Home > Journals > The Journal of Cardiovascular Surgery > Past Issues > The Journal of Cardiovascular Surgery 1998 October;39(5) > The Journal of Cardiovascular Surgery 1998 October;39(5):619-23

CURRENT ISSUE
 

ARTICLE TOOLS

Reprints

THE JOURNAL OF CARDIOVASCULAR SURGERY

A Journal on Cardiac, Vascular and Thoracic Surgery


Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 2,179


eTOC

 

ORIGINAL ARTICLES  CARDIAC PAPERS


The Journal of Cardiovascular Surgery 1998 October;39(5):619-23

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

Vasoplegic syndrome after open heart surgery

Gomes W. J., Carvalho A. C., Palma J. H., Teles C. A., Branco J. N. R., Silas M. G., Buffolo E.

From the Cardiovascular Surgery and Cardiology Disciplines, Escola Paulista de Medicina and São Paulo Hospital - Federal University of São Paulo, São Paulo, S.P. Brazil


PDF  


Back­ground. A new ­form of post­per­fu­sion man­i­fes­ta­tion is ­detailed, a vas­o­plegic syn­drome pre­senting in the post­op­er­a­tive ­period ­after car­di­o­pul­mo­nary ­bypass (CPB) ­heart sur­gery.
­Methods. ­This ret­ro­spec­tive ­study ­included six­teen ­patients who under­went car­di­o­vas­cular sur­gery ­using CPB and exhib­ited clin­ical and hemo­dy­namic fea­tures com­pat­ible ­with vas­o­plegic syn­drome. The tech­nique of CPB was hypo­thermic (28°C) in 15 and nor­mo­thermic in 1 ­patient, and hypo­thermic ­blood car­di­o­plegia was ­employed in all ­patients, ­except 1. The ­mean CPB ­time was 121 min­utes, ­ranging ­from 80 to 210 min­utes.
­Results. The ­patients pre­sented a ­severe fea­ture com­prising hypo­ten­sion, tach­y­cardia, ­normal or ele­vated car­diac ­output, low ­systemic vas­cular resis­tance and ­decreased ­filling pres­sures. ­Fluid admin­is­tra­tion ­alone was not ­capable of ­restoring hemo­dy­namic param­e­ters. Phys­ical exam­ina­tion ­revealed ­normal cap­il­lary ­filling at the extrem­ities ­although oli­guria and hypo­ten­sion ­were ­observed. ­These ­patients ­needed a ­high ­dosage of vas­o­con­strictor ­drugs (nor­epi­neph­rine) for ­blood pres­sure con­trol but ­even ­high ­dose nor­epi­neph­rine did not pro­duce the clas­sical sit­u­a­tion of ­cool extrem­ities and ­weak periph­eral ­pulses, ­with ­increased mor­bidity and mor­tality. ­Severe ­systemic com­pli­ca­tions ­could ­develop if the vas­o­plegic syn­drome per­sisted 36-48 ­hours ­after its ­onset. All ­patients, ­except 3, pre­sented asso­ciated post­op­er­a­tive com­pli­ca­tions and 4 ­patients ­died. The char­ac­ter­is­tics of vas­o­plegic syn­drome are sim­ilar to ­those ­observed in ­septic ­shock, ­where the alter­a­tions are medi­ated by cyto­kines and ­tumor ­necrosis ­factor-α.
Con­clu­sions. The appear­ance of vas­o­plegic syn­drome aug­mented oper­a­tive mor­bidity ­with a con­se­quent ­increased ­risk to the ­patient in the ­early post­op­er­a­tive ­period.

top of page

Publication History

Cite this article as

Corresponding author e-mail