The effect of milrinone on metabolism after cardiopulmonary bypass.

AIM: The aim of this study was to examine the effects of milrinone on tissue metabolism perioperatively in cardiac surgery patients using extracorporeal circulation, in comparison to adrenaline and placebo. These effects were measured indirectly by measuring serum lactate, base excess and glucose levels at standard intervals. METHODS: Seventy-seven consecutive patients, who underwent elective cardiac surgery, were allocated in 3 groups. Inotropic support was initiated coming off CPB (cardiopulmonary bypass) if there was evidence of hypotension (mean arterial pressure [MAP] <60 mmHg), after adequate preload (pulmonary capillary wedge pressure [PCWP] >10 mmHg). Milrinone was used in patients with pulmonary hypertension (MPAP >20 mmHg). Group 1 (N.=26) received no inotropes, placebo. Group 2 (N.=32) received adrenaline. Group 3 (N.=19) received adrenaline + milrinone at 0.5 microg/kg/min infusion. Adrenaline was infused at a variable dose (0.01-0.02 microg/kg/min) to achieve a MAP >60 mmHg. The serum lactate, base excess and glucose levels were measured at standard intervals in all 3 groups. Diabetic, hepatic or renal failure patients (serum creatinine >2 mg/dL), were excluded from the study. Patient demographic and clinical characteristics were similar in all 3 groups. RESULTS: Repeated measure analysis of variance between groups showed significantly lower serum lactate levels and higher base excess in the milrinone group (P<0.05), after 2 to 4 hours of treatment. Serum glucose levels were higher in the adrenaline group (P=0.01). There were no immediate complications, morbidity or mortality in the study groups. CONCLUSION: These findings suggest that milrinone has a beneficiary effect on aerobic tissue metabolism after extracorporeal circulation, reflected on serum lactate, base excess and glucose levels, possibly due to a combination of positive inotropic and peripheral vasodilatory effect of the drug.

Inferior vena cava thrombosis due to migration of retained functionless pacemaker electrode.

Thrombosis of the inferior vena cava due to migration of a pacing wire has not been published previously. We describe such a complication due to migration of a retained pacemaker electrode. The distal cut end of the wire was found looped at the level of thrombosis of the inferior vena cava. The patient was treated initially with heparin and placed later on coumadin. Currently, he is doing well without any evidence of thromboembolism.

Long-term surgical outcome of closed mitral commissurotomy.

Seven hundred and fifty-four patients who underwent closed mitral commissurotomy (CMC) between 1958 and 1993 (71% female, 29% male; mean age 39 years) for acquired mitral stenosis were reviewed postoperatively. Particular attention was given to those patients who later required mitral valve replacement (MVR). The total follow up experience was 9,607.9 years. Eighty-two patients (11%) needed a repeat CMC and 30% of these patients had subsequent MVR. In all, 146 patients (19, 3%) required MVR a mean of 17.0 years after commissurotomy (range one to 35 years). Preoperative factors associated with an unsatisfactory postoperative course and with later MVR included preoperative functional class, calcification of the mitral valve and subvalvular fusion. The adequacy of valvulotomy assessed at operation was also related to outcome. Postoperatively, poor functional improvement, congestive heart failure and the necessity for a repeat CMC were associated with late MVR. The indications for MVR were restenosis (59%), residual stenosis with or without mild mitral regurgitation (30%), and moderate to severe regurgitation (11%). Among survivors, 88% improved at least one functional class after MVR and the majority was free of congestive heart failure. It is concluded that CMC provides excellent long term clinical improvement in appropriately selected patients. The mean time interval of 17 years between CMC and late MVR reveals the efficacy of CMC to achieve satisfactory long term results.

[Surgery of pulmonary hydatid diseases in childhood]. / Zur Chirurgie des Echinococcus cysticus der Lunge im Kindesalter.

Fourteen cases of hydatid cysts of the lung in childhood are reported. The lung organ constitutes the most frequent site of the disease in childhood. The possible pathogenetic factors and the complications such as rupture and suppuration of the cyst are described. Conservative surgical procedures are recommended. The value of prophylaxis against the disease in infants and young children is emphasised.

[Rare primary localizations of Echinococcus cysticus]. / Seltene primäre Lokalisationen des Echinococcus cysticus.

Seven cases of unusual location of echinococcus cysts are described. Three of them were located in the muscles, three in the subcutaneous tissue and one in a retroperitoneal position.

[Nonocclusive vascular insufficiency of the bowel (author's transl)]. / Die funktionelle intestinale Perfusionsischämie.

The particular problems of nonocclusive mesenteric vascular insufficiency are discussed on the basis of reports in the literature and 4 patients observed by the authors. Diminution in splanchnic blood flow as a manifestation of splanchnic compensation to low cardiac output seems to be the most common cause. The symptoms are described and the necessity for early diagnosis and immediate treatment are stressed. Our results of treatment in 4 patients with nonocclusive mesenteric vascular insufficiency are presented.

Complete left atrial obliteration due to localized tamponade after coronary artery perforation during PTCA.

Coronary artery perforation is a rare but important complication of percutaneous revascularization (PTCA). Clinical events following coronary perforation may include cardiac tamponade. After bypass graft operation (CABG), however, cardiac tamponade with subsequent hemodynamic instability is unusual due to the development of pericardial adhesions. We report an unusual case of localized tamponade after coronary artery perforation during PTCA in a patient with previous CABG.