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Eur J Cardiothorac Surg 2001;20:1220-1230
© 2001 Elsevier Science NL
Review |
a Clinic for Cardiothoracic Surgery, University of Cologne, Cologne, Germany
b Michael E. DeBakey Institute, Texas A&M University, College Station, TX, USA
c Center for Microvascular and Lymphatic Studies, Department of Anesthesiology, The University of Texas-Houston Medical School, Houston, TX, USA
Received 6 September 2001; received in revised form 28 September 2001; accepted 1 October 2001.
Corresponding author. Tel.: +49-221-478-6043; fax: +49-221-478-5906
e-mail: uwe.mehlhorn{at}medizin.uni-koeln.de
Fluid accumulation in the cardiac interstitium or myocardial edema is a common manifestation of many clinical states. Specifically, cardiac surgery includes various interventions and pathophysiological conditions that cause or worsen myocardial edema including cardiopulmonary bypass and cardioplegic arrest. Myocardial edema should be a concern for clinicians as it has been demonstrated to produce cardiac dysfunction. This article will briefly discuss the factors governing myocardial fluid balance and review the evidence of myocardial edema in various pathological conditions. In particular, myocardial microvascular, interstitial, and lymphatic interactions relevant to the field of cardiac surgery will be emphasized.
Key Words: Myocardial edema • Lymphatic system • Starling forces • Fluid balance • Cardiac function • Cardiac surgery • Cardioplegia • Contractility
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