Adrenal insufficiency after cardiovascular surgery with cardiopulmonary bypass / 中国胸心血管外科临床杂志

@#Relative/absolute adrenal insufficiency is not uncommmon in the patients undergoing cardiovascular surgery with cardiopulmonary bypass. However, this complication was rarely reported due to its unspecific clinical presentations and the unawareness of ICU physicians and cardiac surgeons. However, this puts them on a higher risk of hemodynamic instability and cardiovascular adverse events during hospitalization. Systematic reviews concentrated on it are rarely reported currently. We aim to review the etiology, risk factors, potential pathogenesis and related research progress for this complication.

Effects of Ulinastatin on Perioperative Inflammatory Response During Cardiopulmonary Bypass:A Systematic Review / 医药导报

Objective To evaluate the effects of ulinastatin on perioperative inflammatory response during cardiopulmonary bypass. Methods Comprehensive search of PubMed,EMbase,the Cochrane Library,CECDB,CQVIP,CNKI databases was conducted for randomized controlled trials(RCTs) published from January 1994 to June 2014.The included studies were evaluated strictly and the extracted data were analyzed by RevMan 5.2. Results A total of 7 RCTs including 335 patients were included,and 154 patients were in the experimental group,while 181 patients were in the control group.In the experimental group, patients were given Ulinastatin during surgery. System evaluation results show that, the concentration of TNF-α [ SMD (95%CI) were -3.48(-4.64,-2.31)] and IL-6 [SMD(95%CI) were -3.04(-4.54,-1.54)] in experimental group at 1 h after weaning from CPB were significantly lower than those in control group. Conclusion Ulinastatin used perioperatively in cardiopulmonary bypass can significantly reduce postoperative inflammation.

Lung protection effect of intra-aortic protamine injection in infants underwent opening heart operation by cardiopulmonary bypass surgery / 中国综合临床

Objective To study the protective effect of intraaortic protamine injection on lung in infants undergwent opening heart operation by cardiopulmonary bypass surgery. Methods Sixty infants (age ≤ 1 year,weight ≤ 10 kg)who accepted opening heart operation by cardiopulmonary bypass surgery were randomly assigned into 2 groups ( n = 30 in each group) reciving intra-aortic and intra-venous protamine injection respectively. P-peak, P-plate, CL, Oxygenation Index, the number of WBC and neutrophil segregated in lungs were compared between two groups before injecting protamine and 10 minutes, 1 hour, 3 hours after injecting protamine. The time of mechanical ventilation were compared as well. Results P-peak, P-plate, the number of WBC and neutrophil segregated in lungs of intra-aortic injection group significantly decreased than intra-venous injection group at 1 hour, 3 hours after injecting protamine (t =2.743, 3.512; 3.218, 3.469; 3.716, 5.243; 3.853,4. 783 respectively, Ps ＜ 0. 05 ), while the CL and Oxygenation Index increased significantly ( t = 3. 976,4. 267; 4. 557,4. 265 respectively, P ＜ 0. 05 ). The duration of mechanical ventilation follow operation in intraaortic injection group ( [8. 03 ± 5. 14] h ) was shorter compared with intra-venous injection group ( [10. 56 ±6.95]h) (t =2.599,P＜0.05). Conclusion By intra-aortic protamine injection the lung injury decreased significantly. It shows good protective effect on lung in infants underwent opening heart operation by cardiopulmonary bypass surgery.

Cirurgia cardíaca com circulação extracorpórea em gestantes. Análise da evolução materno-fetal / Cardiopulmonary Bypass Surgery in Pregnants. Analysis of Maternal and Fetal Outcome

PURPOSE--To analyze maternal and fetal outcome in pregnant undergone to cardiac surgery. METHODS--We studied the evolution of 30 pregnant women submitted to cardiac surgery at the Hospital São Paulo, between Jan/81 and Dec/92 and, further, attended at this Hospital till the parturition. The following variables were analyzed: cardiopulmonary bypass, time of the procedure and time of the anoxia, patient temperature, surgical complications, and neonatal, maternal and fetal outcomes. RESULTS--All patients had rheumatic heart disease and, in 17, mitral stenosis was the main anatomic abnormality. Mitral commissurotomy was performed in 24 patients, double comissurotomy (mitral and aortic) in 1 patient and valve replacement was performed in 5. Cardiopulmonary bypass was utilized in all procedure; occurrence of surgical complications (p < 0.001) and the prolonged surgical time (p = 0.009) were related to the fetal mortality. There was 4 (13.3) maternal deaths and 10 (33.3) fetal deaths related to the surgery. CONCLUSION--The indication of cardiac surgery in pregnant women is heart failure, refractory to conventional therapy; cardiopulmonary bypass is associated with high fetal mortality.

Retrobulbar Hemorrhage during Cardiopulmonary Bypass Surgery

Retrobulbar hemorrhage is a rare complication following cardiopulmonary bypass surgery, which has never been reported in Korea. Our cardiac surgery tearn diagnosed a case of 30 year-old female patient as atrial septal defect and performed direct closure for it. Proptosis of the right eye was developed during surgery and she was consulted to Department of Ophthalmology, St. Mary's Hospital, Catholic University Medical College. We confirmed the evidence of the proptosis of the right eye with Hertel's exophthalmo meter and diagnosed this case as retrobulbar hemorrhage that orbital CT showed a large ovoid shaped non-enhancing hyperdense mass shadow at superior portion of the right orbit. So we report our case with a brief review of the literature related to retrobulbar hemorrhage during cardiopulmonary bypass surgery.