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Biomedical subjects

C Olin

Publications and source records attributed to C Olin.

At least 55 records · Page 3Linked to original sources
PubMed1982

Myocardial and non-myocardial release of myoglobin and creatine-kinase MB following cardiac operations with hypothermic potassium cardioplegia.

Serum time-activity curves for myoglobin, creatine-kinase (CK) and its isoenzyme MB were determined during and after coronary bypass surgery and aortic valve replacement. Hypothermic potassium cardioplegia was the method employed to initiate cardiac arrest. Cardiac myoglobin and CK-MB release rates were maximal 0.5 to 1.0 h post aortic cross-clamp release (PACR) with maximal concentrations at 1 and 4 h PACR respectively. The cardiac release ceased within 5 h PACR but was followed by a noncardiac release with maximal concentrations from 10 to 35 h PACR. The cardiac myoglobin release was significantly lower in the coronary bypass group, whereas no significant intergroup difference was observed for CK-MB. The cumulative CK-MB release corresponded roughly to about 5 g of myocardium.

Aortic Valve↗
PubMed1982

Reconstruction of the right ventricular outflow tract in patients with tetralogy of Fallot: early and late results.

Total correction of tetralogy of Fallot was performed on 161 consecutive patients between 1966 and 1979. Forty-four per cent had undergone a previous palliative operation. A right ventricular outflow patch was used in 58% of the patients. In about half of these cases, the patch extended across the pulmonary annulus onto the main pulmonary artery and in five per cent it extended beyond the pulmonary bifurcation. The overall operative mortality was 13%, for patients less than three years of age it was 38% and for patients three years and older 11%. Operative mortality was chiefly related to an unrelieved right ventricular hypertension. The use of an outflow patch did not influence the operative mortality. Eight survivors (6%) were re-operated upon, six due to residual outflow obstruction, one due to residual ventricular septal defect and in one patient re-operation was indicated because of neo-intimal thickening in a tubular dacron graft. Inadequate infundibulectomy (one patient), narrow pulmonary annulus (two patients), calcified valve remnants (two patients) and a ridge in the posterior wall of the main pulmonary artery (two patients, one of whom underwent two re-operations) were the anatomical bases for the obstructions. It is concluded that at total correction of tetralogy of Fallot every effort should be made to relieve the right ventricular outflow obstruction, even if the pulmonary valves have to be sacrificed. If the pulmonary artery is hypoplastic or has localized stenosis, the pulmonary annulus should be incised and an outflow patch carried all the way to the pulmonary artery branches.

Adolescent↗
PubMed1982

Septicaemia and endocarditis--uncommon but serious complications in connection with permanent cardiac pacing.

Between 1971 and 1978 septicaemia was observed in 14 patients undergoing permanent pacemaker treatment. The causative microorganisms were: S. aureus (9), S. epidermidis (3), alfa-haemolytic streptococci + P. morganii (1), enterococci (1). In 4 patients, a mural endocarditis of the right atrial wall surrounding the electrode was found at operation or autopsy. The interval between the preceding pacemaker operation and onset of septicaemia varied between 2 days and 23 months (median 2 months). In 5 patients, the last operation before septicaemia was performed because of local infection in the pacemaker pocket or along the electrode. A probable portal of entry was found in 11 patients. The electrode was the origin in 8, the pacemaker pocket in one, and a focus outside the pacemaker system in 2. Of the 6 patients treated with antibiotics alone, 3 were cured, 2 died and one is still on treatment. Eight patients underwent various surgical procedures in addition to the antibiotic treatment. In 4 the electrode was completely removed. In 2 of them cardiotomy during extracorporeal circulation had to be used. All of these patients were cured. In 3 the pacemaker system was partially extracted. Only one of them was cured, one developed osteomyelitis and one died. Based on our experience, we now recommend that all foreign material should be removed, if possible, in the presence of septicaemia and/or endocarditis, and that parenteral antibiotic treatment should be given for at least 6 weeks.

Aged↗
PubMed1981

Pulmonary formation of prostacyclin in man.

The pulmonary formation of prostacyclin (PGI2), as reflected by the difference in concentration of pulmonary and systemic arterial radioimmunoassayed 6-keto-PGF1 alpha, was determined in six healthy waking subjects. The systemic arterial 6-keto-PGF1 alpha levels were low (less than or equal to 50 pg/ml), and no evidence of pulmonary formation and release of the compound was noted. In other experiments systemic arterial 6-keto-PGF1 alpha levels were determined in patients prior to and during artificial ventilation, as well as during and after occlusion of the pulmonary circulation (extra-corporeal circulation, ECC). The arterial 6-keto-PGF1 alpha concentration prior to artificial ventilation was 17 +/- 4 pg/ml, i.e. within the range observed in the healthy subjects. During artificial ventilation the arterial levels of 6-keto-PGF1 alpha increased to 191 +/- 21 pg/ml, suggesting that pulmonary formation of PGI2 was stimulated. In the patients subjected to ECC with occluded pulmonary circulation the arterial content of 6-keto-PGF1 alpha was stabilised at an elevated level (120-170 pg/ml). Following re-establishment of the pulmonary circulation the arterial concentrations of 6-keto-PGF1 alpha increased markedly, to 284 +/- 50 pg/ml. It is suggested that the basal pulmonary formation of PGI2 in man is low or non-existent, and that enhanced formation of the compound in the lungs is a consequence of intervention with normal pulmonary ventilation of perfusion.

6-Ketoprostaglandin F1 alpha↗
PubMed1981

Myocardial protection during aortic valve replacement. effects of mannitol in the cardioplegic solution on cardiac metabolism and enzyme release.

Myocardial substrate metabolism and enzyme release following hypothermic potassium cardioplegia with and without the addition of mannitol in the cardioplegic solution were studied in two series of patients undergoing isolated aortic valve replacement. Measurements were made of PO2. O2-saturation and content, PCO2, pH, glucose, lactate, pyruvate, potassium, myoglobin, creatine kinase (CK), its isoenzyme MB and aspartate aminotransferase (ASAT) simultaneously in arterial and coronary sinus blood before cardioplegia and during the first 60 min after the release of aortic cross-clamping. In addition, myoglobin and enzymes were followed in peripheral venous blood for 72 hours after cardioplegia. Analysis of the results revealed no striking difference between the groups. Nevertheless, with the addition of mannitol, there was a slightly lower release of lactate and myoglobin probably indicating a more rapid metabolic recovery of the myocardium.

Aortic Valve↗
PubMed1981

Myocardial protection during aortic valve replacement. Comparison between sanguineous and Asanguineous Cardioplegic Solutions.

Myocardial substrate metabolism and enzyme release following hypothermic potassium cardioplegia were studied in two series of patients undergoing isolated aortic valve replacement. In 15 patients blood was used as cardioplegia vehicle (blood cardioplegia group) and a plain electrolyte solution was used in a control group of 17 patients. Simultaneous blood samples were drawn from arterial and coronary sinus blood before and during the first 60 min after release of aortic cross-clamping. Blood samples were analyzed for PO2. O2-saturation and content, PCO2, pH, lactate, pyruvate, glucose, potassium, myoglobin, creatine kinase (CK), its isoenzyme MB and aspartate aminotransferase (ASAT). In addition, myoglobin and enzymes were followed in peripheral venous blood for 48 hours. The pattern of metabolic changes after cardioplegia was similar in both groups, but some differences were encountered in the degree of the changes in potassium, myoglobin and CK-MB between the groups. The differences were nevertheless small and cell damage was probably of reversible nature in all patients, but the myocardial protection afforded by single dose blood cardioplegia was not unquestionably better than that of the control group.

Aortic Valve↗
PubMed1981

Myocardial protection during aortic valve replacement. Cardiac metabolism and enzyme release following continuous blood cardioplegia.

Cardiac metabolism following hypothermic potassium cardioplegia with blood as cardioplegia vehicle was studied in two groups of patients undergoing aortic valve replacement. In 15 patients, blood was given as single dose infusion (single dose group) and in 18 patients the same initial bolus was followed by a continuous perfusion (25-30 ml/min) with modified blood from the heart-lung machine (continuous blood group). Simultaneous samples were drawn from arterial and coronary sinus blood before and during the first 60 min after cardioplegia. In the continuous blood group, samples were also drawn during the period of cardioplegic perfusion. The samples were analyzed for PO 2, O2-saturation and content, PCO2, pH, lactate, pyruvate, glucose, potassium, myoglobin, creatine kinase (CK), its isoenzyme MB, and aspartate aminotransferase (ASAT). In addition myoglobin and enzymes were followed in peripheral venous blood for 24 hours. Myocardial biopsies were taken from the left ventricle at the beginning and end of cardioplegia and analyzed for adenosine triphosphate (ATP), creatine (C) and creatinephosphate (CP). The pattern of metabolic changes after cardioplegia was similar in both groups with decreased myocardial oxygen extraction, marked lactate and potassium release, increased glucose uptake and significant enzyme and myoglobin release. However, the degree of changes was significantly smaller in the continuous blood group. The myocardial biopsies also showed significantly less ATP and CP decrease in the continuous blood group, suggesting, together with the other metabolic results, that the myocardial protection afforded by continuous blood cardioplegia was superior to that of the single dose group. Furthermore, continuous perfusion permitted easy control of myocardial temperature during the period of aortic cross-clamping.

Aortic Valve↗
PubMed1980

Myocardial protection during aortic valve replacement. Cardiac metabolism and enzyme release following hypothermic cardioplegia.

Cardiac metabolism following hypothermic potassium cardioplegia was studied in 23 patients undergoing isolated aortic valve replacement. All had normal coronary arteries. Cardioplegia was induced by infusing 700-1 000 ml of cold Ringer's acetate containing 20 mekv K+ selectively into the left coronary artery. Simultaneous blood samples were taken from the radial artery, a central vein and from the coronary sinus before and after cardioplegia. The PO2, O2-saturation and content, PCO2, pH, lactate, glucose, potassium, myoglobin, total creatine kinase (CK), its isoenzyme CK-MB, aspartate aminotransferase (ASAT) and alanine aminotransferase (ALAT) were assessed. Before bypass lactate was extracted by the heart. During the initial 10 to 20 min after cardioplegia there was a marked release of lactate in the coronary sinus. Myoglobin concentration and CK-MB serum activity peaked during the first 4 hours after the release of the aortic cross-clamping. In order to determine the best indicator of myocardial damage after cardioplegia, duration of extracorporeal circulation (ECC-time), aortic occlusion time (AOT), mean myocardial temperature (MMT) and the product of AOT and MMT, referred to as time-temperature area (TTA), were related to possible indicators of myocardial injury, such as enzyme and myoglobin release. The TTA was the best way of expressing the degree of exposure of the heart to ischaemia. The CK-MB to peak area (CK-MB max area) was the best indicator of the degree of ischaemic injury sustained by the heart during operation.

Aortic Valve↗
PubMed1980

CK-MB in serum and in heart and skeletal muscles in patients subjected to mitral valve replacement.

Serum catalytic concentrations of total creatine kinase (CK) and its more heart-specific isoenzyme CK-MB were studied in 25 consecutive patients subjected to isolated mitral valve replacement (Björk--Shiley prosthesis). Heart and skeletal muscle CK and CK-MB content was determined in 10 cases. The postoperative serum levels did not reflect differences in myocardial CK-MB content between patients. CK-MB as a percentage of total CK at peak serum CK-MB (16 +/- 1%) (mean +/- SEM) was of similar order as the percentage of CK-MB in the myocardium (papillary muscle 20.9 +/- 1.3%, right auricle 18.2 +/- 0.5%). A small proportion of CK-MB was present in all skeletal muscle samples examined (diaphragm 4.2 +/- 0.6%, rectus abdominis 0.4 +/- 0.1%), indicating that the total CK level should also be taken into account in attempts to determine the origin of a raised postoperative serum CK-MB activity. The degree of postoperative CK-MB elevation was related to the duration of operation and of aortic cross-clamping. Perioperative myocardial infarction occurred in one patient, and serum CK-MB kinetics in this patient, with a biphasic enzyme curve, differed from those in the other patients.

Adult↗
PubMed1979

Massive embolization of cardiac myxoma. A case report.

A case of left atrial myxoma with massive embolization in a 20-year-old woman is described. The initial clinical picture was confusing, but repeated examinations, including enzyme determinations and arteriographies, disclosed the presence of multiple arterial emboli. At embolectomy, histological investigation of embolic masses showed a picture indicating cardiac myxoma. This diagnosis was confirmed by pulmonary angiography and the tumour was removed. Postischaemic oedema of the legs necessitated decompression operations. The peripheral circulation was restored and the final result was excellent. Some aspects of the clinical presentation of this uncommon disease are discussed.

Adult↗
PubMed1979

Myocardial protection during aortic valve replacement. Selective infusion of cold cardioplegic solution into the left coronary artery.

A simple method for hypothermic cardioplegia during aortic valve surgery is described. Cold cardioplegic solution (Ringer's acetate with 16 mEq potassium added) was selectively infused into the left coronary artery after the aorta had been opened. This resulted in an even cooling of the left ventricle with a relatively small amount of cardioplegic solution. Local cooling with "soft ice" was then initiated and the heart isolated from its warmer surroundings with the aid of a specially designed pad of compressed plastic foam. Thus, the left ventricular temperature could be kept below 20 degrees C for more than one hour. One hundred and three (103) patients were operated on with this method during a one-year-period. Only one patient died (1%). There were few early and/or late complications. Postoperative heart function was excellent in 23 patients subjected to a special study. Peak aortic pressure during the first 16 postoperative hours was 130 (+/- 22) mmHg, mean left atrial pressure 12 (+/- 2) mmHg, mean right atrial pressure 10 (+/- 2) mmHg and all patients were in sinus rhythm. There was a brief and limited release of myocardial enzymes postoperatively, indicating slight intra-operative myocardial damage. Apart from the cardioplegic technique, there are certain factors of importance for the efficacy of myocardial protection during aortic valve replacement. Among them may be mentioned avoidance of ventricular fibrillation, gentle reperfusion after release of the aortic cross-clamping, avoidance of left ventricular distension and administration of calcium intravenously before termination of bypass.

Adult↗
PubMed1979

Serum enzymes with special reference to CK-MB following coronary bypass surgery.

In a consecutive series of 25 coronary bypass operations, the postoperative serum activity levels of total creatine kinase (CK) and its more heart-specific isoenzyme CK-MB were examined and related to the levels of aspartate aminotransferase (ASAT), alanine aminotransferase (ALAT) and thermostable lactate dehydrogenase (LD-T), to electrocardiographic (ECG) findings and to surgical characteristics. Detectable CK-MB activity was found in all patients, usually appearing while the operation was still in progress. Peak CK-MB occurred earlier than peak total CK. There was no ECG evidence of myocardial infarction in any patient. The degree of postoperative CK-MB elevation, however, correlated to the duration of extracorporeal circulation (ECC) and aortic cross-clamping (AC). After 120 min of ECC and 70 min of AC, release of CK-MB, as well as of the other enzymes studied, increased considerably. There was a significant correlation between high CK-MB activity and high early postoperative activities of total CK, ASAT and LD-T. When CK-MB determinations are not available, ASAT is preferable to total CK or LD-T in the early evaluation of operative myocardial injury. From the fourth postoperative day, only LD-T is informative in this respect; a second rise of ASAT and ALAT is probably of hepatic origin.

Adult↗
PubMed1978

Myocardial protection during aortic valve replacement. Physiological and metabolic effects of selective coronary perfusion on the fibrillating heart.

The physiological effects and certain aspects of cardiac metabolism were studied in 14 patients undergoing primary aortic valve replacement. The operations were performed under moderate hypothermia (30 degrees +/- 2 degrees C) and blood for coronary perfusion was taken from a sidebranch of the arterial line. The majority of the hearts went spontaneously into ventricular fibrillation at some stage of the operation. In spite of the high resistance measured in the coronary perfusion cannulae, an intraluminar coronary blood flow of 380 ml/min was recorded. The myocardial oxygen uptake decreased to 6.0 ml/min at 29 degrees C compared with 20.0 ml/min at 36 degrees C. The elevated coronary sinus lactate throughout the period of coronary perfusion and the increasing level of ASAT-enzyme indicated that this technique could not fully protect the myocardium from ischaemic changes. One patient died of myocardial infarction and two others needed vasopressor support postoperatively, in spite of documented effective coronary perfusion throughout the procedure. Cannulation of the coronary sinus is a valuable adjunct for the study of cardiac metabolism during ECC and it was accomplished without complications.

Adult↗