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The Journal of Cardiovascular Surgery 2000 April;41(2):291-4

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Postoperative splanchnic perfusion following the re-construction of thoracoabdominal aortic aneurysm involving abdominal visceral branches. Report of a case

Oshima K., Morishita Y., Ishikawa S., Tsuda K., Ohtaki A., Takahashi T., Suzuki M.

From the Second Department of Surgery Gunma University School of Medicine Gunma, Japan


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A 58-­year-old man ­with thor­a­coab­dom­i­nal aor­tic aneu­rysm involv­ing vis­cer­al arter­ies under­went ­graft replace­ment of the thor­a­coab­dom­i­nal aor­ta and asso­ciat­ed recon­struc­tion of abdom­i­nal vis­cer­al branch­es. Femoro-femo­ral extra­cor­po­real ­bypass, inter­mit­tent selec­tive vis­cer­al arte­ri­al per­fu­sion and a stag­ing ­cross-clamp­ing meth­od of the aor­ta ­were uti­lized at sur­gery. The ­total ­cross-clamp­ing ­time of the aor­ta was 165 min­utes. The ­patient’s post­op­er­a­tive ­course was unevent­ful ­with no inci­dence of hepat­ic and ­renal fail­ure or par­a­ple­gia. Although post­op­er­a­tive system­ic ­blood pres­sure and car­diac out­put recov­ered to nor­mal val­ues with­in 7 hrs ­after the ­release of aor­tic clamp­ing, it ­took 18 hrs for hepat­ic ­venous hemo­glo­bin oxy­gen sat­u­ra­tion (ShvO2) to recov­er. Base ­excess in arte­ri­al ­blood, lac­tic ­acid in arte­ri­al and hepat­ic ­venous ­blood, and ­ketone ­body ­ratio in arte­ri­al ­blood (­AKBR) and hepat­ic ­venous ­blood (HVKBR) recov­ered to with­in nor­mal rang­es ­after 18 hrs of the ­release of aor­tic clamp­ing. ShvO2 mon­i­tor­ing is a sim­ple and may be a use­ful param­e­ter in eval­u­at­ing post­op­er­a­tive splanch­nic per­fu­sion and pre­dict­ing abdom­i­nal ­organ fail­ure at the ­time of thor­a­coab­dom­i­nal aor­tic recon­struc­tion involv­ing vis­cer­al arter­ies.

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