The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Oct 2000
Suppression of the secretion of atrial and brain natriuretic peptide after total cavopulmonary connection.
Among the modifications of the Fontan operation currently being used, total cavopulmonary connection offers the greatest potential for optimizing early and long-term postoperative outcomes. Although studies have established that abrupt increases in right atrial pressure elevate the plasma atrial natriuretic peptide level after the Fontan procedure, changes in plasma natriuretic peptide levels after total cavopulmonary connection have not been clarified. Our hypothesis is that secretion of atrial natriuretic peptide may be suppressed in patients undergoing total cavopulmonary connection because the atrium continues to function at low pressure in those patients. In this study, we measured plasma levels of atrial and brain natriuretic peptide before and during the postoperative period in patients undergoing total cavopulmonary connection. ⋯ These results suggest that total cavopulmonary connection attenuates the secretion of atrial and brain natriuretic peptide in the early postoperative period. The suppressed release of atrial and brain natriuretic peptide after total cavopulmonary connection may have clinical importance.
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J. Thorac. Cardiovasc. Surg. · Oct 2000
Surgery for bilateral outflow tract obstruction in elastin arteriopathy.
A number of patients with Williams syndrome or other forms of elastin arteriopathy have stenoses of pulmonary arteries in addition to supravalvular aortic stenosis. We sought to investigate the effect of the degree of pulmonary arterial stenosis on the prognosis after an operation for supravalvular aortic stenosis to help define the optimal treatment strategy for patients with severe forms of elastin arteriopathy. ⋯ Surgical treatment of pulmonary artery obstructions in elastin arteriopathy is palliative but, in conjunction with balloon dilation of peripheral pulmonary arteries, offers good long-term survival to patients with the severest form of elastin arteriopathy.
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J. Thorac. Cardiovasc. Surg. · Oct 2000
Tetrahydrobiopterin improves endothelial function in human saphenous veins.
Diminished production of nitric oxide has been linked to saphenous vein endothelial dysfunction. Tetrahydrobiopterin is an obligate cofactor for the oxidation of L -arginine by nitric oxide synthase in the production of nitric oxide by endothelial cells. The objective of the present study was to examine whether the exogenous addition of tetrahydrobiopterin improves endothelial function in saphenous veins from patients undergoing coronary artery bypass graft operations. ⋯ These data uncover beneficial effects of acute tetrahydrobiopterin addition on endothelial function in human vessels. Because endothelial dysfunction has been implicated in the development of graft failure, studies aimed at chronic delivery of tetrahydrobiopterin would be useful in determining the contribution of this cofactor toward saphenous vein atherosclerosis.
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J. Thorac. Cardiovasc. Surg. · Sep 2000
Randomized Controlled Trial Clinical TrialTriiodothyronine repletion in infants during cardiopulmonary bypass for congenital heart disease.
Cardiopulmonary bypass suppresses circulating thyroid hormone levels. Although acute triiodothyronine repletion has been evaluated in adult patients after cardiopulmonary bypass, triiodothyronine pharmacokinetics and effects have not previously been studied in infants undergoing operations for congenital heart disease. We hypothesized that triiodothyronine deficiency in the developing heart after bypass may adversely affect cardiac function reserve postoperatively. ⋯ These data imply that (1) triiodothyronine in the prescribed dose prevents circulating triiodothyronine deficiencies and (2) triiodothyronine repletion promotes elevation in heart rate without concomitant decrease in systemic blood pressure. Elevation of peak systolic pressure-rate product implies that triiodothyronine repletion improves myocardial oxygen consumption and may enhance cardiac function reserve after cardiopulmonary bypass in infants.