Comparative analysis of myocardial protection with htk solution and hypothermic hyperkalemic blood solution in the correction of acyanogenic congenital cardiopathies - a randomized study

Abstract Objective: The goal of the present study was to compare the myocardial protection obtained with histidine-tryptophan-ketoglutarate (HTK) cardioplegic solution (Custodiol®) and with intermittent hypothermic blood solution. Methods: Two homogenous groups of 25 children with acyanotic congenital heart disease who underwent total correction with mean aortic clamping time of 60 minutes were evaluated in this randomized study. Troponin and creatine kinase-MB curves, vasoactive-inotropic score, and left ventricular function were obtained by echocardiogram in each group. The values were correlated and presented through graphs and tables after adequate statistical treatment. Results: It was observed that values of all the studied variables varied over time, but there was no difference between the groups. Conclusion: We conclude that in patients with acyanotic congenital cardiopathies submitted to total surgical correction, mean aortic clamping time around one hour, and cardiopulmonary bypass with moderate hypothermia, the HTK crystalloid cardioplegic solution offers the same myocardial protection as the cold-blood hyperkalemic cardioplegic solution analyzed, according to the variables considered in our study model.

Relationship between some coagulation indices with hemorrhage complication in patients undergoing cardiac surgery with cardiopulmonary bypass

Background: Cardiac surgery with cardiopulmonary bypass (CPB) can cause haemostatic abnormalities that increase the risk of postoperative hemorrhage. Objectives: (1) To study changes of coagulation in cardiac patients undergoing surgery with CPB. (2) To research the relationship between duration of cardiopulmonary bypass, coagulation tests and postoperative hemorrhage complications. Subjects and methods: A cross sectional descriptive study was carried out on 252 patients (105 women, 147 men) undergoing cardiac surgery with CPB due to congenital heart disease and acquired heart disease at Viet Duc Hospital from December 2005 to August 2006. Results: After surgery, 54 patients had to transfuse the blood products, accounting for 21.4% rate. 21 cases had abnormal bleeding (8.3%). 12 patients assigned to re-operate due to bleeding (4.8%). There was an inverse correlation between platelet counts after surgery with duration of CPB and duration of aortic clamping. Relationship between rate of prothrombin, APTT, fibrinogen after surgery and duration of CPB and duration of aortic clamping was not seen. Duration of CPB prolonging over 120 minutes related to postoperative hemorrhage complication (OR=2.69 (p<0.5)). Reduced platelet count increased the risk of postoperative hemorrhage but not statistically significant (OR=1.36; p>0.05). Prothrombin ratio of less than 50% associated with the risk of postoperative hemorrhage (OR=4.83; p<0.01). Conclusion: The routine coagulation tests can help monitor clotting in patients after cardiac surgery

Role of Apoptosis in the Gut Mucosal Barrier Dysfunction in Rats with Cardiopulmonary Bypass / 中国医师杂志

Objective To investigate the role of cell apoptosis in the gut mucosal barrier dysfunction in rats undergoing cardiopulmonary bypass(CPB) . Methods The rat model of CPB was set up. The rats were divided into CPB group, sham operation(SO) group and normal control group. The morphological changes of ileum mucosal tissues were observed by microscope and electron microscope at 3h, 6h, 12h and 24h after operation, respectively. The apoptotic index of gut mucosal epithelial cells was measured with TUNEL method. Results Gut mucosal morphology was normal in CPB group at 3h, 6h and 12h after operation, but gut mucosal epithelial desquamation occurred at 24h after operation. Typical apoptotic cells could be seen with electron microscope in CPB group at every time point. Apoptotic index of gut mucosal epithelial cells significantly increased in CPB group at every time point compared with SO group, and peaked at 6h after operation. Apoptotic cells were mostly located in the gut crypt. Conclusion The data suggested that the apoptosis of intestinal epithelial cells significantly increased at early stage of post-CPB in rats, which might contribute to gut mucosal barrier dysfunction.

Effect of Intravenous Anesthetics on Systemic Vascular Resistance during Cardiopulmanary Bypass / 대한마취과학회지

We have studied the effect of thiopental sodium, propofol, midazolam and ketamine on systemic vascular resistance(SVR) during cardiopulmonary bypass with constant pump flow in 20 patients undergoing elective open heart surgery. SVR decreased about 13(+/-3.42)% of control values after thiopental sodium 4 mg/kg, about 10 (+/-5.30)% of control after propofol 2 mg/kg and about 8(+/-3.72)% of control after midazolam 0.2 mg/kg; it returned to control values about 2 min 30 sec(+/-1 min 20 sec) after administration of thiopental sodium and about 4 min 30 sec(+/-2 min 15 sec) after administration of propofol. It remained under control values after 10 min after administration of midazolam. Ketamine showed no significant changes on SVR. Analysis of variance showed that there were no significant differences in the changes in SVR between the groups. Change of SVR after administration of thiopental sodium did not have statistical significance(P< 0.05).

Effect of autogenous oxygenator cardiopulmonary bypass on lung protection at cardiac surgery / 重庆医科大学学报

Objective:To investigate lung injury and protective effect of autogenous oxygenator cardiopulmonary bypass(CPB) on lung after CPB.Methods:24 adult mongrels (weight 15?1kg) were randomly divided into two groups,12 for experimental group,in which the dog's own lung was used as oxygenator;12 for control group,in which the artificial lung (bubble oxygenator) was used as oxygenator.Leukocyte count of right atrium and left atrium,difference of transpulmonary leukocyte,the pulmonary artery pressure,and the oxygen pressure of artery were measured during the perioperative period.And lung biopsies were obtained before and after CPB in both groups for microscope pathological examination.Results:Autogenous oxygenator CPB technique could provide satisfactory oxygenation during CPB.The oxygen pressure after CPB was significantly higher in the experimental group than that in the control group at different time points( P