Increased Plasma Adrenomedullin Concentrations during Cardiac Surgery

1998 ◽  
Vol 94 (6) ◽  
pp. 585-590 ◽  
Author(s):  
Toshio Nishikimi ◽  
Yukio Hayashi ◽  
Gentaro Iribu ◽  
Shuichi Takishita ◽  
Yoshio Kosakai ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Pulmonary Vein ◽  
Coronary Sinus ◽  
Vascular Endothelial Cells ◽  
Vascular Endothelial ◽  
Elevated Plasma ◽  
Specific Radioimmunoassay ◽  
Duration Of Surgery ◽  
Severity Of The Disease

1. Adrenomedullin (AM), a potent hypotensive peptide, was originally isolated from human phaeochromocytoma. Plasma AM concentrations are elevated in hypertension, heart failure and renal failure in proportion to the severity of the disease. This study was performed to investigate the pathophysiological significance of AM during cardiac surgery. 2. Serial blood samples were obtained from patients undergoing cardiac surgery and plasma AM concentrations were determined by specific radioimmunoassay. 3. Plasma AM concentrations did not increase with anaesthesia or surgery (n = 9). Plasma AM concentrations gradually increased during cardiopulmonary bypass and after pulmonary reperfusion. After pulmonary reperfusion, plasma AM concentrations increased further. In addition, we measured plasma AM concentrations in the pulmonary vein (n = 8) and coronary sinus (n = 8) to examine the contribution of the lungs and heart to the increase in circulating AM concentrations after cardiopulmonary bypass. However, no significant differences were seen in plasma AM concentrations of the pulmonary vein or the coronary sinus and the aorta. Peak AM concentrations during cardiac surgery correlated with duration of surgery. Elevated plasma AM levels during and after surgery began to decline next day after surgery and returned to normal levels 7 days after surgery. 4. These results demonstrate that plasma AM concentrations increase during cardiac surgery and that the duration of surgery may be related to the changes in AM concentrations. Taken together with recent findings that vascular endothelial cells and vascular smooth muscle cells actively produce AM, these results suggest that plasma AM during cardiac surgery may act as a vasodilatory hormone.

MEASUREMENT OF CYTOKINE LEVELS BY CORONARY SINUS BLOOD SAMPLING DURING CARDIAC SURGERY WITH CARDIOPULMONARY BYPASS

ASAIO Journal ◽  
1996 ◽  
Vol 42 (2) ◽  
pp. 59
Author(s):  
N. Karube ◽  
R. Adachi ◽  
Y. Ichikawa ◽  
T. Kosuge ◽  
Y. Yamazaki ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Coronary Sinus ◽  
Blood Sampling ◽  
Cytokine Levels ◽  
Coronary Sinus Blood

Role of connexin 43 in vascular hyperpermeability and relationship to Rock1-MLC20 pathway in septic rats

2015 ◽  
Vol 309 (11) ◽  
pp. L1323-L1332 ◽  
Author(s):  
Jie Zhang ◽  
Guang-ming Yang ◽  
Yu Zhu ◽  
Xiao-yong Peng ◽  
Tao Li ◽  
...  
Keyword(s):  
Vascular Permeability ◽  
Pulmonary Vein ◽  
Connexin 43 ◽  
Vascular Endothelial Cells ◽  
Pulmonary Veins ◽  
Cecal Ligation ◽  
Underlying Mechanism ◽  
Vascular Endothelial ◽  
Cx 43

Connexin (Cx)43 has been shown to participate in several cardiovascular diseases. Increased vascular permeability is a common and severe complication in sepsis or septic shock. Whether or not Cx43 takes part in the regulation of vascular permeability in severe sepsis is not known, and the underlying mechanism has not been described. With cecal ligation and puncture-induced sepsis in rats and lipopolysaccharide (LPS)-treated vascular endothelial cells (VECs) from pulmonary veins, the role of Cx43 in increased vascular permeability and its relationship to the RhoA/Rock1 pathway were studied. It was shown that vascular permeability in the lungs, kidneys, and mesentery in sepsis rats and LPS-stimulated monolayer pulmonary vein VECs was significantly increased and positively correlated with the increased expression of Cx43 and Rock1 in these organs and cultured pulmonary vein VECs. The connexin inhibitor carbenoxolone (10 mg/kg iv) and the Rock1 inhibitor Y-27632 (2 mg/kg iv) alleviated the vascular leakage of lung, mesentery, and kidney in sepsis rats. Overexpressed Cx43 increased the phosphorylation of 20-kDa myosin light chain (MLC20) and the expression of Rock1 and increased the vascular permeability and decreased the transendothelial electrical resistance of pulmonary vein VECs. Cx43 RNA interference decreased the phosphorylation of MLC20 and the expression of Rock1 and decreased LPS-stimulated hyperpermeability of cultured pulmonary vein VECs. The Rock1 inhibitor Y-27632 alleviated LPS- and overexpressed Cx43-induced hyperpermeability of monolayer pulmonary vein VECs. This report shows that Cx43 participates in the regulation of vascular permeability in sepsis and that the mechanism is related to the Rock1-MLC20 phosphorylation pathway.

Monocyte activation markers during cardiopulmonary bypass

Perfusion ◽  
2003 ◽  
Vol 18 (2) ◽  
pp. 83-86 ◽  
Author(s):  
R Fink ◽  
M Al-Obaidi ◽  
S Grewal ◽  
M Winter ◽  
J Pepper
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Coronary Sinus ◽  
Renal Tissue ◽  
Monocyte Count ◽  
Activation Markers ◽  
Hla Dr ◽  
Atherosclerotic Process ◽  
Extracorporeal Support

Extracorporeal support during cardiac surgery initiates an inflammatory response, causing damage to cardiac, pulmonary and renal tissue [Post Pump Syndrome (PPS)]. This is accompanied by a neutrophil leucocytosis and lymphopenia, but less is known about the role of monocytes and markers of monocyte activity. We studied 19 patients undergoing cardiac surgery, obtaining blood samples from the aortic root (AR) and from the coronary sinus (< s) before the cardiopulmonary bypass (CPB), 1 min after release of the aortic crossclamp and 10 min after weaning from CPB (periods 1, 2 and 3). Leucocyte count, monocyte count and HLADR, CD15, CD11b and CD62L activation markers were measured. In samples obtained from the coronary sinus (CS), HLA-DR, expressed as a percentage of the monocyte count, decreased between periods 1, 2 and 3 by 78%, 66% and 43%, respectively. A similar change was observed in samples from the AR. Conversely, CD62L increased in the CS samples (55%, 68% and 73%), but revealed a lesser increase in the AR samples (51%, 68% and 63%). The other markers showed little change throughout the procedure. Reduced immunological competence could result from the decrease in HLA-DR counts. Increases in CD62L sensitizes monocytes to the tethering effects of endothelial integrins and might contribute to the atherosclerotic process.

MEASUREMENT OF CYTOKINE LEVELS BY CORONARY SINUS BLOOD SAMPLING DURING CARDIAC SURGERY WITH CARDIOPULMONARY BYPASS

ASAIO Journal ◽  
1996 ◽  
Vol 42 (2) ◽  
pp. 59
Author(s):  
N. Karube ◽  
R. Adachi ◽  
Y. Ichikawa ◽  
T. Kosuge ◽  
Y. Yamazaki ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Coronary Sinus ◽  
Blood Sampling ◽  
Cytokine Levels ◽  
Coronary Sinus Blood

Measurement of Cytokine Levels by Coronary Sinus Blood Sampling During Cardiac Surgery With Cardiopulmonary Bypass

ASAIO Journal ◽  
1996 ◽  
Vol 42 (5) ◽  
pp. M787-791 ◽  
Author(s):  
NORIHISA KARUBE ◽  
RYUJI ADACHI ◽  
YUKIO ICHIKAWA ◽  
TAKAYUKI KOSUGE ◽  
ICHIYA YAMAZAKI ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Coronary Sinus ◽  
Blood Sampling ◽  
Cytokine Levels ◽  
Coronary Sinus Blood

Abstract 2353: Angiopoietin Expression in Children Following Cardiopulmonary Bypass

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
John S Giuliano ◽  
Patrick M Lahni ◽  
Michael T Bigham ◽  
David P Nelson ◽  
Peter B Manning ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Troponin I ◽  
Vascular Endothelial Cells ◽  
Vascular Endothelial ◽  
Capillary Leak ◽  
Vascular Growth ◽  
Tie2 Receptor ◽  
Life Threatening ◽  
Host Inflammatory Response

Introduction: Capillary leak syndrome (CLS) is a serious, potentially life-threatening problem in children with congenital heart disease (CHD) that is partly related to the host inflammatory response following cardiopulmonary bypass (CPB). The angiopoietins are a family of vascular growth factors that are necessary for angiogenesis. Two members of the angiopoietin family are well characterized in humans - angiopoietin-1 (angpt-1) and angpt-2 - both of which appear to act on the Tie2 receptor, found primarily on vascular endothelial cells. Angpt-1 protects against capillary leak, while angpt-2 promotes increased vascular permeability and potentiates inflammation. Hypothesis: We hypothesized that plasma angpt-2 levels increase following CPB and correlate with indices of systemic inflammation and capillary leak. Methods: Plasma samples were obtained at baseline and at 0, 4, and 24 h after CPB in 49 children (median age 5 mo) with CHD. Troponin-I, angpt-1, angpt-2, VEGF, and soluble Tie2 (sTie2) were measured via a commercially available ELISA. Cytokines were measured using a multiplex cytokine assay. Results: CPB (mean CPB 119 min, cross-clamp, 71 mins) increased troponin-I, IL-6, IL-8, and IL-10 expression. Plasma angpt-2 levels increased by 6 h (952 pg/mL vs 462 pg/mL, p<0.05) and remained significantly elevated at 24 h after CPB (1850 pg/mL, p<0.05). Plasma angpt-1 levels remained unchanged immediately after CPB, but were significantly decreased at 24 h after CPB (635 pg/mL vs 991 pg/mL, p<0.05). Similarly, plasma sTie2 levels increased after CPB (6.4 ng/mL vs 2.86 ng/mL, p<0.05) before returning to baseline by 6 h after CPB. Plasma VEGF levels were not different at any timepoint. Plasma angpt-2 levels after CPB signficantly correlated with troponin-I, IL-6, IL-8, and IL-10 levels. There was a significant correlation between plasma angpt-2 levels and CPB time. Finally, higher plasma angpt-2 levels at 6 h correlated significantly with increased length of stay in the CICU (r=0.86; p<0.0001). Conclusions: Angpt-2 appears to be an important biomarker of vascular endothelial injury and capillary leak following CPB in children with CHD. Further studies on the role of angpt-2 in the pathophysiology of CLS following CPB are warranted.

scholarly journals Can we use endocan level to determine severity of pancreatitis?

2021 ◽  
Vol 84 (2) ◽  
pp. 321-325
Author(s):  
A.R. Baykan ◽  
I Baydar ◽  
E Şebin ◽  
Y Ozdemir ◽  
S Cerrah ◽  
...  
Keyword(s):  
Vascular Endothelial Cells ◽  
Area Under The Curve ◽  
Scoring Systems ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Vascular Endothelial ◽  
Large Populations ◽  
Index Of Severity ◽  
Severity Of The Disease ◽  
The Relationship

Background and study aims: Endothelial cell specific molecule-1 (ESM-1), also known as endocan, is a soluble proteoglycan secreted by human vascular endothelial cells. In some studies, it has been found that endocan have important effects on cell adhesion, inflammation and angiogenesis. In this study, we aimed to evaluate the endocan level in patients with pancreatitis and the availability of endocan level in determining the severity of the disease. Patients and methods: A total of 42 patients with pancreatitis and 33 healthy individuals were included in the study. The serum endocan levels in patients were evaluated 1st and 3 th days after the symptom’s onset. Current scoring systems and the relationship between the severity of the disease and endocan levels were evaluated. Results: The endocan levels of the patients on day 1 are significantly correlated only with the APACHE II score (p=0.039 r=0.319), while the endocan values on day 3 are significantly correlated with the BISAP (bedside index of severity in acute pancreatitis) (p=0.013 r=0.380), APACHE II (Acute Physiology and Chronic Health Evaluation)(p<0.001; r=0.53) and Ranson (p=0.037 r=0.32) scores. The cutoff level of endocan (day 3) was calculated 92.2 pg/ml (83% sensitivity and 50% specificity; p=0.039 area under the curve 0.706) for severe pancreatitis when considering the patients with a score of 8 or higher in the APACHE II scoring system. Conclusion: Serum endocan level can be used as a marker of prognosis in patients with pancreatitis. However, studies involving large populations are needed on this matter.

Lung and chest wall mechanical properties before and after cardiac surgery with cardiopulmonary bypass

1994 ◽  
Vol 76 (1) ◽  
pp. 166-175 ◽  
Author(s):  
G. M. Barnas ◽  
R. J. Watson ◽  
M. D. Green ◽  
A. J. Sequeira ◽  
T. B. Gilbert ◽  
...  
Keyword(s):  
Mechanical Properties ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Tidal Volume ◽  
Chest Wall ◽  
Respiratory System ◽  
Supine Posture ◽  
Duration Of Surgery ◽  
Before And After ◽  
System Properties

From measurements of airway and esophageal pressures and flow, we calculated the elastance and resistance of the total respiratory system (Ers and Rrs), chest wall (Ecw and Rcw), and lungs (EL and RL) in 11 anesthetized-paralyzed patients immediately before cardiac surgery with cardiopulmonary bypass and immediately after chest closure at the end of surgery. Measurements were made during mechanical ventilation in the frequency and tidal volume ranges of normal breathing. Before surgery, frequency and tidal volume dependences of the elastances and resistances were similar to those previously measured in awake seated subjects (Am. Rev. Respir. Dis. 145: 110–113, 1992). After surgery, Ers and Rrs increased as a result of increases in EL and RL (P < 0.05), whereas Ecw and Rcw did not change (P > 0.05). EL and RL exhibited nonlinearities (i.e., decreases with increasing tidal volume) that were not seen before surgery, and RL showed a greater dependence on frequency than before surgery. The changes in RL or EL after surgery were not correlated with the duration of surgery or cardiopulmonary bypass time (P > 0.05). We conclude that 1) frequency and tidal volume dependences of respiratory system properties are not affected by anesthesia, paralysis, and the supine posture, 2) open-chest surgery with cardiopulmonary bypass does not affect the mechanical properties of the chest, and 3) cardiac surgery involving cardiopulmonary bypass causes changes in the mechanical behavior of the lung that are generally consistent with those caused by pulmonary edema induced by oleic acid (J. Appl. Physiol. 73: 1040–1046, 1992) and decreases in lung volume.

scholarly journals A study on correlation of coronary sinus lactate and troponin T levels with perioperative outcome in patients undergoing cardiac surgery on cardio pulmonary bypass

2021 ◽  
Author(s):  
Rupesh Kumar ◽  
Vidur Bansal ◽  
Subhendu Mahapatra ◽  
Gautam Sengupta
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Coronary Sinus ◽  
Heart Surgery ◽  
Troponin T ◽  
Artery Bypass ◽  
Open Heart Surgery ◽  
Perioperative Outcomes ◽  
Aortic Cross Clamp ◽  
Pulmonary Bypass

Abstract Myocardial ischemia is a metabolic phenomenon that occurs in patients undergoing open heart surgery like coronary artery bypass grafting (CABG), valvular heart surgery, vascular surgeries etc., due to stress imposed during cardiopulmonary bypass (CPB), obligatory interruption of coronary blood flow during aortic cross clamp and reperfusion after aortic cross clamp release. The present study is designed to have a detailed study on estimation of coronary sinus lactate and troponin t levels in patients undergoing cardiac surgery with cardiopulmonary bypass and its correlation with various parameters related to the perioperative outcomes.

scholarly journals Acute Kidney Injury in Cardiac Surgery with Cardiopulmonary Bypass

2021 ◽  
Vol 18 (6) ◽  
pp. 38-47
Author(s):  
Yu. S. Polushin ◽  
D. V. Sokolov ◽  
N. S. Molchan ◽  
R. V. Аkmalova ◽  
O. V. Galkina
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Kidney Disease ◽  
Serum Creatinine ◽  
Renal Dysfunction ◽  
Kidney Injury ◽  
Tubular Damage ◽  
Free Hemoglobin ◽  
Duration Of Surgery

Changes in classification criteria and active introduction of biomarkers of acute kidney injury (KDIGO, 2012) are changing approaches to diagnosis and treatment of postoperative renal dysfunction including cardiac surgery patients operated with cardiopulmonary bypass (CPB). The objective: to compare the detection rate of AKI after surgery with CPB with the use of biomarkers and kidney disease improving global outcomes criteria, as well as to evaluate the cause and localization of structural changes of the nephron.Subjects and Methods. A monocenter observational study among elective cardiac surgery patients (n = 97) was conducted. Inclusion criteria: age over 18 years, duration of surgery (coronary bypass surgery, prosthetic heart valves) from 90 to 180 minutes, no signs of end stage kidney disease. AKI was diagnosed based on changes in serum creatinine and biomarkers (NGAL, IgG, albumin in urine). The studied parameters were recorded 15 minutes after the start and end of anesthesia, as well as 24 and 48 hours after surgery. Retrospectively, the group was divided into three subgroups: 1) patients without AKI after surgery; 2) patients in whom signs of AKI were detected after 24 hours but regressed by the 48th hour; 3) patients in whom AKI persisted during all 48 hours of follow-up.Results. 24 hours after surgery, AKI based on KDIGO criteria was recorded in 56.3% of patients. Using biomarkers, signs of tubular damage (NGAL) at the end of anesthesia were detected in 95.9% of patients; after 24 hours, they were registered in 73.2% of cases. In a subgroup where AKI persisted for more than 24 hours, glomeruli were damaged in addition to tubules which was manifested not only by selective but also by non-selective proteinuria. The duration of CPB, hemodilution (Hb < 90 g/l), the release of free hemoglobin in the blood (> 1.5 mg/l) at low (< 1 g/l) values of haptoglobin were significantly associated with AKI development.Conclusion. The KDIGO criteria do not allow detecting a subclinical form of renal dysfunction which may occur in about 40% of patients after surgery with CPB. AKI can be caused by damage to both the tubular part of the nephron and glomeruli in cases of prolonged CPB with the development of hemolysis, the release of free hemoglobin in the blood, and persisting anemia at the end of the surgery. The NGAL assessment makes it possible to detect subclinical kidney injury in the absence of elevated serum creatinine levels.

Sign in / Sign up

Export Citation Format

Share Document