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Cardiopulmonary bypass and pulmonary thromboxane generation
T Shafique1, F W Sellke, R L Thurer
1Division of Cardiothoracic Surgery, Beth Israel Hospital, Harvard Medical School, Boston, Massachusetts.
The Annals of Thoracic Surgery
|March 1, 1993
Summary
Total cardiopulmonary bypass (CPB) increases thromboxane (Tx) generation in the lungs, potentially contributing to post-operative pulmonary edema. Partial CPB shows a transient effect, while total CPB
Area of Science:
- Cardiovascular Surgery
- Pulmonary Medicine
- Biochemistry
Background:
- Noncardiogenic pulmonary edema is a rare complication following cardiopulmonary bypass (CPB).
- Prostaglandins, specifically thromboxane A2 (TxA2), are implicated in pulmonary pathology.
- Tx generation is linked to organ ischemia, suggesting CPB may stimulate lung Tx synthesis.
Purpose of the Study:
- To investigate whether total cardiopulmonary bypass (CPB) stimulates local thromboxane (Tx) synthesis in the lungs.
- To compare Tx generation during total CPB versus partial CPB.
- To assess the impact of reperfusion on Tx levels.
Main Methods:
- Measurement of thromboxane B2 (TxB2), a stable TxA2 metabolite, in sheep.
- Analysis of TxB2 levels in left and right atria during and after total CPB (105 minutes).
- Evaluation of TxB2 levels during partial CPB in sheep to assess effects without significant pulmonary perfusion alteration.
Main Results:
- Total CPB significantly increased TxB2 concentrations in the left atrium compared to the right.
- TxB2 levels in both atria rose significantly immediately after reperfusion but normalized with continued pulmonary perfusion.
- Partial CPB caused a transient increase in TxB2, which diminished over time.
Conclusions:
- Total cardiopulmonary bypass stimulates thromboxane generation in the lung.
- The increase in Tx generation during total CPB is progressive and is reversed by reperfusion.
- Partial CPB induces a transient Tx generation effect, suggesting perfusion alterations are key factors.