Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-10T16:33:27.982Z Has data issue: false hasContentIssue false
  • English
  • Français

Cardiopulmonary bypass—organ blood flow and metabolism in the pediatric patient

Published online by Cambridge University Press:  19 August 2008

W. Douglas Lazenby Jr  and
Karl H. Krieger
W. Douglas Lazenby Jr
Affiliation:
From the Department of Cardiothoracic Surgery, Cornell University Medical Center, New York
Karl H. Krieger*
Affiliation:
Washington University School of Medicine, Saint Louis and The Department of Cardiothoracic Surgery, Cornell University Medical Center, New York
*
Dr. Karl H. Krieger, 525 East 68th St., Room F2108, The New York Hospital-Cornell University Medical Center, New York, NY 10021, USA.
Get access Rights & Permissions [Opens in a new window]

Extract

Congenital heart disease occurs in roughly 0.7% of live-births. Approximately one-half of these defects are severe, requiring surgical correction or palliation. In a large percentage of such procedures in children, moderate or profound hypothermic cardiopulmonary bypass is employed. Because, nowadays, early correction of the defect rather than a palliative procedure is more frequently pursued, the surgeon, anesthesiologist, and perfusionist are called upon to manage younger and smaller children undergoing longer and more complex operations which necessitate longer times on bypass. Due to the particular underlying heart defect, the pathway of flow and viscosity of the blood are frequently different from those encountered in the adult with atherosclerotic coronary arterial or valvar heart disease. Thus, it is important for those caring for children undergoing cardiac surgery utilizing bypass to be well informed about its possible detrimental effects on the various organs. The purpose of this review will be to focus on the effects of bypass on flow to, and metabolism of, the organs and to highlight what is known with regard to these features in children rather than adults.

Keywords

Cardiopulmonary bypassorgan floworgan metabolismperfusion
Type
World Forum for Pediatric Cardiology Symposium on Cardiopulmonary Bypass (Part 1)
Information
Cardiology in the Young , Volume 3 , Issue 3 , July 1993 , pp. 232 - 243
Copyright
Copyright © Cambridge University Press 1993

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Moore, KL. The Developing Human. WB Saunders, Philadelphia, 1977.Google Scholar
2.Miller, DC. Anesthetic techniques for cardiopulmonary by pass. In: Taylor, KM (ed). Cardiopulmonary Bypass: Prin ciples and Management. Williams and Wilkins, Baltimore, 1986, pp 41–54.Google Scholar
3.Kirklin, JW, Barratt-Boyes, BG. Cardiac Surgery. Churchill Livingstone, New York, 1993.Google ScholarPubMed
4.Elliot, MJ, Hamilton, JRL. Perfusion for pediatric open-heart surgery. Perfusion 1990; 5: 1–8.CrossRefGoogle Scholar
5.Novak, I, Davies, PSW, Elliot, MJ. Noninvasive estimation of total body water in critically ill children after cardiac opera tions. J Thorac Cardiovasc Surg 1992; 104: 585–589.CrossRefGoogle Scholar
6.Yeh, T Jr, Parmar, JM, Rebeyka, IM, Lofland, GK, Allen, EL, Dignan, RJ, Dyke, CM, Wechsler, AS. Limiting edema in neonatal cardiopulmonary bypass with narrow-range molecu lar weight hydroxyethyl starch. J Thorac Cardiovasc Surg 1992; 104: 659–665.CrossRefGoogle Scholar
7.Christakis, GT, Koch, JP, Deemar, KA, Fremes, SE, Sinclair, L, Chen, E, Salerno, TA, Goldman, BS, Lichtenstein, SV. A randomized study of the systemic effects of warm heart sur gery. Ann Thorac Surg 1992; 54: 449–459.CrossRefGoogle Scholar
8.Lazenby, WD, Ko, W, Zelano, JA, Lebowitz, N, Shin, YT, Isom, OW, Krieger, KH. Effects of temperature and flow rate on regional blood flow and metabolism during cardiopulmonary bypass. Ann Thorac Surg 1992; 53: 957–964.CrossRefGoogle ScholarPubMed
9.Honig, CR. Modern Cardiovascular Physiology. Little, Brown, Boston, 1981.Google Scholar
10.Sabiston, DC Jr, Theilen, EO, Gregg, DE. The relationship of coronary blood flow and cardiac output and other parameters in hypothermia. Surgery 1955; 38: 498–505.Google ScholarPubMed
11.Ankeney, JL, Murthy, SK. A study of the peripheral (IVC and SVC) and central (splanchnic) venous flow rates during extra-corporeal bypass. J Thorac Cardiovasc Surg 1962; 44: 589–599.CrossRefGoogle Scholar
12.Kahler, RL, Goldblatt, A, Braunwald, E. Circulatory effects of profound hypothermia during extracorporeal circulation. Am J Physiol 1962; 202: 523–526.CrossRefGoogle ScholarPubMed
13.Green, JF, Jackman, AP. Mechanism ofthe increased vascular capacity produced by mild perfusion hypothermia in the dog. Circ Res 1979; 44: 411–419.CrossRefGoogle Scholar
14.Mavroudis, C, Brown, GL, Katzmark, SL, Howe, WR, Gray, LA Jr. Blood flow distribution in infant pigs subjected to surface cooling, deep hypothermia, and circulatory arrest. J Thorac Cardiovasc Surg 1984; 87: 665–672.CrossRefGoogle ScholarPubMed
15.Kent, B, Pierce, EC II. Oxygen consumption during cardiop ulmonary bypass in the uniformly cooled dog. J AppI Physiol 1974; 37: 917–922.Google Scholar
16.Davis, FM, Parimelaxhagan, KN, Harris, EA. Thermal balance during cardiopulmonary bypass with moderate hypothermia in man. Br J Anaesth 1977; 49: 1127–1132.CrossRefGoogle ScholarPubMed
17.Campbell, DE, Raskin, SA. Cerebral dysfunction after cardiop ulmonary bypass: aetiology, manifestations and interventions. Perfusion 1990; 5: 251–260.CrossRefGoogle Scholar
18.Tuman, KJ, McCarthy, RJ, Najafi, H, Ivankovich, AD. Differ ential effects of advanced age on neurologic and cardiac risks ofcoronary artery operations. J Thorac Cardiovasc Surg 1992; 104: 1510–1517.CrossRefGoogle Scholar
19.van der Linden, J, Priddy, R, Ekroth, R, Lincoln, C, Pugsley, W, Scallan, M, Tyden, H. Cerebral perfusion and metabolism during profound hypothermia in children. J Thorac Cardiovasc Surg 1991; 102: 103–114.CrossRefGoogle ScholarPubMed
20.Gillinov, AM, Davis, EA, Curtis, WE, Schleien, CL, Koehler, RC, Gardner, TJ, Traystman, RJ, Cameron, DE. Cardiopulmo nary bypass and the blood-brain barrier. J Thorac Cardiovasc Surg 1992; 104: 1110–1115.CrossRefGoogle Scholar
21.Santillan, GG, Chemnitius, JM, Bing, RJ. The effect ofcardiop ulmonary bypass on cerebral blood flow. Brain Research 1985; 345: 1–9.CrossRefGoogle Scholar
22.Johnston, WE, Vinren-Johansen, J, DeWitt, DS, O'Steen, WK, Stump, DA, Prough, DS. Cerebral perfusion during canine hypothermic cardiopulmonary bypass: Effect of arterial car bon dioxide tension. Ann Thorac Surg 1991; 52: 479–489.CrossRefGoogle Scholar
23.Anderson, K, Waaben, J, Husum, B, Voldby, B, Bodker, A, Hansen, AJ, Gjedde, A. Nonpulsatile cardiopulmonary bypass disrupts the flow-metabolism couple in the brain. J Thorac Cardiovasc Surg 1985; 90: 570–579.CrossRefGoogle Scholar
24.Johnsson, P, Messeter, K, Ryding, E, Nordstrom, L, Stahl, E. Cerebral blood flow and autoregulation during hypothermic cardiopulmonary bypass. Ann Thorac Surg 1987; 43: 386–390.CrossRefGoogle ScholarPubMed
25.Greeley, WJ, Ungerleider, RM. Assessing the effect of cardiopulmonary bypass on the brain. Ann Thorac Surg 1991; 52: 417–419.CrossRefGoogle ScholarPubMed
26.Rogers, AT, Stump, DA, Gravlee, GP, Prough, DS, Angert, KC, Wallenhaupt, SL, Roy, RC, Phipps, J. Response of cerebral blood flow to phenylephrine infusion during hypothermic cardiopulmonary bypass: Influence of PaCO2 management. Anesthesiology 1988; 69: 547–551.CrossRefGoogle ScholarPubMed
27.Croughwell, N, Smith, LR, Quill, T, Newmnan, M, Greeley, W, Kern, F, Lu, J, Reves, JG. The effect of temperature on cerebral metabolism and blood flow in adults during cardiopulmonary bypass. J Thorac Cardiovasc Surg 1992; 103: 549–554.CrossRefGoogle ScholarPubMed
28.Fox, LS, Blackstone, EH, Kirklin, JW, Bishop, SP, Bergdahl, LAL, Bradley, EL. Relationship ofbrain blood flow and oxygen consumption to perfusion flow rate during profoundly hypo thermic cardiopulmonary bypass. J Thorac Cardiovasc Surg 1984; 87: 658–664.CrossRefGoogle Scholar
29.Murkin, JM, Farrar, JK, Tweed, WA, McKenzie, FN, Guiraudon, G. Cerebral autoregulation and flow/metabolism coupling during cardiopulmonary bypass: the influence of PaCO2. Anesth Analg 1987; 66: 825–832.CrossRefGoogle ScholarPubMed
30.Greeley, WJ, Ungerleider, PM, Smith, LR, Reves, JG. The effect of deep hypothermic cardiopulmonary bypass and total circu latory arrest on cerebral blood flow in infants and children. J Thorac Cardiovasc Surg 1989; 97: 737–745.CrossRefGoogle Scholar
31.Kern, FH, Ungerleider, RM, Quill, TJ, Baldwin, B, White, WD, Reves, JG, Greeley, WJ. Cerebral blood flow response to changes in arterial carbon dioxide tension during hypothermic cardiopulmonaiy bypass in children. J Thorac Cardiovasc Surg 1991; 101: 618–622.CrossRefGoogle ScholarPubMed
32.Watanabe, T, Miura, M, Inui, K, Minowa, T, Shimanuki, T, Nishimura, K, Washio, M. Blood and brain tissue gaseous strategy for profoundly hypothermic total circulatory arrest. J Thorac Cardiovasc Surg 1991; 102: 497–504.CrossRefGoogle ScholarPubMed
33.Rogers, AT, Prough, DS, Roy, RC, Gravlee, GP, Stump, DA, Cordell, AR, Phipps, J, Taylor, CL. Cerebrovascular and cere bral metabolic effects of alterations in perfusion flow rate during hypothermic cardiopulmonary bypass in man. J Thorac Cardiovasc Surg 1992; 103: 363–368.CrossRefGoogle Scholar
34.Leitman, TM, Paull, DE, Bane, PS, Isom, OW, Shires, GT. Intra abdominal complications of cardiopulmonary bypass operations. Surg Gynecol Obstet 1987; 165: 251–254.Google ScholarPubMed
35.Krasna, MJ, Flancbaum, L, Trooskin, SZ, Fitzparrick, JC, Scholz, PM, Scott, GE, Spotnitz, AJ, Mackenzie, JW. Gastrointestinal complications after cardiac surgery. Surgery 1988; 104: 773–780.Google ScholarPubMed
36.Desai, JB, Ohri, SK. Gastrointestinal damage following car diopulmonary bypass. Perfusion 1990; 5: 161–168.CrossRefGoogle Scholar
37.Landymore, RW, Murphy, DA, Longley, WJ. Effect ofcardiop ulmonary bypass and hypothermia on pancreatic endocrine function and peripheral utilization of glucose. Can J Surg 1979; 22: 248–250.Google Scholar
38.Mime, EMG, Elliot, MJ, Pearson, DT, Holden, MP, Orskov, H, Alberti, KGMM. The effect on intermediary metabolism of open-heart surgery with deep hypothermia and circulatory arrest in infants of less than 10 kilograms body weight. A preliminary study. Perfusion 1986; 1: 29–40.Google Scholar
39.Vigneswaran, WT, Pollock, JCS, Jamieson, MPG, Torsney, B, Beastal, GH. Plasma levels of glucose, insulin and cortisol in children undergoing cardiac surgery: Effects of pulsatile and nonpulsatile perfusion. Perfusion 1989; 4: 33–39.CrossRefGoogle Scholar
40.Smith, EEJ, Naftel, DC, Blacksrone, EH, Kirklin, JW. Micro-vascular permeability after cardiopulmonary bypass. J Thorac Cardiovasc Surg 1987; 94: 225–233.CrossRefGoogle Scholar
41.Rocke, DA, Gaffin, SL, Wells, MT, Koen, Y, Brock-Utine, JG. Endotoxemia associated with cardiopulmonary bypass. J Thorac Cardiovasc Surg 1987; 93: 832–837.CrossRefGoogle ScholarPubMed
42.Silane, MF, Symchych, PS. Necrotizing enrerocolitis after cardiac surgery. A local ischemic lesion? Am J Surg 1977; 133: 373–376.Google ScholarPubMed
43.Shepherd, AP, Granger, DN. Metabolic regulation of the intestinal circulation. In: Shepherd, AP, Granger, DN (eds). Physiology of the Intestinal Circulation. Raven Press, New York, 1984, Pp 33–47.Google Scholar
44.Reilly, P, Bulkley, GB. The splanchnic hemodynamic response to circulatory shock. In: Peters, TJ (ed). The Cell Biology of Inflammation in the Gastrointestinal Tract. Corners Publications, London, 1990, pp 145–166.Google Scholar
45.Kvietys, PR, Granger, DN. Physiology, pharmacology, and pathologyofthe colonic circulation. In: Shepherd, AP, Granger, DN (eds). Physiology of the Intestinal Circulation. Raven Press, New York, 1984, pp 131–142.Google Scholar
46.Taylor, KM. Vasopressor release and multiple organ failure in cardiac surgery. Perfusion 1988; 3: 1–16.CrossRefGoogle Scholar
47.Taylor, KM, Brannan, JJ, Bain, WH, Caves, PK, Morton, IJ. Role of angiotensin II in the development of peripheral vasocon striction during cardiopulmonary bypass. Cardiovasc Res 1979; 13: 269–273.CrossRefGoogle Scholar
48.Gorin, AB, Liebler, J. Changes in serum angiotensin-convert ing enzyme during cardiopulmonary bypass in humans. Am Rev Respir Dis 1986; 134: 79–84.Google Scholar
49.Favre, L, Vallotton, MB, Muller, AF. Relationship between plasma concentrations of angiotensin I, Angiotensin II, and plasma renin activity during cardiopulmonary bypass in man. Europ J Clin Invest 1974; 4: 135–140.CrossRefGoogle ScholarPubMed
50.Harker, LA, Malpass, TW, Branson, HE, Hessel, EA IISlichter, SJ. Mechanism of abnormal bleeding in patients undergoing cardiopulmonary bypass: Acquired transient platelet dysfunction associated with selective granule release. Blood 1980; 56: 824–834.Google ScholarPubMed
51.Marath, A, Man, W, Taylor, KM. Paediatric extracorporeal priming procedures: Does low temperature priming promote histamine release? Perfusion 1988; 3: 287–293.CrossRefGoogle Scholar
52.Marath, A, Man, W, Taylor, KM. Histamine release in paediatric cardiopulmonary bypass-a possible role in the capillary leak syndrome. Agents Actions 1987; 20: 299–302.CrossRefGoogle ScholarPubMed
53.Pang, LM, Stalcup, SA, Lipset, JS, Hayes, CJ, Bowman, FO Jr, Mellins, RB. Increased circulating bradykinin during hypo thermia and cardiopulmonary bypass in children. Circulation 1979; 60: 1503–1512.CrossRefGoogle Scholar
54.Mohamed, MS.Bean, JW. Local and general alterations of blood CO and influence of intestinal motility in regulation of intestinal blood flow. Am J Physiol 1951; 167: 413–425.CrossRefGoogle Scholar
55.Svanvik, J, Tyllstrom, J, Wallentin, I. The effects of hypercapnia and hypoxia on the distribution of capillary blood flow in the denervated intestinal vascular bed. Acta Physiol Scand 1968; 74: 543–551.CrossRefGoogle ScholarPubMed
56.Mathie, RT, Desai, JB, Taylor, KM. The effect of normorher mic cardiopulmonary bypass on hepatic blood flow in the dog. Perfusion 1986; 1: 245–253.CrossRefGoogle Scholar
57.Waldhausen, JA, Lombardo, CR, McFarland, JA, Cornell, WP, Morrow, AG. Studies of hepatic blood flow and oxygen consumption during total cardiopulmonary bypass. Surgery 1959; 46: 1118–1127.Google Scholar
58.Rudy, LW Jr, Heymann, MA, Edmunds, LH Jr. Distribution of systemic blood flow during cardiopulmonary bypass. J Appl Physiol 1973; 34: 194–200.CrossRefGoogle ScholarPubMed
59.Boucher, JK, Rudy, LW Jr, Edmunds, LH Jr. Organ blood flow during pulsatile cardiopulmonary bypass. J AppI Physiol 1974; 36: 86–90.CrossRefGoogle ScholarPubMed
60.Lees, MH, Herr, RH, Hill, JD, Morgan, CL, Oschner, AJ III, Van Fleet, DL. Distribution of systemic blood flow of the rhesus monkey during cardiopulmonary bypass. J Thorac Cardiovasc Surg 1971; 61: 570–586.CrossRefGoogle Scholar
61.Rudy, LW, Boucher, JK, Edmunds, LH Jr. The effect of deep hypothermia and circulatory arrest on the distribution of systemic blood flow in rhesus monkeys. J Thorac Cardiovasc Surg 1972; 64: 706–713.CrossRefGoogle ScholarPubMed
62.Swain, JA. Acid-base status, hypothermia, and cardiac surgery. Perfusion 1986; 1: 231–238.CrossRefGoogle Scholar
63.Ream, AK, Reitz, BA, Silverberg, G. Temperature correction of PCO2 and pH in estimating acid-base status: An example of the emperor's new clothes? Anesthesiology 1982; 56: 41–44.CrossRefGoogle ScholarPubMed
64.Schupbach, P, Pappova, E, Schilt, W, Kollar, J, Kollar, M, Sipos, P, Vucic, D. Perfusate oncotic pressure during cardiopulmo nary bypass: Optimum level as determined by metabolic acidosis, tissue edema, and renal function. Vox Sang 1978; 35: 332–344.CrossRefGoogle Scholar
65.Kuttila, K, Valtonen, M, Kostewicz, W, Vanttinen, E, Niinikoski, J. Visceral and peripheral tissue perfusion during hypothermic cardiac surgery. Perfusion 1991; 6: 131–139.CrossRefGoogle Scholar
66.Edelstone, DI, Holzman, IR. Fetal and neonatal intestinal circulations. In: Shepherd, AP, Granger, DN (eds). Physiology of the Intestinal Circulation. Raven Press, New York, 1984, pp 179–190.Google Scholar
67.Ohri, SK, Abel, PD. The pathophysiology of nephrourological complications following cardiopulmonary bypass. Perfusion 1991; 6: 79–91.CrossRefGoogle Scholar
68.Koning, HM, Koning, AJ, Defauw, JJAM. Optimal perfusion during extra-corporeal circulation. Scand J Thor Cardiovasc Surg 1987; 21: 207–213.Google ScholarPubMed
69.Weinstein, GS, Rao, PS, Vretakis, G, Tyras, DH. Serial changes in renal function in cardiac surgical patients. Ann Thorac Surg 1989; 48: 72–76.CrossRefGoogle ScholarPubMed
70.Ridgen, SPA, Barratt, TM, Dillon, MJ, DeLeval, M, Stark, J. Acute renal failure complicating cardiopulmonary bypass surgery. Arch Dis Child 1982; 57: 425–430.Google Scholar
71.Tanaka, J, Yasui, H, Nakano, E, Sese, A, Matsui, K, Takeda, Y, Tokunaga, K. Predisposing factors of renal dysfunction follow ing total correction oftetralogy of Fallot in the adult. J Thorac Cardiovasc Surg 1980; 80: 135–140.CrossRefGoogle Scholar
72.Bove, EL, West, HL, Pasanik, AM. Hypothermic cardiopulmo nary bypass: A comparison between alpha and pH stat regula tion in the dog. J Surg Res 1987; 42: 66–73.CrossRefGoogle Scholar
73.Utley, JR, Wachtel, C, Cain, RB, Spaw, EA, Collins, JC, Stephens, DB. Effects of hypothermia, hemodilution, and pump oxy genation on organ water content, blood flow and oxygen delivery, and renal function. Ann Thorac Surg 1981; 31: 121–133.CrossRefGoogle Scholar
74.Withey, WR, Chapman, BJ, Munday, KA. Distribution of blood flow in the hypothermic (27°C) dog kidney. Clin Science Molecular Med 1976; 51: 583–588.Google Scholar
75.Utley, JR, Stephens, DB, Wachtel, C, Cain, RB, Collins, JC, Spaw, EA, Moores, WY. Effect of albumin and mannitol on organ blood flow, oxygen delivery, water content, and renal function during hypothermic hemodilution cardiopulmo nary bypass. Ann Thorac Surg 1982; 33: 250–257.CrossRefGoogle Scholar
76.Dworkin, LD, Brenner, BM. The renal circulations. In: Brenner, BM, Rector, FC Jr (eds). The Kidney. WB Saunders, Philadelphia, 1991, pp 164–204.Google Scholar
77.Maddox, DA, Brenner, BM. Glomerular ultrafiltration. In Brenner, BM, Rector, FC Jr (eds). The Kidney. WB Saunders, Philadelphia, 1991, pp 205–244.Google Scholar
78.Beran, AV, Sperling, DR, Wakabayashi, A, Connolly, JE. Renal tissue oxygenation during pulsatile and nonpulsatile left heart bypass. Adv Exp Med Biol 1973; 37A: 407–415.CrossRefGoogle ScholarPubMed
79.Thompson, T, Minami, K, Dramburg, W, Vyska, K, Koerfer, R. The influence of pulsatile and nonpulsatile extracorporeal circulation on fluid retention following coronary artery bypass grafting. Perfusion 1992; 7: 201–211.CrossRefGoogle ScholarPubMed
80.Mavroudis, C. To pulse or not to pulse. Ann Thorac Surg 1978; 25: 259–271.CrossRefGoogle ScholarPubMed
81.Hickey, PR, Buckley, MJ, Philbin, DM. Pulsatile and nonpulsatile cardiopulmonary bypass: Review of a counter productive controversy. Ann Thorac Surg 1983; 36: 720–737.CrossRefGoogle Scholar
82.Louagie, YA, Gonzalez, M, Collard, E, Mayne, A, Gruslin, A, Jamart, J, Buche, M, Schoevardts, JC. Does flow character of cardiopulmonary bypass make a difference? J Thorac Cardiovasc Surg 1992; 104: 1628–1638.CrossRefGoogle Scholar
83.London, MJ, Franks, M, Verrier, ED, Merrick, SH, Levin, J, Mangano, DT. The safety and efficacy often percent pentastarch as a cardiopulmonary bypass priming solution. J Thorac Cardiovasc Surg 1992; 104: 284–296.CrossRefGoogle ScholarPubMed
84.Paret, G, Cohen, AJ, Bohn, DJ, Edwards, H, Taylor, R, Geary, D, Williams, WG. Continuous arteriovenous hemofiltration after cardiac operations in infants and children. J Thorac Cardiovasc Surg 1992; 104: 1225–1230.CrossRefGoogle ScholarPubMed
85.Andersen, MN, Hambraeus, G, Alfano, GA, Schenk, WG Jr. Distribution of splanchnic and peripheral blood flow during acute reduction in circulatory rate. Ann Surg 1961; 153: 477–482.CrossRefGoogle ScholarPubMed
86.Ebert, PA, Greenfleld, LJ, Gilbert, JW, Morrow, AG. Physi ologic changes accompanying profound hypothermia. Surg Gynecol Obstet 1961; 113: 138–142.Google Scholar
87.Fantini, GA, Zadeh, BJ, Chiao, j, Krieger, KH, Isom, OW, Shires, GT. Effect of hypothermia on cellular membrane function during low-flow extracorporeal circulation. Surgery 1987; 102: 132–139.Google ScholarPubMed
88.Zwischenberger, JB, Kirsh, MM, Dechert, RE, Arnold, DK, Bartlett, RH. Suppression of shivering decreases oxygen con sumption and improves hemodynamic stability during post operative rewarming. Ann Thorac Surg 1987; 43: 428–431.CrossRefGoogle Scholar
89.Jani, K, Carli, FM, Bidstrup, BP, Royston, D. Prevention of body temperature reduction (afterdrop) following hypother mic perfusion. Perfusion 1988; 3: 301–306.CrossRefGoogle Scholar
90.Pennock, JL, Pierce, WS, Waldhausen, JA. The management of the lungs during cardiopulmonary bypass. Surg Gynecol Obstet 1977; 145: 917–927.Google ScholarPubMed
91.Balis, JU, Cox, WD, Pifarre, R, Lynch, R, Neville, WE. The role ofpulmonary hypoperfusion and hypoxia in the postperfusion lung syndrome. Ann Thorac Surg 1969; 8: 263–273.CrossRefGoogle Scholar
92.Kaplan, SL, Sullivan, SF, Maim, JR. Bowman, FO Jr, Papper, EM. Effect of cardiac bypass on pulmonary diffusing capacity. 1969; 57: 738–746.Google ScholarPubMed
93.Jones, DK, Higenbottam, TW, Wheeldon, D, Kneeshaw, J, Bethune, D, Wallwork, J. Prostacyclin, cardiopulmonary by pass and the alveolar capillary membrane. Perfusion 1986; 1: 165–173.CrossRefGoogle Scholar
94.Almond, CH, Jones, JC, Snyder, HM, Meyer, BW, Patrick, J. Hypoxia of the lung parenchyma during cardiopulmonary bypass. Arch Surg 1966; 93: 986–989.CrossRefGoogle ScholarPubMed
95.Ghia, J, Andersen, NB. Pulmonary function and cardiopulmo nary bypass. J Am Med Assoc 1970; 212: 593–597.CrossRefGoogle Scholar
96.Mills, AN, Haworth, SG. Greater permeability of the neonatal lung. J Thorac Cardiovasc Surg 1991; 101: 909–916.CrossRefGoogle ScholarPubMed
97.Mandelbaum, I, Giammona, ST. Bronchial circulation during cardiopulmonary bypass. Ann Surg 1966; 164: 985–989.CrossRefGoogle ScholarPubMed
98.Robbins, SL, Cotran, RS. Pathologic Basis of Disease. W.B. Saunders, Philadelphia, 1979.Google Scholar
99.Rudy, LW, Heymann, MA, Edmunds, LH Jr. Distribution of systemic blood flow during total cardiopulmonary bypass in rhesus monkeys. Surg Forum 1970; 21: 149–151.Google ScholarPubMed
100.Miller, DR.Kuenzig, MC. Pulmonary changes following nor mothermic and profound hypothermic perfusion in dogs. Thorac Cardiovasc Surg 1968; 56: 717–731.CrossRefGoogle Scholar
101.Gallagher, JD, Moore, RA, Kerns, D, Jose, AB, Botros, SB, Flicker, S, Naidech, H, Clark, DL. Effects of colloid or crystal. bid administration on pulmonary extravascular water in the postoperative period after coronary artery bypass grafting. Anesth Analg 1985; 64: 753–758.CrossRefGoogle ScholarPubMed
102.Svennevig, JL, Lindberg, H, Geiran, O, Semb, BKH, Abdelnor, M, Ottesen, S, Vatne, K. Should the lungs be ventilated during cardiopulmonary bypass? Clinical, hemodynamic, and meta bolic changes in patients undergoing elective coronary artery surgery. Ann Thorac Surg 1984; 37: 295–300.CrossRefGoogle Scholar
103.Weedn, RJ, Coalson, JJ, Greenfleld, U. Effects of oxygen and ventilation on pulmonary mechanics and ultrastructure dur ing cardiopulmonary bypass. Am J Surg 1970; 120: 584–590.CrossRefGoogle Scholar
104.Cartwrighr, RS, Lim, TPK, Luft, UG, Palich, WE. Pathophysi ological changes in the lung during extracorporeal circulation. Circ Res 1962; 10: 131–141.CrossRefGoogle Scholar
105.Sullivan, SF, Patterson, RW, Malm, JR. Effect of heart-lung bypass on the mechanics of breathing in man. J Thorac Cardiovasc Surg 1966; 51: 205–212.CrossRefGoogle ScholarPubMed
106.Puskas, JD, Hirai, T, Christie, N, Mayer, E, Slutsky, AS, Patterson, GA. Reliable thirty-hour lung preservation by donor lung hyperinflation. J Thorac Cardiovasc Surg 1992; 104: 1075–1083.CrossRefGoogle ScholarPubMed