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J Thorac Cardiovasc Surg 1998;116:432-436
© 1998 Mosby, Inc.

Surgery for Congenital Heart Disease

Effects of various flow types on maternal hemodynamics during fetalbypass: Is there nitric oxide release during pulsatile perfusion?

Supported in part by a research contract (JE 1949) with Claude BernardUniversity, Lyon, France.

Received for publication Dec. 22, 1997. Revisions requested March 25, 1998; revisions received April 27, 1998. Accepted for publication April 28, 1998. Address for reprints: C. Vedrinne, MD, Hopital Cardiologique LouisPradel, 59 Boulevard Pinel, 69003, Lyon, France.

Objective: This study investigates therole of various flow conditions on maternal hemodynamics during fetalcardiopulmonary bypass. Methods: Normothermicfetal bypass was conducted under pulsatile, or steady flow, for a 60-minuteperiod. Fetal lamb preparations were randomly assigned to 1 of the 3 groups:steady flow (n = 7), pulsatile flow (n = 7), or pulsatile blocked flow bypass (n = 7), where fetuses were perfused withN-nitro-L-arginineafter the first 30 minutes of pulsatile flow to assess the potential role ofendothelial autacoids.
Results: Maternaloximetry and pressures remained unchanged throughout the procedure. Under fetalpulsatile flow, maternal cardiac output increased after 20 minutes of bypass andremained significantly higher than under steady flow at minute 30 (8.8 ±0.7 L · min^-1 vs 5.9 ± 0.5 L · min^-1,P = .02). Maternal cardiac output in thepulsatile group also remained higher than in both steady and pulsatile blockedflow groups, reaching respectively 8.7 ± 0.9 L · min^-1vs 5.8 ± 0.4 L · min^-1(P =.02)and5.9 ± 0.3 L · min^-1(P =.01)at minute 60. Maternal systemic vascular resistances were significantlylower under pulsatile than under steady flow after 30 minutes and until the endof bypass (respectively, 9.1 ± 0.6 IU vs 12.7 ± 1.1 IU,P = .02 and 8.9 ± 0.5 IU vs12.9 ± 1.2 IU, P = .01).Infusion of N-nitro-sc-arginine was followed by an increase in systemicvascular resistances from 9.3 ± 0.7 IU, similar to that of thepulsatile group, to 13.5 ± 1 IU at 60 minutes, similar to that ofthe steady flow group.
Conclusions:Maternal hemodynamic changes observed under fetal pulsatile flow arecounteracted after infusion of N-nitro-L-arginine, suggesting nitric oxide release from thefetoplacental unit under pulsatile fetal flow conditions. (J Thorac CardiovascSurg 1998;116:432-9)

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