Myonephropathic-metabolic syndrome as a complication of cardiopulmonary bypass

We encountered eight rare cases of myonephropathic metabolic syndrome (MNMS) which developed as a complication of the femoral arterial cannulation (FAC) during cardiopulmonary bypass (CPB). Seven were boys ranging in age from 4-17 years, and all had undergone open heart surgery using CPB with a hemodilution technique. These eight corresponded to 1.9 per cent of the 420 patients treated with CPB before June, 1974. The pump priming fluid used was either Ringer's lactate solution alone or that containing a small amount of colloidal solution. Duration of CPB ranged from 52 min to 2 hrs and 42 min, but the FAC period was more than 3 hrs in each case. Acute renal failure occurred in 3 and 2 required peritoneal dialysis. Severe respiratory insufficiency occurred in 2 and one died 3 months after the operation. The most effective means to prevent the development of MNMS seems to be the local cooling of the cannulated limb during FAC. MNMS did not occur in 444 cases of CPB with FAC after July 1974, and here local cooling was applied in all cases.