Biomedical subjects
Publications and source records attributed to K Inokawa.
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Surface induced deep hypothermia combined with cardiopulmonary bypass (combined method) is excellent in open heart surgery of infants which combines each advantage of cardiopulmonary bypass and hypothermia. The present study was performed to investigate pathophysiological changes, especially metabolic changes, in combined method induced by two stressors such as cardiopulmonary bypass and hypothermia. In general, metabolic changes during hypothermia are temporarily enhanced immediately after the start of cardiopulmonary bypass. Lactacidemia and metabolic acidosis are rapidly improved after the start of perfusion rewarming, but abnormality of ceruloplasmin and cholesterol metabolism in the liver and hypopotassemia are not rapidly improved. Therefore, the treatment for these metabolic abnormalities seems to be necessary during and after the procedure.
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In surface-induced deep hypothermia, metabolic acidosis resulting from lactacidemia was observed. In the hypothermic heart, the rate of reduction in the coronary arteriovenous (A-V) difference ratio of lactate, pyruvate, and nonesterified fatty acids (NEFA) was proportionately less than that of coronary flow and myocardial oxygen consumption, suggesting that lactate, pyruvate, and NEFA play important roles as energy fuels in the hypothermic heart. Myocardial metabolism of glucose was reduced; exogenous corticosteroids and ATP do not influence the myocardial metabolism of carbohydrates and lipids in the hypothermic heart.
Two hundred fifty patients more than 2 years of age having correction of congenital heart diseases by simple deep hypothermia alone were investigated in respect to metabolic abnormalities, post-operative complications, intellectual development and postoperative EEGs. LOS in lethal complications was attributed to the difficulty of resuscitation, indicating the application of this method is ideal for patients less than 6 years in age or less than 20 kg in weight. No impairment of intellectual development was observed when compared IQ before the operation and at the time of long term follow-up in serial study, but electroencephalographic assessment indicated that postoperative abnormalities might occur more frequently than previously suspected. Conclusively, it would appear that hypothermic intracardiac surgery is a safe method, provided circulatory arrest time is not allowed to exceed a limited period and the procedure is reasonably performed having a good understanding in the pathophysiology of hypothermia.