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The Journal of Thoracic and Cardiovascular Surgery, Vol 104, 1110-1115, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
AM Gillinov, EA Davis, WE Curtis, CL Schleien, RC Koehler, TJ Gardner, RJ Traystman and DE Cameron
The diffuse inflammation produced by cardiopulmonary bypass might disrupt
the blood-brain barrier and lead to the transient neurologic dysfunction
occasionally seen after cardiac operations. To evaluate this possibility,
blood-brain barrier integrity was measured by carbon 14-aminoisobutyric
acid tracer technique after 2 hours of cardiopulmonary bypass in piglets.
Six animals were cooled to 28 degrees C on cardiopulmonary bypass and then
rewarmed to 38 degrees C before carbon 14-aminosisobutyric acid was
injected intraarterially. A control group of six animals underwent median
sternotomy and heparinization but were not placed on cardiopulmonary
bypass. Blood-to- brain transfer coefficients for carbon
14-aminosisobutyric acid were calculated for multiple brain regions; higher
coefficients reflect greater flux of carbon 14-aminosisobutyric acid and
suggest loss of blood-brain barrier integrity. The brain regions examined
and their transfer coefficients (cardiopulmonary bypass versus control mean
+/- standard error of the mean ml/gm/min) were middle cerebral artery
territory cortex (0.0032 +/- 0.0002 versus 0.0030 +/- 0.0002; p = 0.42),
diencephalon (0.0031 +/- 0.0003 versus 0.0029 +/- 0.0002; p = 0.50),
midbrain (0.0028 +/- 0.0002 versus 0.0027 +/- 0.0002; p = 0.86), cerebellum
(0.0036 +/- 0.0003 versus 0.0029 +/- 0.0002; p = 0.22), and spinal cord
(0.0035 +/- 0.0003 versus 0.0041 +/- 0.0008; p = 0.48). There were no
significant differences in transfer coefficients between animals placed on
cardiopulmonary bypass and control animals in any brain region examined.
The pituitary gland lacks a blood-brain barrier and had a correspondingly
high coefficient in control animals and those undergoing cardiopulmonary
bypass (0.077 +/- 0.012 versus 0.048 +/- 0.008; p = 0.07). Two hours of
moderately hypothermic cardiopulmonary bypass does not disrupt the
blood-brain barrier.
ARTICLES
Cardiopulmonary bypass and the blood-brain barrier. An experimental study
Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Md.
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