Scandinavian journal of thoracic and cardiovascular surgery
-
Scand J Thorac Cardiovasc Surg · Jan 1981
Reduced lactate washout from the myocardium after combining St. Thomas I type cardioplegia with topical cooling of the heart. Myocardial oxygenation and performance after cardioplegia in coronary artery bypass grafting patients.
The myocardial oxygen extraction was diminished with a resulting coronary sinus blood oxygen saturation of 48 +/- 5 (SEM) %, as compared to the pre-bypass control level of 30 +/- 1%, two minutes after the ischaemic period in St. Thomas I type cardioplegia (CPL) with topical cooling of the heart during a coronary bypass operation. The myocardial oxygen extraction returned to prebypass levels after ten minutes of reperfusion following ischaemia and remained so after the bypass. ⋯ The greatest arterial-coronary sinus lactate difference in the IITC-group was -1.7 +/- 0.2 mmol/l and in the CPL-group -0.7 +/- 0.2 mmol/l. Cardiac performance (assessed by the CI-PCWP relationship) which was moderately depressed by the anaesthesia and surgery before bypass, returned gradually to the control level within 20 hours after operation. The present study shows that no apparent postischaemic abnormality in myocardial oxygen utilization develops when single dose cardioplegia, together with topical cooling of the heart, is used for myocardial protection, and that the accumulation of myocardial lactate during ischaemia is less during cardioplegia with topical cooling of the heart than during intermittent ischaemic with topical cooling for coronary artery bypass grafting operations.
-
Scand J Thorac Cardiovasc Surg · Jan 1981
Pulmonary oxygenation, central haemodynamics and glomerular filtration following cardiopulmonary bypass with colloid or non-colloid priming solution.
Plasma colloid osmotic pressure (COP), blood erythrocyte volume fraction (B-EVF), arterial oxygen tension at an inspired oxygen concentration of 30% (PaO2 (FIO2 0.3)), cardiac index, stroke volume, arterial mean pressure, left atrial mean pressure, pulmonary av-difference of oxygen (Ca-v O2) and creatinine clearance were studied in 16 patients during isolated aortic valve replacement. The patients were divided into two groups with different priming solutions in the oxygenator. In the non-colloid group 2,000 ml of Ringerdex was used, while the colloid group had 1,600 ml of Ringerdex and 400 ml of albumin 20% (80 g). ⋯ Cardiopulmonary bypass produced no changes in cardiac index, stroke volume, arterial mean pressure, left atrial mean pressure, Ca-v O2 or creatinine clearance in either of the groups. PaO2 (FIO2 0.3) remained unchanged in the non-colloid group and showed a small but significant reduction (p less than 0.01) in the colloid group. No positive effects of a colloid prime were demonstrated.
-
An analysis of 337 wilfully inflicted penetrating thoracic injuries is made. In 22 cases thoracotomy was performed; in 19 cases laparotomy was indicated, ten times for direct trauma and nine times for lesions caused by abdominal stabbing in addition to penetrating thoracic injuries. Eight patients died, one of whom was not operated on. A necrology is presented and it is also concluded from the recent literature that a more aggressive approach, e.g. immediate operation, is indicated for serious penetrating thoracic trauma.