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Eur J Cardiothorac Surg 2005;27:529
© 2005 Elsevier Science NL

Letter to the Editor

Vasomotor dysfunction after cardiac surgery; another look

Mansoura University, Faculty of Medicine, Cardiothoracic Surgery, Mansoura 123, Egypt

Received 15 November 2004; accepted 22 November 2004.

^* Tel.: +20 10 616 6470; fax: +20 50 226 5471. (E-mail: sameh001{at}yahoo.com).

Key Words: Cardiopulmonary bypass • Methylene blue

Cardiopulmonary bypass activates five plasma protein systems: contact, intrinsic coagulation, extrinsic coagulation, complement, and fibrinolytic systems. Blood cells activated by CPB are platelets, neutrophils, monocytes, endothelial cells, and lymphocytes. Activation of these blood elements mediates the principal complications of CPB; bleeding, thromboembolism, fluid retention, and temporary organ dysfunction [1].

Review of the Vasomotor dysfunction after cardiac surgery [2] must include the combined stresses of anaesthesia, surgery, anticoagulation, hypothermia and CPB as triggering factors for a hormonal stress response and a massive defence reaction compounded by the hemodilution and the non pulsatile flow [3].

A vasoctive substance may be defined as any substance that causes vascular smooth muscle to contract or relax, that causes an endothelial cell to contract or relax, or that influences myocele contractility. Large numbers of vasoactive substances are produced or affected by CPB and open-heart operations. These substances produce edema, decrease myocardial contractility, and change vascular resistance in various vascular beds. Vasoctive substances include epinephrine, norepinephrine, renin, angiotensin, vasopressin, aldostyerone, atrial naturetic factor, glucagon, thyroid hormones, calcium, magnesium, potassium, membrane attack complex, oxygen free radicals, lysosomal enzymes, proeases, leuckotriens e4, c4 and d4, interleuckins 1,6,8,10, platelet activating factor, prostacyclins, thromboxane a2, prostaglandins e2, Nitric oxide, Endothelin 1, serotonin and Histamine [4].

Low systemic vascular resistance syndrome (vasoplegic syndrome) expresses a form of inflammatory response, constituting a known postoperative cardiac surgery complication characterized by a content–continent disproportion, with a marked increase in the second. This is clinically revealed as severe hypotension and shock (distributive shock) with an inadequate response to volume expansion. Cardiac surgery patients were consecutively included. Vasoplegic syndrome was defined by the presence of the following five criteria: (a) hypotension, (b) low filling pressures, (c) high or normal cardiac index, (d) low peripheral resistance, and (e) vasopressor requirements. Methylene blue reduces mortality and morbidity in vasoplegic patients after cardiac surgery as a nitric oxide inhibitor like vasopressin. In a 1.5mg/kg dose infused over a 1h span of time [5].

References

1. Edmunds HL. Extracorporeal perfusion. In: Edmunds HL, editor. Cardiac surgery in the adult. 1st ed. New York: Mc Graw-Hill; 1997. pp. 255-294.
2. Ruel M, Khana TA, Voisine P, Bianchi C, Sellke FW. Vasomotor dysfunction after cardiac surgery. Eur J Cardiothorac Surg 2004;26:1002-1014.[Abstract/Free Full Text]
3. Holland FW, Brown PS, Weintraub BD, Clarck RE. Cardiopulmonary bypass and thyroid function; a euthyroid sick syndrome. Ann Thorac Surg 1991;52:64.
4. Downing SW, Edmunds Jr LH. Release of vasoactive substances during cardioplumonary bypass. Ann Thorac Surg 1992;54:1236.[Abstract]
5. Levin RL, Degrange MA, Bruno GF, Del Mazo CD, Daniel J, Taborda DJ, Griotti JJ, Boullon FJ. Methylene blue reduces mortality and morbidity in vasoplegic patients after cardiac surgery. Ann Thorac Surg 2004;77:496-499.[Abstract/Free Full Text]

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Sersar, S. I. Articles by Elgamal, M. A. F. Search for Related Content PubMed PubMed Citation Articles by Sersar, S. I. Articles by Elgamal, M. A. F. Related Collections Cardiac - pharmacology Extracorporeal circulation Myocardial protection