An assessment of cardiopulmonary bypass in atrial septal defect repair surgery of the patients who underwent in molecule genetic study / Монголын Анагаах Ухаан

ABSTRACT

Background: Atrial septal defect (ASD) repair surgery is the most common open heart surgery. In last5 years, a total of 729 patients underwent in open heart surgery, whereas 561 patients (76.95%) hadcongenital heart disease (CHD), its 284 patients (50.6%) had ASD.Objective: To describe approach of cardiopulmonary bypass (CPB) in surgery of common ASD.Methods: We analyzed condition and process of CPB in ASD repair surgery (Department ofCardiovascular Surgery, Shastin Central Hospital of Mongolia) in 118 patients who had undergonegenetic testing in Research Center of Leipzig and Halle, Germany and Mongolian Academy of MedicalSciences. This has been found to be adequate for the routine open heart case, flow rates of 2.6-3.5 l/m2/min. The perfusionist should record the flow rate, arterial blood pressure, gas flow rate, temperature andtime regularly every 5, 10, 20, 30 minutes during bypass or when one of these parameters in changed.The beginning of bypass an activated clothing time (ACT) may be performed at the pump side to determineanticoagulation status. With clotting times below 300 sec additional heparin should be administrateddepending on the stage of the operative procedure.Results: The process of extracorporeal circulation of ASD repair surgery was observed in 118 patientswho underwent in genetic testing. There were 32.2% (38) males and 67.8% (80) females. Mean agewere 22.3±12.9 and mean body weight were 70kg. O2 consumption was 240 ml/min and CO2 productionwas 196 ml/min. In the beginning of surgery mean blood pressure were 92±5 mmHg and 58 mmHg afterthe dissection of major vessels. It is associated with a decrease of venous return to heart and cardiacoutput. After 30 minutes of CPB, blood pressure was 63 mmHg. During CPB, metabolic acidosis isalways a result of inadequate perfusion. Although the acid-base status may be immediately correctedby the administration of bicarbonate the abnormal process leading to the metabolic acidosis is notcorrected until perfusion becomes adequate. The best corrective measure is therefore to take whateversteps necessary in order to increase perfusion.Conclusion:1. Perfusion measurement of the chosen cases was measured in the level of international expertise.2. Hemodynamic aberrations were observed in the beginning of CPB, which demonstrates arequirement for increasing the pump flow rate of the machine (2.6-3.5 l/m2/min).3. Due to the fact that ASD repair surgery lasts for short period, CPB can be done in 320C of bodytemperature. Hence there is no need of hemoconcentration.