| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
J Thorac Cardiovasc Surg 1997;114:738-745
© 1997 Mosby, Inc.
SURGERY FOR CONGENITAL HEART DISEASE |
Supported in part by a research contract (JE1949) with Claude Bernard University.
Received for publication May 6, 1997 revisions requested June 25, 1997; revisions received July 21, 1997 accepted for publication July 22, 1997. Address for reprints: G. Champsaur, MD, Hôpital Cardiologique, 59 Boulevard Pinel, 69003, Lyon, France.
Abstract
Objective: This study was initiated to test the hypothesis that fetal hemodynamic changes observed under pulsatile flow bypass might be related to the release of endothelium-derived relaxing factor through oscillating shear stress. Methods: Normothermic bypass was instituted in utero in 21 preterm fetal lambs for a 1-hour period through the right atrium and main pulmonary artery. Ultrasonic flowmeters were positioned around the descending aorta and the umbilical artery. The circuit consisted of an oxygenator and a pump set to either continuous flow (n = 7) or pulsatile flow (n = 7) and adjusted to maintain a fetal main arterial pressure of 50 mm Hg. In seven other animals, endothelium-derived relaxing factor was blocked by a continuous infusion of N 
-nitro-L-arginine after 30 minutes of pulsatile flow. Results: During the first 30 minutes of bypass, pump flows were significantly lower in the continuous-flow group than in the pulsatile-flow or blocked-flow groups (respectively, 612 ± 144, 907 ± 153 and 987 ± 228 ml/min), with similar changes in aortic and umbilical flows. Systemic vascular resistances were significantly lower in the pulsatile-flow and blocked-flow groups than in the continuous-flow group (550 ± 106 vs 821 ± 212 dynes/sec/cm-5). However, after blockade of endothelium-derived relaxing factor, resistances increased gradually in the blocked-flow group to reach the level of that of the continuous-flow group at the end of bypass (943 ± 77 vs 556 ± 143 dynes/sec/cm-5 in the pulsatile-flow group). Conclusions: Blockade of endothelium-derived relaxing factor after 30 minutes of pulsatile flow returns fetal hemodynamics to continuous flow conditions. The specific inhibitor of endothelium-derived relaxing factor used in this experiment suggests that nitric oxide may be released by fetal endothelium during pulsatile bypass.
This article has been cited by other articles:
|
|
 |
|
  C. Lam, R. S. Baker, J. McNamara, R. Ferguson, J. Lombardi, K. Clark, and P. Eghtesady Role of Nitric Oxide Pathway in Placental Dysfunction Following Fetal Bypass Ann. Thorac. Surg., September 1, 2007; 84(3): 917 - 925. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Ji and A. Undar Comparison of perfusion modes on microcirculation during acute and chronic cardiac support: is there a difference? Perfusion, March 1, 2007; 22(2): 115 - 119. [Abstract] [PDF]
|
|
|
|
 |
|
 C. W. Hogue Jr, C. A. Palin, and J. E. Arrowsmith Cardiopulmonary bypass management and neurologic outcomes: an evidence-based appraisal of current practices. Anesth. Analg., July 1, 2006; 103(1): 21 - 37. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Jahangiri and J. Clark Surgery for type A aortic dissection in pregnant patients with Marfan syndrome Eur. J. Cardiothorac. Surg., February 1, 2006; 29(2): 264 - 264. [Full Text] [PDF]
|
|
|
|
|
|
Y. Oishi, M. Masuda, T. Yasutsune, N. Boku, S. Tokunaga, S. Morita, and H. Yasui Impaired Endothelial Function of the Umbilical Artery After Fetal Cardiac Bypass Ann. Thorac. Surg., December 1, 2004; 78(6): 1999 - 2003. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Christiansen, S. Brose, L. Demircan, and R. Autschbach A new right ventricular assist device for right ventricular support Eur. J. Cardiothorac. Surg., November 1, 2003; 24(5): 834 - 836. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Khan, C. Pumphrey, J. Clarke, and M. Jahangiri Aortic root replacement in pregnancy J R Soc Med, November 1, 2003; 96(11): 551 - 552. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Jahangiri, J. Clark, F. Prefumo, C. Pumphrey, and D. Ward Cardiac surgery during pregnancy: pulsatile or nonpulsatile perfusion? J. Thorac. Cardiovasc. Surg., September 1, 2003; 126(3): 894 - 895. [Full Text] [PDF]
|
|
|
|
|
|
C. Vedrinne, F. Tronc, S. Martinot, J. Robin, A.-M. Allevard, M. Vincent, J. J. Lehot, M. Franck, and G. Champsaur Better preservation of endothelial function and decreased activation of the fetal renin-angiotensin pathway with the use of pulsatile flow during experimental fetal bypass J. Thorac. Cardiovasc. Surg., October 1, 2000; 120(4): 770 - 777. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. V. Bilfinger and G. B. Stefano Human aortocoronary grafts and nitric oxide release: relationship to pulsatile pressure Ann. Thorac. Surg., February 1, 2000; 69(2): 480 - 485. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. F. Tripp, R. M. Stiegel, and J. P. Coyle The use of pulsatile perfusion during aortic valve replacement in pregnancy Ann. Thorac. Surg., April 1, 1999; 67(4): 1169 - 1171. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. M. Reddy, D. B. McElhinney, H. A. Rajasinghe, J. R. Liddicoat, K. Hendricks-Munoz, J. R. Fineman, and F. L. Hanley ROLE OF THE ENDOTHELIUM IN PLACENTAL DYSFUNCTION AFTER FETAL CARDIAC BYPASS J. Thorac. Cardiovasc. Surg., February 1, 1999; 117(2): 343 - 351. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Vedrinne, F. Tronc, S. Martinot, J. Robin, C. Garhib, J. Ninet, J. J. Lehot, M. Franck, and G. Champsaur Effects of various flow types on maternal hemodynamics during fetalbypass: Is there nitric oxide release during pulsatile perfusion? J. Thorac. Cardiovasc. Surg., September 1, 1998; 116(3): 432 - 436. [Abstract] [Full Text]
|
|
| 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 |
