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At least 505 records · Page 28Linked to original sources
PubMed1991

[Closure of patent ductus arteriosus under extracorporeal circulation through pulmonary arteriotomy].

Twenty-nine patients underwent closure of patent ductus arteriosus (PDA) via pulmonary arteriotomy under low-flow extracorporeal circulation combined with profound hypothermia. No complications from air embolism or hemorrhage were encountered during the operation. The early and late results were satisfactory. This technique was used as a safe method for PDA complicated by severe pulmonary hypertension, infective endocarditis, recurrence of ductal patency and for PDA in adults or coexistence of intracardiac anomaly.

Adolescent↗
PubMed1992

Microcomputer-based automatic regulation of extracorporeal circulation: a trial for the application of fuzzy inference.

Since its establishment many researchers have been trying to automate the process of extracorporeal circulation (ECC). We developed a preliminary experimental model of an automatic regulatory system for ECC. The purpose of the system was to regulate basic hemodynamic parameters such as pump flow and withdrawal blood volume. It was divided into three main components: data sampling unit, central processing unit, and controlling unit. Based on this model we were able to achieve autoregulation of ECC using minimum configuration; however, the system lacked smoothness. This was partly because it was based on a "static" regulation system which used conditional statements having multiple parameters. In this study, we applied fuzzy logic to the former model to achieve more accurate and reliable regulation. We report experimental results for the new system and compare the data between clinical circulation in 13 infants (mean body weight, 13.32 +/- 5.99 kg) and experimental regulation in 7 mongrel dogs (mean body weight, 11.9 +/- 2.53 kg). The comparative study revealed no statistical difference between the two groups. This result suggests that the automatic regulation of ECC may be an alternative to manual operation by a professional perfusionist in the near future.

Animals↗
PubMed1989

Deleterious effects of complement activation on the lungs during extracorporeal circulation and its inhibition by FUT-175.

The purpose of this paper is to review the deleterious effects of complement activation during extracorporeal circulation on the lungs and to discuss the feasibility of FUT-175, a new synthetic protease inhibitor, as a complement activation inhibitor. Complement activation causes leukocyte aggregation and aggregated leukocytes behave as microemboli in the pulmonary vessels. Anaphylatoxins produced by complement activation have potent vasoactive properties and many chemical mediators are also released from leukocytes. FUT-175 might be effective to inhibit complement activation during cardiopulmonary bypass (CPB). Although deleterious effects of CPB on the lungs are multifactorial, we hypothesize that complement activation may play a major role in lung injury during CPB.

Animals↗
PubMed1981

Effect of PGI2 infusion during long term extracorporeal circulation with membrane lung in sheep.

PGI2 plus very low dose of heparin was infused in 6 lambs connected for long term extracorporeal circulation with a membrane lung. Hemodynamic and hemostasis parameters were compared to those of a control group treated only with standard doses of heparin. PGI2 efficacy in inhibiting platelet aggregation and platelet fall was confirmed. A small platelet release, measured as antiheparin activity, was observed during all the by-pass, but did not influence platelet capacity of recovering when PGI2 effect dissolved. Heparin needed resulted less than a quarter of the quantity used for the control group. In our experimental conditions the hemodynamic changes were mainly limited to a decrease in diastolic blood pressure.

Animals↗
PubMed1995

Extracorporeal circulation with autogenous oxygenation: hemodynamic and gasometric parameters.

Ten experimental perfusions with autogenous oxygenation were performed in mongrel dogs to evaluate the efficacy of the procedure in maintaining normal hemodynamic the efficacy of the procedure in maintaining normal hemodynamic conditions and adequate blood gases for 1 h. Blood was drained from the right and left atria and pumped to the pulmonary artery and aorta, respectively. Two closed circuits containing compliant chambers and roller pumps were utilized. Artificial ventilation with an FiO2 of 50% were used in 5 animals and with an FiO2 level of 30% in the other 5. EKG, cardiac output, aortic, pulmonary artery, and left atrium pressures were registered. Pulmonary tissue was biopsied after perfusion. The heart was electrically fibrillated after perfusion was established and defibrillated at the end of the bypass. The procedure was able to maintain blood gases and pulmonary, aortic, and left atrial pressures within normal ranges during the perfusion. The mobility of the heart and the access to all coronary arteries was excellent. Clinical central nervous system evaluation, EKG tracings, and pulmonary histological exams showed no adverse effects of perfusion. We conclude that the technique employed may present a suitable proceeding for extracorporeal circulation in closed heart surgeries, and its clinical application should be evaluated as a safe and economical alternative.

Animals↗
PubMed1989

[Surgical treatment of chronic pulmonary embolism using thromboembolectomy under extracorporeal circulation and deep hypothermia--a new approach route. 3 cases].

The authors, who have successfully performed thrombectomy of the pulmonary artery under extracorporeal circulation and deep hypothermia in three patients, wish to draw attention to the principal factors of success. The decision to operate, as accepted by most surgeons, rests on the patient's functional status (stage III or IV) and on the presence of a systolic pulmonary arterial pressure exceeding 50 mmHg. Deep hypothermia combined with circulatory arrest seems to be the best method, as it improves visual control, thereby avoiding damage to the endothelium or fracture of the distal thrombi during thrombectomy. Finally, a new approach route (severing of the superior pulmonary vein, opening of the pulmonary artery and use of Volmar-Sisteron strippers) makes it possible to remove the entire thrombus, thus obtaining an almost normal pressure in the pulmonary artery. In all three patients, the complications that are mostly due to intrabronchial haemorrhage by disruption of the endothelium, fracture of the distal thrombus or pulmonary artery contusion were avoided.

Adult↗
PubMed1995

[Hemostatic mechanism associated with aprotinin during and after the extracorporeal circulation for cardiac and great vessel surgery].

It has been reported that aprotinin (apr) is effective for hemostasis during and after the extracorporeal circulation (ECC) for cardiac or great vessel surgery. However its mechanism remains still obscure. In this study, we observed relationships between changes in interleukin-8 (IL-8), endothelial factors, or D-dimer and aprotinin administered before and after the ECC. Fourteen patients in whom cardiac or great vessel surgery was done using ECC were divided randomly into two groups. Seven subjects in Group I (G-I) were infused 10(6) KIU of apr immediately after anesthesia, immediately before and after the ECC, respectively, and 10(6) KIU of apr were also added during the ECC. Seven other subjects (G-II) were infused 10(6) KIU of apr immediately before and at three hours after the ECC, and also 2 x 10(6) KIU of apr immediately after the ECC. No marked hemorrhagic tendency was noted in all subjects and increase in plasma D-dimer was not marked. Immediately after the ECC, granulocyte elastase in plasma increased markedly in both groups but subsequently decreased in the G-II alone while it remained unchanged in the G-I. Similar changes were observed in plasma IL-8 values. During the ECC, intercellular adhesion molecule-1 in plasma decreased in both groups but von Willebrand factor activity decreased in the G-I alone. From the above data, the hemostatic effect of apr may contribute to protect the dysfunction of endothelial cells or to enhance recovering from the dysfunction during the ECC.

Aged↗
PubMed1991

[New dosage of heparin during cardiac surgery with extracorporeal circulation].

We studied the effect of 4 mg/kg of heparine, measured with the activity cosgulation time (hemocron), in cardiac surgical patients operated with extracorporeal circulation. The basal TCA was 118 +/- 13 seg with this doses of heparine. The majority of the patients (83.33%) with 4 mg/kg of heparine had more than 450 seg in comparison with the number of patients (30%) who had more than 450 seg with 3 mg/kg of heparine.

Adult↗
PubMed1992

[Antibacterial prophylaxis in heart surgery interventions with extracorporeal circulation].

Clinico-laboratory studies were conducted in 30 patients who underwent operations for heart diseases and thromboembolism of the pulmonary artery under extracorporeal circulation. Gentamicin and tobramycin were used for antibacterial prophylaxis. Study of the pharmacokinetics of the agents disclosed essential changes of the distribution volume and clearance of the antibiotics in the patients of the studied group, which made the routine regimen of their administration modified. Analysis of the results of administration of the agents according to a modulatory regimen showed its high prophylactic efficacy in the absence of side effects.

Adolescent↗
PubMed1984

The value of activated coagulation time in monitoring heparin therapy during extracorporeal circulation.

The anticoagulant effect of heparin was studied in 20 patients undergoing aortocoronary bypass surgery. The protamine dose necessary to reverse heparin after extracorporeal circulation (ECC) was assessed in ten patients from individual heparin dose-response curves (HDR group). The other ten patients received protamine according to a routine protocol (control group). The protamine administration was followed in both groups by injection of 3-5 g tranexamic acid (Cyklokapron). A wide range of sensitivity to heparin was shown by the patients. Although almost twice as much protamine was given to the control group as to the HDR group, the effect on heparin reversal was similar. The variability of protamine dose did not influence the post-bypass levels of fibrinogen, AT-III, activated coagulation time (ACT) or Cephotest, and fibrinolysis was not observed in either of the groups. During ECC there was poor correlation between ACT and plasma heparin levels, and the use of heparin dose-response curves was grossly misleading in regard to true heparin concentration. The postoperative bleeding was not related to the levels of heparin or coagulation parameters after heparin reversal. The concentrations of fibrinogen and AT-III showed variations dependent on the changes in haematocrit. A number of factors other than heparin that influence ACT are discussed.

Aged↗
PubMed2004

Early experience with the minimal extracorporeal circulation system (MECC) during thoracoabdominal aortic aneurysm repair.

AIM: The purpose of this report is to describe our early experience with a minimal extracorporeal circulation system (MECC), a compact closed heparin coated system consisting of a centrifugal pump and a membrane oxygenator, during thoracoabdominal aortic aneurysm (TAAA) repair. METHODS: Between January and December 2002 the MECC system was employed in seven consecutive patients (four TAAA type II, two TAAA type I and one TAAA type III according to the Crawford classification). In all patients distal aortic, selective renal and visceral perfusion was performed with this compact closed heparin coated system consisting of a centrifugal pump and a membrane oxygenator. RESULTS: The MECC system was used in all cases with no technical malfunctions. Six out seven patients were discharged from the unit. One patient developed paraplegia after TAAA repair and died on the third post-operative day from multi-organ failure. In this case the total spinal ischaemic time was 120 min and the distal aortic perfusion pressure was <50 mmHg. No cardiac, cerebral, renal, hepatic or bleeding complications were recorded in the remaining six patients. CONCLUSION: Our early experience with MECC during TAAA repair showed that it is feasible for distal aortic spinal and visceral selective perfusion. Further large clinical trials are required to determine the efficacy of this technique.

Aged↗
PubMed1987

Erythrocyte crenation induced by free fatty acids in patients undergoing extracorporeal circulation.

Normal erythrocyte morphology is necessary for proper distribution of blood-flow in the microcirculation. Erythrocyte shape was studied in 20 patients undergoing extracorporeal circulation (EC) during coronary bypass surgery. Crenated erythrocytes comprised a mean 64% of all erythrocytes during and 29% after EC. Free fatty acid (FFA) content of the erythrocyte membranes was significantly increased at both times, and FFA content correlated with the proportion of crenated erythrocytes. Washing crenated cells with defatted albumin solution transformed them back to discocytes, simultaneously removing more FFA than that removed from pre-EC discocytes. The plasma FFA to albumin ratio became disproportionately increased during EC; the increased level correlated with severity of erythrocyte crenation. Maintaining a higher level of albumin during EC by adding 50 g human albumin to the extracorporeal system prevented erythrocyte crenation. Entry of plasma FFA not bound to albumin into erythrocyte membranes during EC causes massive erythrocyte crenation.

Adult↗
PubMed1983

Phospholipase A activation following extracorporeal circulation and its blockade by procaine.

The phospholipase A activity of human plasma was investigated in the course of operations with the aid of extracorporeal circulation. After an initial increase following heparin application, there is a continuous rise up to the end of perfusion and a decrease to normal values 30 minutes after the end of perfusion and the application of protamine. Procaine is suitable for the inhibition of the increased phospholipase A activity. In accordance with in vitro determinations of an effective dose of 1 mmol/ml, corresponding concentrations were attained with an infusion rate of 1.5-2 mg/kg/min. In a second series of investigations, a significantly smaller phospholipase A activation in the course of perfusion was detectable through the addition of procaine.

Coronary Artery Bypass↗
PubMed1995

Use of thoracoscopy and a minimal thoracotomy, in mammary-coronary bypass to left anterior descending artery, without extracorporeal circulation. Experience in 2 cases.

A new surgical approach to mammary-coronary bypasses, to the left anterior descending artery, without the use of extracorporeal circulation, is described here. A minimal left anterior thoracotomy and the use of thoracoscopy are combined in this procedure performed in two patients (54-year-old male and 56-year-old male). Results were excellent: both patients were soon discharged from hospital (3 days patient 1 and 36 hours patient 2). Neither blood nor inotropic drugs were required. New angiographies previous to discharge were done, showing 100% patency of the mammary grafts. Both patients are angina-free. Due to its simplicity, and with more experience, this technique could be a good alternative for patients with severe lesions of the left anterior descending artery.

Extracorporeal Circulation↗
PubMed1979

Prostacyclin: a solution to some problems of extracorporeal circulation. Experiments in greyhounds.

In cardiopulmonary-bypass experiments in greyhounds the effects of adding prostacyclin, prostacyclin plus heparin, and heparin alone to the extracorporeal circulation were compared. With heparin alone platelet count and function were reduced, the pressure differential across the arterial filters rose, platelet deposits were found on the arterial filters, and plasma-fibrinogen levels fell. Plasma from these dogs was toxic to fetal-mouse hearts in culture. With prostacyclin alone, fibrinogen levels fell, but the platelets were preserved. With a combination of prostacyclin and heparin, platelet count and function were maintained, there was no consumption of fibrinogen, and there was little deposition on the arterial filters.

Animals↗
PubMed1985

[Effects of ventilation with various end expiratory pressures on extravascular lung water following extracorporeal circulation].

The influence of ventilation with different endexpiratory pressure (0, 5, 10 cm H2O) on extravascular lung water (EVLW) in the period immediately after extracorporeal circulation (ECC) was investigated in a total of 35 patients undergoing coronary artery bypass surgery. Lung water measurement was performed by using the thermal-green dye double indicator dilution technique with indocyanine green and a microprocessed lung water computer. Ventilation with a moderate PEEP-level (5 cm H2O) led to an intensive reduction in lung water content, whereas EVLW-reduction was less pronounced, when higher PEEP-level (10 cm H2O) was applied. No significant relationship to various hemodynamic parameters, especially pulmonary artery pressure (PAP), pulmonary capillary wedge pressure (PCWP) or pulmonary vascular resistance (PVR) could be seen.

Blood Pressure↗