PubMed · 5065414
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C Hisatomi, Y Suzuki. 1972. [Simultaneous bilateral angiography].. https://pubmed.ncbi.nlm.nih.gov/5065414/
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We studied gut mucosal perfusion in 24 neonates requiring cardiopulmonary bypass (CPB). Group A patients (n = 12) had obstruction to their aorta such that gut perfusion before operation was dependent on flow through a ductus arteriosus (DA). Group B neonates were of similar age and size and required a similar duration of CPB, but did not have a DA. An orogastric tonometer allowed intermittent calculations of gastric intramucosal pH (pHi), and rectal mucosal perfusion ("flux") was monitored using laser Doppler flowmetry. Measurements of arterial base deficit, and lactate and pyruvate concentrations were made intermittently. Before CPB, mean femoral arterial pressure (MAP) and base deficit in group A were not significantly different from those in group B. However, mean flux before CPB was significantly lower and the lactate/pyruvate (L/P) ratio was significantly higher in group A compared with group B. Mean pHi was below normal (< 7.26) throughout the operative period in group A, although it remained normal (> 7.33) in group B. After corrective surgery, both during warm CPB and after CPB, we found no significant difference in MAP, L/P ratio or base deficit between the groups, but both flux and pHi were significantly lower in group A compared with group B. We conclude that neonates requiring aortic arch surgery may be at particular risk of gut mucosal hypoxia both before and after operation.
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Our surgical experiences in 9 patients who required steroid treatment for systemic diseases before, during and after the open heart surgery were reviewed. Subjects included 3 patients with systemic lupus erythematodes, 3 with aortitis syndrome, 1 with Behçet disease and 1 with rheumatoid arthritis. Cardiovascular lesion was aortic valve regurgitation in 2, Stanford A aortic dissection in 1 and ischemic heart disease in 3 patients. Duration of morbidity for systemic diseases before the surgery ranged between 0 nd 102 months, with a mean of 36 months. Steroid treatment was continued for 4 to 216 months (mean 70+/-76 months) before the surgery at a dose of 5-40 mg per day for conversion into prednisolone. In principal, methylprednisolone was given during the surgery, and the prednisolone was given at a dose of 20-140 mg per day on the day of operation or on the first postoperative day. Surgical procedures included a aortic valve prosthesis with Dacron cloth skirt implantation in 1 patient, surgical angioplasty of the left main coronary ostium in 1 and internal thoracic arteries grafting in 2 patients. Hospital mortality was 1 patient due to low cardiac output syndrome. Acute renal failure occurred in 2 patients with systemic lupus erythematodes, and wound complication was observed in 2 patients. In our experience, appropriate treatment for systemic diseases, timing of surgery and continuation of steroid treatment at an appropriate dose during and after the surgery seemed very important such as surgical procedure in order to prevent postoperative complications such as periprosthetic leakage and failure of anastomosis.