ORIGINAL ARTICLES  CARDIAC PAPERS 

The Journal of Cardiovascular Surgery 1999 April;40(2):191-5

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

Impaired lung oxygenation in acute aortic dissection

Hasegawa Y., Ishikawa S., Ohtaki A., Otani Y., Takahashi T., Sato Y., Koyano T., Yamagishi T., Ohki S., Kanda T., Morishita Y.

From the Second Department of Surgery and * Department of Laboratory Medicine Gunma University School of Medicine Maebashi, Japan

Back­ground. In the ­early ­phase ­after the ­onset of ­acute ­aortic dis­sec­tion, oxy­gen­a­tion impair­ment ­often ­occurs. How­ever, the eti­ology and clin­ical ­course of ­this phe­nom­enon ­have not ­been estab­lished. We exam­ined the ­serial ­changes of oxy­gen­a­tion, inflam­ma­tory reac­tion and labor­a­tory ­data in ­patients ­with ­acute ­aortic dis­sec­tion.
­Methods. ­Nine ­patients (­DeBakey ­type I; 4, ­type II; 3 and ­type ­IIIb; 2), ­aged 46 to 82 ­years ­were ­included in ­this ­study. All ­patients ­were man­aged in the inten­sive ­care ­unit, and sys­tolic arte­rial pres­sure was main­tained at ­around 110 to 120 ­mmHg. Oxy­gen­a­tion was ­impaired in all ­patients, ­three (33%) of ­whom ­required mechan­ical ven­til­a­tory sup­port.
­Results. ­Pleural effu­sion was ­observed in ­eight (89%) of ­nine ­patients. Res­pir­a­tory ­index was 0.98±0.19 (­mean ± SEM) at the ­time of admis­sion, and ele­vated to 1.59±0.35, 1.58±0.21, 1.60±0.28 respec­tively, at day 1, 2 and 3. Oxy­gen­a­tion ­index was 318±34 at the ­time of admis­sion, and ­decreased to 271±34, 255±19, 263±26, respec­tively, at day 1, 2 and 3. ­These ­values recov­ered to ­normal ­after day 4. The ­increase of ­white ­blood ­cells and ­high ­fever (>38°C) con­tinued ­until day 3. ­Platelet ­counts recov­ered ­after day 4. The ­serum bilir­ubin ­level was ­highest (2.0±0.5 mg/dl) at day 3, and ­decreased grad­u­ally ­after day 4. In two ­recent ­patients ­whose ­serum inter­leukin-8 (IL-8) was meas­ured, IL-8 ­levels ­increased ­according to the ­impaired oxy­gen­a­tion or aneu­rysmal enlarge­ment. ­Impaired oxy­gen­a­tion, inflam­ma­tory ­changes, ­platelet con­sump­tion and bilir­ubin ele­va­tion con­tinued ­until day 3 and ­resumed ­normal ­levels ­after day 4.
Con­clu­sions. ­These ­changes may be due to hemol­ysis, con­sump­tion coag­u­lop­athy or inflam­ma­tion asso­ciated ­with ­acute ­aortic dis­sec­tion. IL-8 ele­va­tion may be asso­ciated ­with aneu­rysmal enlarge­ment and ­these phe­nomena.