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Characterization of lipid particles in shed mediastinal blood
Atli Eyjolfsson1, Sara Scicluna, Per Johnsson
1Department of Cardiothoracic Surgery, Center for Heart and Lung Disease, Lund University Hospital, Lund, Sweden.
Insights
Shed mediastinal blood in cardiac surgery contains over 300,000 lipid microemboli per milliliter. These particles, originating from the mediastinum, pose a risk for patients undergoing cardiopulmonary bypass.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Lipidomics
Background:
- Shed mediastinal blood is a recognized source of microemboli during cardiac surgery.
- Microemboli can lead to complications and adverse outcomes in patients.
Purpose of the Study:
- To comprehensively characterize the lipid particles present in shed mediastinal blood.
- To investigate the origin and composition of these lipid particles.
Main Methods:
- Analysis of shed mediastinal blood and arterial blood from 24 cardiac surgery patients.
- Particle counting and sizing using Coulter counter technique.
- Gas chromatography for lipid composition analysis and comparison with mediastinal adipose tissue.
- Scanning electron microscopy for particle visualization.
Main Results:
- Characterization of lipid particles sized 10-60 micrometers in shed mediastinal blood.
- Quantification of over 300,000 particles per milliliter of shed blood.
- Similar triglyceride profiles between shed blood lipid particles and mediastinal adipose tissue, indicating mediastinal origin.
- Scanning electron microscopy confirmed spherical lipid particles matching Coulter counter measurements.
Conclusions:
- The study defines the nature and quantity of lipid microemboli in shed mediastinal blood.
- Findings suggest mediastinal adipose tissue as the source of these lipid particles.
- Strategies to mitigate microembolism, such as excluding shed blood or implementing purification techniques, may enhance surgical outcomes.
Background:
Shed mediastinal blood is known to be a source of microemboli in cardiac surgery. The aim of this study was to characterize in detail the lipid particles found in this blood.
Methods:
Blood samples were collected from 24 patients undergoing routine cardiac surgery with cardiopulmonary bypass. Arterial and shed blood was analyzed using the Coulter counter technique to establish the number and size of particles. The composition of these lipid particles was compared with that of adipose tissue from the mediastinum using gas chromatography. Scanning electron microscopy was used to visualize the lipid particles in samples of shed blood.
Results:
Lipid particles in the size range of 10 to 60 microm were characterized in shed mediastinal blood, and more than 300,000 particles per milliliter of blood were found. Triglyceride profiles in these lipid particles and in adipose tissue were similar, suggesting that their origin is the mediastinum. Scanning electron microscopy showed spherical formations corresponding in size to the particles counted using the Coulter counter.
Conclusions:
During the past decade attention has focused on microembolism in cardiac surgery, and this study has helped define the problem. Different strategies, such as eliminating the use of shed mediastinal blood or purifying the blood by different techniques, may improve the results of cardiac surgery in the future.
