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

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


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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.

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