PubMed Health⌕ Search
Home/Archive/PubMed

PubMed · 7970561

Postpump retinopathy.

S E Marren
View original source ↗Export metadata ↓

Abstract

Postpump syndrome is a systemic manifestation which occurs somewhat frequently after cardiac surgery when cardiopulmonary bypass (CPB) is used. It is probably caused by platelet injury secondary to plasma contact with the CPB machinery. Damaged platelets aggregate and result in small emboli which course throughout the body, causing short-lived infarcts in the smaller blood vessels in multiple organs including the eyes where the result is retinopathy. Postpump syndrome is well documented in the cardiovascular literature but not in the ophthalmologic literature. We report a case of postpump syndrome retinopathy seen in a 56-year-old black male who had previously undergone valve replacement surgery for endocarditis. Follow-up revealed a postoperative embolus which necessitated further evaluation by the cardiologist and cooperative care with the optometrist/ophthalmologist team at The Eye Institute. Sequential photographs document this retinopathy as well as the embolic complication.

Explore related subjects

Cardiopulmonary BypassEndocarditisFundus OculiHumansMaleMiddle AgedPostoperative ComplicationsRetinal DiseasesRetinal VesselsSyndromeCase ReportsJournal Article

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

S E Marren. 1994. Postpump retinopathy.. https://doi.org/10.1097/00006324-199407000-00006

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

PubMed1997

Intraoperative ultrasonographic troubleshooting after the arterial switch operation.

BACKGROUND: Less than perfect coronary artery translocation accounts for the majority of perioperative deaths after the arterial switch procedure for transposition of the great arteries. Some types of coronary arterial anatomy are associated with a higher risk of death. METHODS: Prospective epicardial ultrasound examination of all neonates with failing left ventricle or difficulty in weaning off cardiopulmonary bypass was performed after completion of the arterial switch operation during a 2-year period from March 1994 to February 1996. The aim was to identify any mechanical, and potentially remediable, factors accounting for ventricular failure. RESULTS: Four neonates fulfilling the above criteria were identified during a 2-year period when epicardial echocardiography was routinely applied. In 2 patients coronary arterial problems in the form of kinking of the proximal left coronary artery (1 patient) and extrinsic compression of the artery by the neo-pulmonary trunk (1 patient) were identified and successfully corrected. In 2 other patients, supravalvar aortic stenosis was recognized, leading to prompt revision. CONCLUSIONS: Epicardial echocardiography has an important "troubleshooting" role in the subgroup of patients with a suboptimal hemodynamic result after the arterial switch operation. Patients with unusual coronary anatomy should routinely be candidates for such studies.

Cardiopulmonary Bypass↗
PubMed1997

Hemofiltration during cardiopulmonary bypass: the effect on anti-Xa and anti-IIa heparin activity.

Previous studies have demonstrated that heparin concentrations during cardiopulmonary bypass (CPB) may vary considerably, which may be related to variability in redistribution, cellular and plasma protein binding, and clearance of heparin. The purpose of this study was to determine whether hemofiltration removes lower molecular weight fractions of heparin from plasma and thus contributes to variability of blood levels of heparin. Twenty patients undergoing cardiac surgery with CPB were enrolled in this study after informed consent was obtained. The study was subdivided into two phases. The first 10 patients were enrolled in Phase I, which was designed to determine whether hemofiltration removes lower molecular weight fractions of heparin from blood. Blood specimens obtained from the inflow line and outflow lines of the hemofiltration unit were used to measure complete blood counts (CBC) and plasma heparin activity by anti-Xa and anti-IIa assays. Phase II was designed to evaluate the effect of hemofiltration on circulating plasma heparin activity. In Phase II, blood specimens were obtained from 10 patients via the arterial cannula of the extracorporeal circuit prior to and after hemofiltration for measurements of CBCs, anti-Xa plasma heparin, as well as whole blood heparin concentration using an automated protamine titration assay (Hepcon instrument, Medtronic Inc., Parker, CO). Ultrafiltrate and reservoir volumes were measured in both phases of the study. Hemofiltration did not remove lower (anti-Xa measurable) molecular weight heparin, but it resulted in a considerable increase in heparin activity in the outflow line, as measured by both anti-Xa and anti-IIa assays. The plasma anti-Xa heparin activity obtained after hemofiltration (5 +/- 1.8 U/mL) was substantially (P = 0.003) greater than heparin activity obtained prior to hemofiltration (3.9 +/- 1.7 U/mL). The increase in heparin activity with hemofiltration was directly related to ultrafiltrate volume (r = 0.63, P < 0.0001) and hematocrit (r = 0.73, P < 0.0001). Hemofiltration increases heparin concentration and may contribute to variability in heparin activity during CPB. Point-of-care heparin concentration methods would allow identification of the anticipated rise in heparin concentration, with the apparent clinical implication of a reduced need for supplemental heparin to maintain a target whole blood heparin concentration.

Cardiopulmonary Bypass↗