JTCS Email Content Delivery
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Jacob, L.
Right arrow Articles by Celerier, M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Jacob, L.
Right arrow Articles by Celerier, M.

J Thorac Cardiovasc Surg 1994;107:68-73
© 1994 Mosby, Inc.

GENERAL THORACIC SURGERY

Decreased mesenteric blood flow supplying retrosternal esophageal ileocoloplastic grafts during positive-pressure breathing

L. Jacob, MD, S. Boudaoud, MD, O. Rabary, MD, D. Payen, MD, PhD, E. Sarfati, MD, D. Gossot, MD, E. Rolland, MD, B. Eurin, MD, M. Celerier, MD


Paris France

Supported by Faculty Institutional grant program of Faculté de Médecine Lariboisière-Saint-Louis, Université Paris VII, Fédération Française de Cardiologie and Institut National de la Santé et de la Recherche Médicale (INSERM), contract No. 86-3-37-E.

Received for publication Jan. 13, 1993. Accepted for publication May 24, 1993. Address for reprints: Laurent Jacob, MD, Service d'Anesthésiologie- Réanimation Chirurgicale, Hôpital Saint-Louis, 1 Ave. Claude Vellefaux, 75010 Paris, France.

Abstract

Esophageal replacement after esophagogastric injury caused by ingestion of lye may require the interposition of a retrosternal ileocolic graft. In this new anatomic situation, the mesenteric circulation supplying the graft is subjected to the intrathoracic pressure surrounding the graft. Thus, mesenteric blood flow supplying the graft may be impaired when intrathoracic pressure is increased during mechanical ventilation. This study was designed to evaluate the effect of increasing intrathoracic pressure by application of a positive end-expiratory pressure on mesenteric blood flow supplying esophageal ileocolic grafts. Eight cases were studied in the immediate postoperative period. Miniaturized implantable Doppler microprobes were sutured to the single artery supplying the graft and connected to an 8 MHz pulsed Doppler flowmeter. Two sets of measurements were successively performed with zero end-expiratory pressure ventilation and after application of a 15 cm water positive end-expiratory pressure. Positive end-expiratory pressure induces mean arterial pressure (-12%); p < 0.05) and cardiac output (-17%; p < 0.05) decrease. Mesenteric blood flow also decreases (-38%; p < 0.05) as did the mesenteric blood flow/cardiac output ratio, suggesting a potential mesenteric vasoconstriction assessed by mesenteric vascular resistance increase and mesenteric diastolic blood flow velocity decrease. These results suggest that, in the particular anatomic situation of the graft, increased intrathoracic pressure induces mesenteric blood flow decrease in relation to systemic hemodynamic alterations associated with perivisceral pressure increase. This change may be deleterious to graft perfusion. (J THORAC CARDIOVASC SURG 1994;107:68-73)






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 1994 by The American Association for Thoracic Surgery.