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J Thorac Cardiovasc Surg 1994;107:1044-1049
© 1994 Mosby, Inc.

CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

Hemodynamic and cerebral repercussions arising from surgical interruption of the superior vena cavaExperimental model

Valladolid, Spain

From the Department of Thoracic and Cardiovascular Surgery ^a and Division of Neuropathology, ^b Hospital Universitario of Valladolid, Valladolid, Spain.

Received for publication May 13, 1993. Accepted for publication Sept. 27, 1993. Address for reprints: Jose A. Gonzalez-Fajardo, MD, Department of Thoracic and Cardiovascular Surgery, Hospital Universitario, 47011-Valladolid, Spain.

Abstract

This study was designed to analyze the hemodynamic and cerebral repercussions arising from the surgical interruption of the superior vena cava. The experiments were carried out in 12 mongrel dogs under two different conditions: with shunt (group A, n = 6) and without the installation of a shunt (group B, n = 6). The period of occlusion was 35 minutes. The right atrium pressure, pulmonary arterial pressure, and aortic pressure are not significantly modified in the two groups. The intracranial pressure had an important correlation with the central venous pressure (r²= 0.8572). In group B, the intracranial pressure had a sharp increase between the basal period (6.9 ± 1.47 mm Hg) and the clamping superior vena cava (17.2 ± 1.05 mm Hg), accentuated with the interruption of the azygous vein (32.2 ± 0.7 mm Hg). In group A, the use of a shunt avoided this alteration during clamping of the superior vena cava (6.8 ± 2.0 mm Hg) and the azygous vein (8.0 ± 2.24 mm Hg). However, after removal of the clamps in group B, an elevated residual intracranial pressure was observed (21.1 ± 3.33 mm Hg) in contrast to the central venous pressure, which returned to the basal values (4.4 ± 0.7 mm Hg). The biomechanic findings of the volume-pressure curves (with Miller and Marmarou-Shapiro tests) and the cerebral necropsy showed brain damage in group B, without the shunt. Three animals had areas of hemorrhagic infarction. Histologic study demonstrated signs the incipient vasogenic edema. In group A, all findings were compatible with the normal. In conclusion, these results suggest the importance of shunting the blood in those cases of a nonobstructed superior vena cava because the clamping and reconstruction produce hemodynamic compromise and brain damage. (J THORACCARDIOVASCSURG1994;107:1044-9)

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