HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Paul M. Kirshbom Louis R. DiBernardo Ross M. Ungerleider Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kirshbom, P. M. Articles by Gaynor, J. W. Search for Related Content PubMed PubMed Citation Articles by Kirshbom, P. M. Articles by Gaynor, J. W.

J Thorac Cardiovasc Surg 1996;111:1248-1256
© 1996 Mosby, Inc.

CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

EFFECTS OF CARDIOPULMONARY BYPASS AND CIRCULATORY ARREST ON ENDOTHELIUM-DEPENDENT VASODILATATION IN THE LUNG

Received for publication May 30, 1995 Accepted for publication August 28, 1995 Address for reprints: J. William Gaynor, MD, Pediatric Cardiothoracic Surgery, Children's Hospital of Philadelphia, 34th St. and Civic Center Blvd., Philadelphia, PA 19104.

Abstract

Endothelial injury with failure of pulmonary endothelium–dependent vasodilatation has been proposed as a possible cause for the increased pulmonary vascular resistance observed after cardiopulmonary bypass, but the mechanisms underlying this response are not understood. An in vivo piglet model was used to investigate the role of endothelium-dependent vasodilatation in postbypass pulmonary hypertension. The pulmonary vascular responses to acetylcholine, a receptor-mediated endothelium-dependent vasodilator, and nitric oxide, an endothelium-independent vasodilator, were studied in one group of animals after preconstriction with the thromboxane A₂analog U46619 (n= 6); a second group was studied after bypass with 30 minutes of deep hypothermic circulatory arrest (n= 6). After preconstriction with U46619, both acetylcholine and nitric oxide caused significant decreases in pulmonary vascular resistance (34% ± 6% decrease, p= 0.007, and 39% ± 4% decrease, p= 0.001). After cardiopulmonary bypass with circulatory arrest, acetylcholine did not significantly change pulmonary vascular resistance (0% ± 8% decrease, p= 1.0), whereas nitric oxide produced a 32% ± 4% decrease in pulmonary vascular resistance (p= 0.007). These results demonstrate a loss of receptor- mediated endothelium-dependent vasodilatation with normal vascular smooth muscle function after circulatory arrest. Administration of the nitric oxide synthase blocker N-nitro-L-arginine-methyl-ester after circulatory arrest significantly increased pulmonary vascular resistance; thus, although endothelial cell production of nitric oxide may be diminished, it continues to be a major contributor to pulmonary vasomotor tone after cardiopulmonary bypass with deep hypothermic circulatory arrest. In summary, cardiopulmonary bypass with deep hypothermic circulatory arrest results in selective pulmonary endothelial cell dysfunction with loss of receptor-mediated endothelium-dependent vasodilatation despite preserved ability of the endothelium to produce nitric oxide and intact vascular smooth muscle function. (J THORACCARDIOVASCSURG1996;111:1248-56)

This article has been cited by other articles:

				J. D. Schmoker, C. Terrien III, K. J. McPartland, J. Boyum, G. C. Wellman, L. Trombley, and J. Kinne Cerebrovascular response to continuous cold perfusion and hypothermic circulatory arrest. J. Thorac. Cardiovasc. Surg., February 1, 2009; 137(2): 459 - 464. [Abstract] [Full Text] [PDF]

				C. Pizarro, K. A. Murdison, C. D. Derby, and W. Radtke Stage II Reconstruction After Hybrid Palliation for High-Risk Patients With a Single Ventricle Ann. Thorac. Surg., April 1, 2008; 85(4): 1382 - 1388. [Abstract] [Full Text] [PDF]

				E. J. Hickey, X. You, V. Kaimaktchiev, and R. M. Ungerleider Hypoxemic reperfusion exacerbates the neurological injury sustained during neonatal deep hypothermic circulatory arrest: a model of cyanotic surgical repair Eur. J. Cardiothorac. Surg., May 1, 2007; 31(5): 906 - 914. [Abstract] [Full Text] [PDF]

				S. K Ohri and T. Velissaris Gastrointestinal Dysfunction Following Cardiac Surgery Perfusion, July 1, 2006; 21(4): 215 - 223. [PDF]

				A. Della Corte, M. Scardone, G. Romano, C. Amarelli, A. Biondi, L. S. De Santo, M. De Feo, G. Nappi, and M. Cotrufo Aortic Arch Surgery: Thoracoabdominal Perfusion During Antegrade Cerebral Perfusion May Reduce Postoperative Morbidity Ann. Thorac. Surg., April 1, 2006; 81(4): 1358 - 1364. [Abstract] [Full Text] [PDF]

				D. K. Harrington, J. P. Lilley, S. J. Rooney, and R. S. Bonser Nonneurologic morbidity and profound hypothermia in aortic surgery Ann. Thorac. Surg., August 1, 2004; 78(2): 596 - 601. [Abstract] [Full Text] [PDF]

				F. Doguet, P.-Y. Litzler, F. Tamion, V. Richard, M.-F. Hellot, C. Thuillez, A. Tabley, F. Bouchart, and J. P. Bessou Changes in mesenteric vascular reactivity and inflammatory response after cardiopulmonary bypass in a rat model Ann. Thorac. Surg., June 1, 2004; 77(6): 2130 - 2137. [Abstract] [Full Text] [PDF]

				T. Nakano, H. Kado, Y. Shiokawa, K. Fukae, Y. Nishimura, K. Miyamoto, Y. Tanoue, H. Tatewaki, and N. Fusazaki The low resistance strategy for the perioperative management of the Norwood procedure Ann. Thorac. Surg., March 1, 2004; 77(3): 908 - 912. [Abstract] [Full Text] [PDF]

				F. D. Wagner, S. Buz, C. Knosalla, R. Hetzer, and B. Hocher Modulation of Circulating Endothelin-1 and Big Endothelin by Nitric Oxide Inhalation Following Left Ventricular Assist Device Implantation Circulation, September 9, 2003; 108(90101): II-278 - 284. [Abstract] [Full Text] [PDF]

				T. Kovesi, D. Royston, M. Yacoub, and N. Marczin Basal and nitroglycerin-induced exhaled nitric oxide before and after cardiac surgery with cardiopulmonary bypass Br. J. Anaesth., May 1, 2003; 90(5): 608 - 616. [Abstract] [Full Text] [PDF]

				H. A. Hennein Inflammation After Cardiopulmonary Bypass: Therapy for the Postpump Syndrome Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2001; 5(3): 236 - 255. [Abstract] [PDF]

				C. Joffs, C. A. Walker, J. W. Hendrick, D. J. Fary, D. K. Almany, J. N. Davis, A. T. Goldberg, F. A. Crawford Jr, and F. G. Spinale Endothelin receptor subtype A blockade selectively reduces pulmonary pressure after cardiopulmonary bypass J. Thorac. Cardiovasc. Surg., August 1, 2001; 122(2): 365 - 370. [Abstract] [Full Text] [PDF]

				W. A. Cooper, I. G. Duarte, V. H. Thourani, M. Nakamura, N.-P. Wang, W. M. Brown III, J. P. Gott, J. Vinten-Johansen, and R. A. Guyton Hypothermic circulatory arrest causes multisystem vascular endothelial dysfunction and apoptosis Ann. Thorac. Surg., March 1, 2000; 69(3): 696 - 702. [Abstract] [Full Text] [PDF]

				P. J. Chai, J. A. Williamson, A. J. Lodge, C. W. Daggett, J. E. Scarborough, J. N. Meliones, I. M. Cheifetz, J. J. Jaggers, and R. M. Ungerleider Effects of ischemia on pulmonary dysfunction after cardiopulmonary bypass Ann. Thorac. Surg., March 1, 1999; 67(3): 731 - 735. [Abstract] [Full Text] [PDF]

				L. C. Wagerle, P. Russo, N. S. Dahdah, N. Kapadia, and D. A. Davis Endothelial dysfunction in cerebral microcirculation duringhypothermic cardiopulmonary bypass in newborn lambs J. Thorac. Cardiovasc. Surg., May 1, 1998; 115(5): 1047 - 1051. [Abstract] [Full Text] [PDF]

				K. Bando, P. Vijay, M. W. Turrentine, T. G. Sharp, L. J. Means, G. J. Ensing, B. J. Lalone, Y. Sekine, L. Szekely, and J. W. Brown Dilutional And Modified Ultrafiltration Reduces Pulmonary Hypertension After Operations For Congenital Heart Disease: A Prospective Randomized Study J. Thorac. Cardiovasc. Surg., March 1, 1998; 115(3): 517 - 527. [Abstract] [Full Text]

				I. M. Cheifetz, M. L. Cannon, D. M. Craig, G. Quick, F. H. Kern, P. K. Smith, R. M. Ungerleider, and J. N. Meliones Liquid Ventilation Improves Pulmonary Function And Cardiac Output In A Neonatal Swine Model Of Cardiopulmonary Bypass J. Thorac. Cardiovasc. Surg., March 1, 1998; 115(3): 528 - 535. [Abstract] [Full Text]

				P. Zanaboni, P. A. Murray, B. A. Simon, K. Zehr, K. Fleischer, E. Tseng, and D. P. Nyhan Selective endothelial dysfunction in conscious dogs after cardiopulmonary bypass J Appl Physiol, June 1, 1997; 82(6): 1776 - 1784. [Abstract] [Full Text] [PDF]

				P. M. Kirshbom, S. O. Page, M. T. Jacobs, S. S. L. Tsui, E. Bello, R. M. Ungerleider, D. A. Schwinn, and J. W. Gaynor CARDIOPULMONARY BYPASS AND CIRCULATORY ARREST INCREASE ENDOTHELIN-1 PRODUCTION AND RECEPTOR EXPRESSION IN THE LUNG J. Thorac. Cardiovasc. Surg., April 1, 1997; 113(4): 777 - 783. [Abstract] [Full Text]