into
the right atrium, into the right and, partially, into the left ventricle. Three-fifths of all the
blood passing through the coronary vessels flows through the coronary sinus, while the
remaining two-fifths of the blood are collected by other venous trunks [3, 4]. Contractions of
the heart occur automatically, but its activity is regulated depending on the needs of the div
by the central nervous system.
The transplantation methods include the atrial technique of orthotopic heart transplantation
(anastomosis of the left atrium, interatrial septum, right atrium, aorta and pulmonary artery
of the donor and recipient hearts), the cava-caval technique of heart transplantation, which
differs from the atrial technique in that it anastomoses the superior and inferior vena cava
without dissecting the right atrium, and a combined technique (Shumakov V.I.). Unlike the
above, it involves the imposition of an anastomosis either between the recipient's vena cava
with the donor's right atrium (in the form of a narrow "bridge"), or between the lateral edge
of the incision of the inferior vena cava of the donor heart and the posterior wall of the
recipient's right atrium, lateral to the oval fossa, as well as between the opposite edge of the
incision of the inferior vena cava of the donor heart and the edge of the recipient's right
atrium. After transplantation, immunosuppressive drugs are prescribed [2].
According to the results of uncontrolled trials, anticoagulants, aspirin and high doses of
cyclosporine have little effect on the risk of coronary arteriopathy, and 5 years after
transplantation it occurs in 40-45% of patients. Sometimes in such cases a repeat heart
transplant is performed, but due to the low survival rate after it and the shortage of donors,
this is rarely done [3].
СОNСLUSIОN
Thus, despite advances in the field of pharmacotherapy of cardiovascular diseases, heart
transplantation remains the only treatment method for a number of patients with heart failure
that significantly improves their prognosis and quality of life. However, it should be noted
that detailed knowledge of the anatomy of the heart and blood vessels is crucial for the
successful implementation of this operation.
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RЕFЕRЕNСЕS
1. Gauthier S.V. Transplantology: results and prospects / S.V. Gauthier. - Volume IV. – M.
– Tver: OOO "Izdatelstvo" Triada ", 2013. – 304 p.
2. Gaivoronsky I.V. Normal human anatomy / I.V. Gaivoronsky. – Textbook. In 2 volumes.
Volume 1. – SPb: SpetsLit, 2013. – 560 p.
3. Sapin M.R. Normal human anatomy / M.R. Sapin, G.L. Bilich. – Book 2. – M.: MIA,
2010. – 480 p.
4. Kozlov V.I. Anatomy of the cardiovascular system / V.I. Kozlov. – M. Practical medicine,
2016 – 192 p.
5. Sapin M.R. Human anatomy / M.R. Sapin, D.B. Nikityuk, V.N. Nikolenko et al. -
Textbook. In 2 volumes. – M.: GEOTAR-MEDIA, 2015. – 528 p.
