ObjectiveTo investigate the inhibitory effects of L arginine (L arg) on systemic inflammatory response after cardiopulmonary bypass(CPB).MethodsFifty one patients with rheumatic heart disease were randomly divided into two groups: L arg group ( n =25) and control group ( n =26). For L arg group, L arg at 300mg/kg was given during operation. Plasma levels of tumor necrosis factor α(TNF α),interleukin 1β(IL 1β)and interleukin 10(IL 10) were measured by enzyme linked immunosorbent assay technique at baseline(before operation) and at 2,4,8,24 and 48 h after CPB termination.ResultsTNF α,IL 1β and IL 10 levels were increased in both groups after CPB ( P lt;0.05); levels of TNF α, IL 1β returned to normal at 48 h after CPB; In L arg group, TNF α and IL 1β levels were significantly lower than those in control group at 4,8 and 24 h after CPB ( P lt; 0 05). No significant difference were detected in IL 10 between groups( P gt;0.05).ConclusionL arg may decrease plasma levels of TNF α and IL 1β after CPB, it implies L arg may inhibit inflammation induced by CPB.
Abstract： Objective To investigate the effect of salvianolate on myocardium against ischemiareperfusion injury (IRI) in valve replacement with cardiopulmonary bypass (CPB), its outcome and mechanism, and the applicability and safety of salvianolate as a protection agent for CPB central muscles. Methods Thirty patients undergoing cardiac valve replacement were randomly divided into two groups by lot. In the control group, there were 15 patients including 5 males and 10 females, while in the 15 patients in the trial group, 7 were male and 8 were female. Salvianolate of 200 mg was given to the patients in the trial group intravenously. Hemodynamic parameters, blood gas analysis results, recovery of heartbeat, the dosage of dopamine used, and assisted ventilation time were recorded for both groups before aorta clamping, 2 h, 8 h, and 24 h after aorta declamping. Besides, ICU detention time, the amount of urine in 24 hours, and the amount of drainage in 24 hours after operation were also recorded. Blood samples were taken to determine serum cardial troponin I(cTnI), creatine kinase MB isoenzyme (CK-MB), malondialdehude (MDA), and superoxide dismutase (SOD) in both groups respectively at different times including after the induction of anesthesia, aorta opening, termination of CPB, end of operation, and one day after operation. Results There was no significant difference in hemodynamic parameters, the dosage of dopamine used, spontaneous recovery of heartbeat, and the amount of urine in 24 hours and drainage after operation for 24 hours between the two groups (Pgt;0.05). The rate of ventricular rhythm, blood lactic acid level, the time of assisted ventilation and ICU detention time for the trial group were significantly lower than those for the control group (Plt;0.05), while partial pressure of oxygen in artery(PaO2) was significantly lower in the trial group 8 h after aorta declamping (Plt;0.05). The levels of serum CK-MB, cTnI, and MDA after operation for both groups were higher than those before operation; and those levels for the trial group were significantly lower than the control group at various time points (Plt;0.05). The concentration of SOD decreased after operation in both groups (Plt;0.05), and it was higher in the trial group than the control group at different time points. The decrease of SOD level in the trial group was less than that in the control group. Conclusion Salvianolate can protect myocardium from ischemiareperfusion injury in cardiac valve replacement with CPB effectively, through promoting the activity of antioxidative enzymes and eliminating oxygen free radicals. Patients can be treated with salvianolate for antimyocardial ischemia reperfusion injury.
Objective To study the protective effects and mechanism of intermittent ventilation on lung injury during cardiopulmonary bypass(CPB). Methods Twenty-four patients with rheumatic heart disease (RHD) were divided into two groups with random number table: treatment group (n=13),given intermittent ventilation once every 5 minutes during CPB; control group (n=11),no ventilation during CPB. Blood samples were obtained preoperatively. A bronchoalveolar lavage was performed at 2 hours after CPB. The numbers of granulocytes, total protein (TP) and tumor necrosis factor-alpha(TNF-α) content in the bronchoalveolar lavage fluids(BALF) were measured, and lung oxygenate index (OI) were measured preoperatively and 1 hour, 4 hours after CPB termination,respectively. Results The numbers of granulocytes, TP and TNF-α content of treatment group in the BALF were significantly lower than those of the control group (Plt;0.01, P=0.02,0.02),and the lung OI of treatment group at 1 hour and 4 hours after CPB termination was also significantly lower than that of the control group(Plt;0.05); a significant increase of lung OI occurred in both groups at 1 hour and 4 hours after CPB when compared with the same group at baseline before CPB(Plt;0.05). Conclusion Intermittent ventilation has the protective effects on lung injury during CPB by decreasing granulocytes adhesion and alleviating lung inflammatory reaction and endothelial cells injury.
Objective To introduce alternative approach of right auxiliary artery cannulation through a 8 mm hemoshield graft for cardiopulmonary bypass and selective antegrade cerebral perfusion. Methods Twentythree cases of acute type A dissection and 7 cases of ascending aortic aneurysm, in which aortic arch was involved, were evaluated. An 4-5 cm long incision beneath right clavicle was made to expose auxiliary artery with auxiliary vein and brachial plexus intact. An 8 mm hemoshield graft was anastomosed to auxiliary artery and connected to the arterial end of cardiopulmonary bypass circuit. The auxiliary artery cannula was used for arterial perfusion and also used for selective antegrade cerebral perfusion. Fifteen total arch and 15 semi-total arch replacement were performed. The graft connecting auxiliary artery was simply ligated when cardiopulmonary bypass was concluded. Results Arterial perfusion flow and pressure through auxiliary artery were not significantly different from that of cannulation via ascending aorta. No significant postoperative cerebral deficits and complications of right upper limb associated with cannulation of auxiliary artery occurred. Conclusion Arterial perfusion through right auxiliary artery provides an excellent approach for surgery of acute type A dissection and ascending aortic aneurysm with optimized body perfusion and allows for antegrade cerebral perfusion during circulatory arrest.
Objective To introduce a novel approach using parallel placement of another oxygenator in the recirculation line as oxygen supply for oxygenator failure without circulatory arrest in cardiopulmonary bypass （CPB），and confirm its outcomes in an animal experiment. Methods A traditional piglet CPB model was established. Oxygenator failure model was established by reducing fraction of inspired oxygen （FiO2） from 80% to 21% after aortic cross-clamp and cardiac arrest in CPB. Another oxygenator was then parallel placed in the recirculation line to supply 100% oxygen.Dynamic changes in partial pressure of oxygen （PaO2），mixed venous oxygen saturation （SvO2），arterial oxygen saturation（SaO2） and blood pH of blood samples from the arterial perfusion duct were monitored with different blood flow of400 ml/min，800 ml/min and 1 100 ml/min. Results When FiO2 was reduced to 21%，PaO2 decreased to 64-67 mm Hg（P＜0.001），SaO2 decreased significantly to 88%-90% （P＜0.001），SvO2 decreased to 69%-72% （P＜0.001），and blood pH decreased too，all indicating oxygenator failure. After parallel placement of another oxygenator in the recirculation line was performed，PaO2，SaO2 and SvO2 all significantly increased，as well as blood pH. When the blood flow in the recirculation line achieved 33% or above of overall arterial perfusion flow，clinical oxygen demand was generally satisfied. Conclusion Parallel placement of another oxygenator in the recirculation line may be utilized as a treatment strategy for oxygenator failure without circulatory arrest and changeover of failed oxygenator.
Objective To evaluate the effect of cardiopulmonary bypass （CPB） on pulmonary function in infants with variable pulmonary arterial pressure resulting from congenital ventricular septal defect （VSD）. Methods Twenty infants with VSD underwent corrective surgery were divided into pulmonary hypertension group （n= 10） and non-pulmonary hypertension group （n= 10） according to with pulmonary hypertension or not. Pulmonary function was measured before CPB , 3h,6h,9h,12h,15h,18h,21h, and 24h after CPB and duration for mechanical ventilation and cardiac intensive care unit stay were recorded. Results Pulmonary function parameters before CPB in nonpulmonary hypertension group were superior to those in pulmonary hypertension group （P〈0.01）, and pulmonary function parameters after CPB deteriorated than those before CPB （P〈0.05）, especially 9h,12h and 15h after CPB （P〈0.01）. Compared to pulmonary function parameters before CPB, pulmonary function parameters of pulmonary hypertension group at 3h after CPB were improved （P〉0.05）, but they deteriorated at 9h,12h and 15h after CPB （P〈0. 05）. Pulmonary function parameters at 21h and 24h after CPB was recoverd to those before CPB in two groups. Conclusions Although exposure to CPB affects pulmonary function after VSD repair in infants, the benefits of the surgical correction to patients with pulmonary hypertension outweigh the negative effects of CPB on pulmonary function. Improvement of cardiac function can avoid the nadir of pulmonary function decreasing. The infants with pulmonary hypertension will be weaned off from mechanical ventilator as soon as possible, if hemodynamics is stable, without the responsive pulmonary hypertension or pulmonary hypertension crisis after operation.
Abstract:Objective To evaluate the effects of modified uhrafihration （MUF）on blood rheology in infants after open cardiac surgery. Methods According to admission number, 22 infants of body weight less than 10 kilograms with ventricular septal defect （VSD） and pulmonary hypertension （PH） were divided into control group （10 infants, the mantissa of their admission number was odd number） and experimental group （12 infants, the mantissa of their admission number was even number）. Cases in control group didn＇t undergo MUF at the end of cardiopulmonary bypass （CPB）, while cases in experimental group underwent MUF; the flow rate of MUF ranged from 10 ml/min · kg to 15 ml/min · kg. MUF lasting for 10-15 minutes. Blood samples were repeatedly collected as following time： before operation, at the end of CPB, 15 minutes after CPB or the end of MUF, 2, 24 h after operation. Blood sample of 2. 5 ml was collected from the radial artery with hepathrom test-tube. The changes of relative indexes of the blood rheology were observed by MDK-3200 completely automatic dual pathways blood rheology testing analysator at 37±1 C. Results Hemoglobin, hematocrit, red cell count, blood yielding stress, plasma viscosity, the whole blood viscosity at high shear rate, the whole blood viscosity at middle shear rate and low shear rate, the whole blood reduction viscosity at high shear rate and middle shear rate, the whole blood reduction viscosity at low shear rate and Casson viscosity in experimental group at the end of MUF were significantly higher than those in control group at 15 minutes after CPB （P〈0. 05）. There was no significant difference in red cell aggregation index and red cell deformity between two groups at each moment （P 〉 0.05 ）. Conclusion Hemoglobin, hematocrit and red cell count are significantly elevated through MUF after CPB. Whole blood viscosity in infants undergone open cardiac surgery after CPB with MUF is higher than those who didn＇t undergo MUF.
Objective To investigate the role of endothelin（ET） in lung injury during cardiopulmonary bypass （CPB） and study the possible mechanism of ET-mediated lung injury and the protective effect of ferulic acid（FA） during the procedure. Methods Twelve dogs were randomly divided into 2 groups and models of CPB with pulmonary perfusion were established by perfusion of 4 C FA solution through proximal pulmonary artery in the experiment group while control group only received 4 C crystal cardiac arrest solution without pulmonary perfusion. Changes in the content of ET, NO, malonaldehyde （MDA）, dry to wet （D/W） in lung tissue and lung function- related indices PaO2/FiO2, airway pressure （AWP）, pulmonary vascular resistance （PVR）, lung compliance before and after CPB in both groups were measured respectively. Results ET content increased after CPB in control group （P〈0. 05） ,while experiment group had a lower level of ET than that of control group （P〈0.05）; D/W, MDA levels in experiment group decreased （P〈0. 05）, but NO content increased （P〈0. 05） as compared with control group. After pulmonary perfusion with FA, PaO2/FiO2 and lung compliance values in experiment group were higher than those of control group （P〈0.05）,AWP, PVR values lowered accordingly（P〈0. 05）. Lung injury was less severe in the experiment group. Conclusion ET is involved in pathogenesis of lung injury during CPB, FA can effectively reduce lung injury and improve lung function thus having a good protective effect on the lung.
Objective Summarize and review on surgical repair of congenital heart disease in infants. Methods Between January 1988 and June 2003, seven hundred and eighty seven less than 6 months of age patients were operated. There were 109 cases of complete transposition of the great arteries(D-TGA), 51 total abnormal pulmonary venous connection(TAPVC), 16 pulmonary atresia with ventricular septal defect(VSD), 33 coarctation of aorta, 299 VSD with pulmonary hypertention, 44 tetralogy of Fallot, 23 double outlet right ventricle, 9 pulmonary atresia with intact ventricle septum, et al. The operative procedure was dependent on different disease. Results There were 77 patients died, the total mortality was 9.78%(77/787). Following improvement of surgical procedure, the mortality was decreased from 25% in 1988-1995 to 4.11% in 2003. In the D-TGA patients, there was one residual VSD who was repaired 3 months late, and two had mild pulmonary and aortic supravalve obstruction. They were still be followed up. Two patients with intracardiac type of TAPVC had venous return obstruction, one was died and another was re-operated 4 days later. In the VSD patients, there were 5 patients with residural VSD, but all of them did not need to repair. Conclusion The time of surgical repair is very important, especially for complex congenital heart disease. The best operative procedure will be lost, if the infants is repaired too late, the postoperative events and mortality will be increased.