The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Dec 1993
Randomized Controlled Trial Clinical TrialRight ventricular function after normothermic versus hypothermic cardiopulmonary bypass.
Normothermic systemic perfusion in patients undergoing cardiopulmonary bypass may compromise myocardial hypothermia, a mainstay for preservation of ventricular function during iatrogenic cardiac arrest. The right ventricle is the area of the heart most susceptible to rewarming. We prospectively evaluated myocardial rewarming and indexes of right ventricular function in 30 patients undergoing coronary artery bypass grafting randomized to receive moderate hypothermic (bladder temperature 25 degrees C) or normothermic perfusion and multidose cold blood cardioplegia during cardiopulmonary bypass. ⋯ A right ventricular ejection fraction/volumetric catheter was used to assess right ventricular function by right ventricular ejection fraction and a preload (right ventricular end-diastolic volume) normalized right ventricular stoke work index in the prebypass and postbypass periods. Findings included the following: (1) Greater rewarming of all areas of the heart occurs with normothermic bypass, with the mean temperature difference at the end of each intracardioplegic period ranging from 4.0 degrees to 6.3 degrees C warmer than with hypothermic bypass; (2) the right ventricle was not more susceptible to rewarming than the posterior left ventricle or interventricular septum in either group; (3) right ventricular function did not differ between groups at any time in the study, including the immediate postarrest period; and (4) right ventricular function was preserved and equivalent to the prebypass baseline. We conclude that the moderate myocardial rewarming that occurs with normothermic perfusion does not compromise right ventricular preservation in patients with right coronary artery disease undergoing revascularization with multidose cold blood cardioplegia to maintain electromechanical arrest.
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J. Thorac. Cardiovasc. Surg. · Dec 1993
Complement activation during cardiopulmonary bypass in infants and children. Relation to postoperative multiple system organ failure.
Twenty-nine children 3 months to 17 years of age undergoing operations for congenital heart disease were included in this prospective study. Complement activation, activation of the plasma contact system, leukocytes, leukocyte elastase release, and C-reactive protein were studied during and after cardiopulmonary bypass for the first postoperative week and related to multiple system organ failure occurring in eight (27.5%) of the 29 children. During cardiopulmonary bypass complement activation via the alternative pathway as indicated by significant conversion of C3 (expressed by C3d/C3) and abnormally high C5a values at the end of cardiopulmonary bypass without consumption of C4 was shown in all children. ⋯ This study demonstrates that, in children, cardiopulmonary bypass induces complement activation principally via the alternative pathway. It suggests a relationship between complement activation and multiple system organ failure observed in the postoperative period. Furthermore, it points out the role of multiple system organ failure itself on the C3 conversion and on the synthesis of the markers of the inflammatory response in children after heart operations.
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J. Thorac. Cardiovasc. Surg. · Dec 1993
Bronchoplastic procedures for tuberculous bronchial stenosis.
Thirty-six patients underwent tracheobronchoplastic procedures for treatment of tuberculous tracheobronchial stenosis. The modes of operations were left upper sleeve lobectomy in 13 patients, sleeve resection of the left main bronchus in 12 patients (two underwent concomitant left upper lobectomy), right upper sleeve lobectomy in five patients, sleeve resection of the right intermediate bronchus in two patients, right sleeve superior segmentectomy of the lower lobe in one patient, sleeve resection of the trachea with concomitant left pneumonectomy in one patient, carinal resection with right upper sleeve lobectomy and middle lobectomy in one patient, and dilatation of the left main bronchus with a free skin graft reinforced with a steel wire in one patient. One patient died of pulmonary edema of unknown cause on the first postoperative day. ⋯ One patient died in the hospital of massive bleeding during endoscopic dilatation 4 months after operation. Slight to moderate stenosis resulted in the remaining patients. Although there are some complications, we believe bronchoplastic operation is worthwhile for restoring pulmonary function in patients with tuberculous tracheobronchial stenosis.
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J. Thorac. Cardiovasc. Surg. · Dec 1993
Cytokine and complement levels in patients undergoing cardiopulmonary bypass.
Patients undergoing cardiopulmonary bypass are known to develop whole body inflammation that often results in a characteristic syndrome early postoperatively. This phenomenon has been attributed to complement activation caused by exposure of blood to the foreign surfaces of the cardiopulmonary bypass circuit. It has been unknown if cytokines are involved. ⋯ There was no statistically significant correlation among hemodynamic variables or pulmonary function and complement, interleukin, or tumor necrosis factor-alpha levels. These results confirm the presence of complement activation and demonstrate the production of IL-6 after the generation of C5b-9 in patients undergoing cardiopulmonary bypass. IL-6 may contribute to adverse systemic reactions associated with cardiopulmonary bypass.