摘要:

AbstractThe alpha‐agonist drug phenylephrine has been generally considered to be contraindicated in patients with heart failure for the reason that increased afterload produced by the vasoconstriction should decrease ventricular function; the beta‐adrenergic blocking drugs generally have been considered to be contraindicated in heart failure because of the dependence of the failing heart on beta‐sympathetic agonism; the angiotensin converting enzyme inhibitors have been indicted recently as causing undesirable cardiovascular depression in patients for coronary artery bypass surgery. Yet recently, phenylephrine has been shown to have positive cardiac inotropic effects in a variety of experimental preparations including intact humans; the beta‐adrenergic blocking drugs have been shown to be therapeutically effective in treating patients with chronic congestive heart failure (CHF); and the “gold standard” for treating chronic CHF at present are the ACEI. Consequently, the clinician caring for patients with cardiac disease needs to reevaluate the use of classic drugs whose original pharmacological properties may either have changed because of advances in technology or may be producing effects that were unanticipated

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1995.tb00686.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractAtheroembolism from the ascending aorta is an emerging cause of noncardiac complications after open heart surgery. We designed a new arterial cannula specifically to reduce the exit force and velocity of blood flow, thereby reducing the “sandblasting” effect of the exiting blood jet. The cannula has a closed tip and an internal cone that diffuses blood flow such that it enters the aorta via multiple side holes. Fluid dynamics of the cannula were tested against five frequently used cannulae: Sarns High‐Flow (3M™Sarns™High‐Flow, Ann Arbor, Ml, USA), DLP 83024 (DLP Inc., Grand Rapids, Ml, USA), RMI ARS 024C (Research Medical Inc. of Research Industries Corp., Midvale, UT, USA), Bard 1966 (C.R. Bard Inc., Haverhill, MA, USA), and Argyle THI (Sherwood Medical Co. Sub American Home Products Corp., St. Louis, MO, USA). All cannulae had an 8.0‐mm external diameter. The new cannula demonstrated a similar pressure drop and internal tip diameter as the others. The exit force (newtons) of the Soft Flow cannula was significantly less than the Sarns High‐Flow (p<0.05), DLP (p<0.001), RMI (p<0.01), Bard (p<0.001), and the Argyle (p<0.001) cannulae. Peak velocity (cm/s) of the Soft Flow cannula was significantly less than the DLP (p<0.01), RMI (p<0.01), Bard (p<0.01), and Argyle (p<0.001). The cannulae all had similar hemolysis rates. The new arterial cannula produced the lowest exit force and flow velocity with no increase in hemolysis and may help to decrease the incidence of atheroemboli a

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1995.tb00687.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

AbstractIntraoperatively, myocardial ischemia is more common after cardiopulmonary bypass (CPB) than before CPB. Ischemia associated with coronary vasospasm and thrombosis may be much more common toward the end of surgery and early in the postoperative period than previously appreciated. This may be because the coagulation system is altered during CPB, and the coronary endothelium is damaged significantly as a result of cardioplegic arrest followed by reperfusion. In this milieu, vasospasm and thrombosis may be caused by the administration of protamine. Some of the ischemia observed in this period actually is not reversible and is associated with myocardial injury and infarction. It may be ameliorated by the administration of calcium channel blockers, aspirin, and anticoagulants. Electrocardiography may be the most suitable modality for the detection of ischemia after CPB and postoperatively. During this period, many episodes of ST deviation are of a nonischemic etiology, and the ECG needs careful interpretation. Transesophageal echocardiography is suitable for use intraoperatively and early on in the intensive care unit.

ISSN:0886-0440    

DOI:10.1111/j.1540-8191.1995.tb00688.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY