JTCS Speed Up Your Browser
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
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 Böhm, S.
Right arrow Articles by Böhm, M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Böhm, S.
Right arrow Articles by Böhm, M.

J Thorac Cardiovasc Surg 1995;109:185-186
© 1995 Mosby, Inc.

BRIEF COMMUNICATIONS

Cardiac cannulation, sodium and water balance, and ANF plasma levels

S. Böhm, MD, R. M. Arendt, MD, B. Reichart, MD, R. H. G. Schwinger, MD, M. Böhm, MD


Köln, Germany

From the Klinik III für Innere Medizin, Joseph-Stelzmann Str. 9, D-50924 Köln, Germany.

Atrial natriuretic factor (ANF) is released in response to atrial distention and has been suggested to play an important role in the regulation of sodium and water homeostasis.Go 1 In an interestingstudy, Omari, Nelson and RobertsonGo 2 reported reduced sodium and water excretion in patients after coronary bypass grafting in whom an atrial appendectomy was performed. The reduction of sodium and water excretion was accompanied by reduced plasma levels of atrial natriuretic peptide (ANF) after volume challenge with 5% human albumin infusion (12.5 ml/kg intravenously). This study is of great potential clinical relevance, because an alternative approach to venous cannulation, like cannulation of the lateral atrial wall, could be applied to limit damage to the right atrial appendage.

As an extension to this study, we have investigated sodium and water excretion, as well as plasma ANF levels (studied with a radioimmunoassay), after coronary artery bypass grafting in two groups of patients. One group (n = 10) was operated on with cannulation of the right atrium and removal of a small piece of appendage tissue; in the second group of patients (n = 10), venous cannulation was performed through the right lateral atrial wall with careful avoidance of mechanical irritation of the atrium. In the postoperative phase, patients were given optimal medical treatment without experimental interventions like volume loading. Only patients with normal left ventricular function were enrolled to avoid interferences from extraatrially formed ANF.Go 3 Fig. 1 summarizes the data. No significant difference was noted between the two groups concerning renal sodium excretion before, during, and 3 hours after bypass. Similar results were obtained with urinary output. In addition, no difference was found in plasma ANF concentrations, although pieces of atrial myocardium of 323.8 ± 104.4 mg (range 100 to 1230 mg) containing ANF concentrations of 0.97 ± 0.23 pmol/mg (range 0.55 to 2.58 pmol/mg) had to be removed during atrial cannulation.



View larger version (34K):
[in this window]
[in a new window]
  		Fig. 1. Renal sodium excretion (top) and serum ANF levels (bottom) before, during, and 3 hours after cardiopulmonary bypass in percent of prebypass values of patients without (open bars) and with (closed bars) partial removal of the right atrial appendage. Basal values for renal sodium excretion (mean ± standard error of the mean): Patients without atrial appendectomy, 0.64 ± 0.2 mmol/min; patients with atrial appendectomy, 0.59 ± 0.16 mmol/min. Basal values for serum ANF concentration (mean ± standard error of the mean): Patients without atrial appendectomy, 13 ± 3 fmol/ml; patients with atrial appendectomy, 9.8 ± 2.8 fmol/ml.

 
Taken together, these data suggest that partial removal of atrial myocardium from the right appendage for venous cannulation during coronary artery bypass grafting does not lead to postoperative disturbances in water and sodium excretion or decreases in plasma ANF levels. Thus cannulation of the right atrial appendage does not lead to serious complications when extreme situations like volume overload or total atrial appendectomy are avoided. Studies addressing such clinically important questions should be performed under appropriate conditions that reflect the clinical conditions of optimal patient care.

Footnotes

J THORAC CARIOVASC SURG 1995;109:185-6 Back

References

  1. Genest J, Cantin M. Atrial natriuretic factor. Circulation 1987;75(Suppl):I118-24.
  2. Omari BO, Nelson RJ, Robertson JM. Effect of right atrial appendectomy on the release of atrial natriuretic hormone. J Thorac Cardiovasc Surg1991;102:272-9.
  3. Michel J-B, Arnal J-F, Corvol P. Atrial natriuretic factor as a marker in congestive heart failure. Horm Res 1990;34:166-8.[Medline]




This Article
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 Böhm, S.
Right arrow Articles by Böhm, M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Böhm, S.
Right arrow Articles by Böhm, M.

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