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N. UNNO, N. SHINOZUKA, Y. KUWABARA, T. OKAI, S. KOUZUMA, M. MIZUNO, K. ...
1989 Volume 18 Issue 2 Pages
963-967
Published: April 15, 1989
Released on J-STAGE: October 07, 2011
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The oxygen consumption (OC) patterns of the goat fetuses in the extrauterine fetal incubation system were investigated. OC remained nearly constant (6-7ml/min/kg) above a oxygen delivery (OD) of 10ml/min/kg, and the OC became linearly dependent upon the OD below a OD of 10ml/min/kg. There was no significant difference between the OCs of the REM and the non-REM periods. It was suggested that there was mild suppression in the oxygen consumption of the extrauterine fetuses.
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[in Japanese]
1989 Volume 18 Issue 2 Pages
968
Published: April 15, 1989
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T. SEO, T. ITO, K. IIO, H. TAKAGI
1989 Volume 18 Issue 2 Pages
969-972
Published: April 15, 1989
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Hemodynamic effect of VA-ECMO using an air-driven, pulsatile blood pump (Takagi's pump) was studied by measuring PAP, LAP, LVP, RVP and AP in six small mongrel dogs. Swan-Ganz catheter and catheters through the auricles were used. Mean PAP, RVP, RVEDP decreased when bypass flow increased. These findings indicated a definite support to the right heart. LV systolic pressure was equivalent to systolic AP at the low bypass flow rate. On the other hand, systolic AP tended to decrease, though LV systolic pressure remained stable at the flow rate of 60ml/kg/min or more. This discrepancy in pressure between LV and femoral artery was observed even when bypass flow rate was decreased, and appeared to be related with circulatory failure.
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I. SAKUMA, A. FUNAKUBO, Y. FUKUI, T. KAWAMURA
1989 Volume 18 Issue 2 Pages
973-976
Published: April 15, 1989
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We developed a prototype of a compact ECMO system for the neonates with resipiratory failure. The features of the system are: 1) A single lumen catheter is used for both blood withdrawal and infusion. 2) The blood pump system consists of 1 diaphragm pump and 3 clamps controlled by a microcomputer. 3) Activated coagulation time both in vivo and in ECMO system are adjusted by controlled injection of anticoagulant using two drug infusion pumps. 4) Compact size and low priming volume (65ml). The ECMO system offers favorable gas transfer, while avoiding excessive negative pressure at blood withdrawal. Activated clotting time was controlled by heparin and protamine infusion and by an ultra-short acting anticoagulant naf amostat mesilate (FUT-175) infusion.
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S. TANABE, T. YAMADA, H. NAKAHARA, N. OHSIMA
1989 Volume 18 Issue 2 Pages
977-980
Published: April 15, 1989
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Reported are the beneficial use of membranous oxygenator on the respiratory function but controversy still exists in the superiority of the membranous oxygenator to the bubble oxygenator. Influence on the postperative respiratory index (RI) was compared between the group of membranous oxygenator (M-group, HF 4000: 24, CAPIOX-E: 9, CAPIOX-II: 2, MAXIMA: 8 cases) and bubble oxygenator (B-group, H 1700: 62 cases) with no significant difference in the age, BSA, MPAWP, MPAP, CI, Pa02 (Fi02 0.2) and type of cardiac diseases preoperatively and in the perfusion time, aortic cross-clamp time, lowest body temperature, fluid and blood balance, platelet count and free Hb level at the end of CPB. RI at 1st POD>2 was observed in 17 of 43 patients in M-group and 4 of 62 patients in B-group (p<0.05) and mean RI in the in 6 post operative hour and 1st POD was 2.07 in M-group and 1.18 in B-group (p<0.05), respectively despite no significant correlation between hemodynamics and RI, nor between oncotic pressure and RI, postoperatively. The data did not indicate the superiority of membranous oxygenator on the postoperative respiratory function.
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Y. MAEO, M. YAMASAKI, T. YAMASHIRO, S. IZUMI, Y. NONAMI, K. MATSUSAKI, ...
1989 Volume 18 Issue 2 Pages
981-986
Published: April 15, 1989
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Complement activation, especially anaphylatoxin levels was investigated in 68 patients undergoing cardiopulmonary bypass (CPB). They were divided into membrane (MOG) and bubble oxygenator groups (BOG). Influence of primed homologous to circulating autologous blood volume ratio (H/A) was also examined. Each group was further divided into following subgroups: those primed with homologous whole blood (BOG-W, MOG-W) and those primed with fresh homologous concentrated red cells and human albumin (BOG-A, MOG-A). C4a increased slowly during CPB in both groups, maintaining slightly higher levels in the BOG than in the MOG. C3a increased more steeply in the BOG than in the MOG. C5a levels in the BOG were higher than those in the MOG. Influence of H/A ratio was milder in the MOG than in the BOG. In the BOG-A, anaphylatoxin levels were slightly lower than in the BOG-W. In experimental studies with monkeys, continuous intraaortic infusion of O
2 bubbled autologous blood increased C4a and C3a levels, while autologous blood extracorporeally contacted with nylon increased C3a levels alone. In vitro studies, human Immunoglobulin (Ig) denatured by O
2 bubbling produced C4a, C3a, and C5a in a dose-dependent manner, whereas human albumin treated identically as human Ig did not produce them. It was thus inferred that (1) during CPB, complement is predominantly activated via classical pathway in the BOG and via alternative pathway in the MOG; and (2) Ig-free sera reduce complement activation, particularly in the BOG at high H/A ratio.
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A. HIRANO, M. YAMASHITA, K. HISATOMI, T. ISOMURA, Y. ISAMOTO, I. KOUSA ...
1989 Volume 18 Issue 2 Pages
987-990
Published: April 15, 1989
Released on J-STAGE: October 07, 2011
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Post perfusion syndrome sometimes occurs after cardiopulmonary bypass. It is reported that pulmonary leukocyte sequestration and complement activation play a causative role to induce the syndrome. The purpose of this study is to compare bubble oxygenators with membrane oxygenators effecting on neutrophil function, complement activation and pulmonary leukocyte sequestration. Patient were divided into two groups. 10 patients were perfusate with bubble oxygenators (Group B) and 20 patients were perfusate with membrane ooxygenators (Group M). Number, H
2O
2 generation and agglutination of neutrophil, and serum complement activation (C3a, C5a)were measured. Lung biopy was performed in 5 of Group B and 10 of Group M before and after cardio ulmonary bypass and the number of neutrophil in the specimen from lung biopy were counted under light microscope. The results were as follows:
1. In Group B there were more increased neutrophil number, H202 generation during cardiopulmonary bypass and the increasing ratio of serum C3a between pre and post cardiopulmonary bypass as compares to those in Group M.
2. In Group B there were more number of agglutinative neutrophiles in the pulmonary tissue than those in Group M. These findings may suggest that membrane oxygenators is more physiological apparatous than bubble oxygenators.
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[in Japanese]
1989 Volume 18 Issue 2 Pages
991
Published: April 15, 1989
Released on J-STAGE: October 07, 2011
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T HOSHINO, I KOYAMA, M KAZUI, R OMOTO, N NAGASHIMA, M KADOKURA
1989 Volume 18 Issue 2 Pages
992-999
Published: April 15, 1989
Released on J-STAGE: October 07, 2011
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This study was designed to evaluate the possibility of successful liver transplantation from non-heart-beating donors (NHBD) by core cooling technique (CCT). Anesthetized pigs were subjected to varying periods of cardiac arrest (CA) followed by reoxygenation and cooling by cardiopulmonary bypass (CPB), i. e. CCT. In the orthotopic liver transplantation model, recipient pigs survived for more than four days when livers were harvested by CCT from NHBD, which had been subjected to relatively short periods (less than 20 minutes) of CA. On the other hand, all the recipients died when livers were removed by currently-used flush technique (FT) from NHBD, regardless of the duration of CA. Those survival rates correlated well with the recovery of Energy Charge and Oxygen Consumption of the livers. Continuous oxygenation of organs by CCT appeared to play a major role in recovery of liver viability from ischemic insults.
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M NARUKO, H TOYOHIRA, A NISHIMURA, K FURUZONO, D TABATA, R ISHIBE
1989 Volume 18 Issue 2 Pages
1000-1003
Published: April 15, 1989
Released on J-STAGE: October 07, 2011
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Blood flow was recorded with two electromagnetic flow probes on the brachiocephalic artery (BCA) and one common femoral artery (CFA) during hypothermic pulsatile cardiopulmonary bypass (CPB). Significant decrease of BCA blood flow (26 to 20°C) following mild decrease of that (28°C) was observed. A decreasing tendency of CFA blood flow was seen more than that of BCA blood flow during CPB. These data indicate that change of cerebral blood flow is more mild than the other organs in this region.
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K. ASHIMURA, H. GOTO, V. KANEKO, K. NISHIMURA, J. UTOH, V. MIYAUCHI
1989 Volume 18 Issue 2 Pages
1004-1007
Published: April 15, 1989
Released on J-STAGE: October 07, 2011
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This study was performed to assess application of VPCML to the adult cases in comparison with IFCML on the 112 patients receiving cardiac surgery. Priming volume was significantly lower in VPCML group (64 cases) than IFCML group (48 cases). In spite of small membrane surface area of VPCML, good gas transfer data was obtained in VPCML group through deep anesthesia, quick control of FiO
2 based on O
2 saturation data, and control of blood flowand warming speed. Cases with body weight over 65kg in VPCML group showed longer warming time, however, weaning from CPB was smmoth. Total priming volume of VPCML group could be reduced to 1100ml. These results suggest that VPCML can be used for adult cardiac surgery without homologous blood transfusion.
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K SOEJIMA, Y IMAI, Y BEPPU, Y FUKUI, K. TSUTIYA
1989 Volume 18 Issue 2 Pages
1008-1011
Published: April 15, 1989
Released on J-STAGE: October 07, 2011
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Developing pulsatile cardiopulmonary bypass (CPB) system for infants, experimental and clinical studies were done. In experiments of 5 dogs, pulsatile (PF) and steady (SF) flow perfusion were exchanged every 20min. in each dogs. Systemic vascular resistance (SVR) in PF was significantly lower than in SF. Renal blood flow in PF significantly showed higher than in SF. At the same level of mean blood pressure, renal blood flow in PF was significantly higher than in SF. One hundred and twenty one clinical cases were performed open heart operations by this system. Ninety four of 121 cases were mainly perfused by PF. These age were ranged 2 days-10 years old, weight were 2.2-26.0Kg and perfusion time were 22-272min. Comparing with clinical data in PF (n=10) and SF (n=12), Jatene's operations were studied. SVR in PF significantly showed lower than in SF. Systemic venous return in PF was significantly better than in SF. There was no problem during open heart operation using this system.
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[in Japanese]
1989 Volume 18 Issue 2 Pages
1012
Published: April 15, 1989
Released on J-STAGE: October 07, 2011
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J. KAMO, K. KAMADA, T. TAKEMURA
1989 Volume 18 Issue 2 Pages
1013-1016
Published: April 15, 1989
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The gas transfer performances in gas-membrane-water were investigated with various membranes, and consequently optimal design of the hollow fiber membrane for artificial lungs was determined. Refer to this analysis, we developed a multilayered composite hollow fiber membrane [MHF] that has a thin dense layer. In vitro evaluation MHF showed good gas transfer for long-term perfusion, and no serum leakage was observed. Moreover, vapor loss was less enough. MHF could have the possbility for ECMO.
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K. HAGIWARA, H. KITOH, H. OSHIYAMA, O. NOMURA, A. NOGAWA, Y. KATURA, H ...
1989 Volume 18 Issue 2 Pages
1017-1020
Published: April 15, 1989
Released on J-STAGE: October 07, 2011
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We developed the method of covalent binding of heparin to the plastic surfaces with amino residues in heparin. We applied this method to the oxygenators and cicuits and evaluated its thrombo-resistant property using A-V shunt method for 8 hours circulation with dogs. In heparinized cases, circulations was smoothly performed through 8 hours, and the release of heparin and the hematological changes were not observed. IN no heparinized cases, blood flow was stopped within 4 hours circulation in 2 cases. And in 1 case, ciculation was performed through 8 hours, but the blockade rate of oxygenator was up to 80% after circulation. These result demonstrate that the heparinized oxygenaters and circuits applied our method have a good thrambe-resistant property.
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K. ESAKI, J. TAKESHITA, T. TANOUE, H. KISHI, K. HIGASHI, H. TERASAKI, ...
1989 Volume 18 Issue 2 Pages
1021-1024
Published: April 15, 1989
Released on J-STAGE: October 07, 2011
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Effects of heparin bonded artificial membrane lung and circuit on blood coagulation were invsstigated in prolonged extracorporeal lung assist of goats. A veno-venous bypass ECLA was performed in twelve goats up to ten days. Six of them (group I) were with heparin bonded device and the other six (group II) were with the usual device. In group I, heparin was continuously infused at a rate of 17 unit/kg/hr to maintaine the activated coagulation time at around 130 seconds, while in group II 30unit/kg/hr of heparin was necessary to maintain ACT at about 200 seconds to prevent blood coagulation in the bypass circuit. Number of platelet decreased significantly in group I (by 40% of pre ECLA value) as well as group II, but aggregation activity was higher than in group II. Fibrinopeptide A and antithrombin III and other coagulation factors showed no significant difference between two groups. Autopsy showed no major pathological findings. ECLA with heparin bonded surface provided excellent blood compartibility and required only a little systemic heparin administration. The heparin bonded bypass circuit will enable ECLA even in hemorrahgic patients.
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J. ISOBE, H. MIZUNO, S. MATUNOBE, K. CHIHARA, S. WATANABE, Y. SHIMIZU, ...
1989 Volume 18 Issue 2 Pages
1025-1028
Published: April 15, 1989
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6 Mongrel dogs were anesthetized and intubated. After muscular paralysis induced by pancronium, extracorporeal circulation (ECC) was initiated under apneic CPAP, i. e. 100% O
2, 10cm H
2O airway pressure. Oxygenation was maintained by transalveolar oxygen diffusion, while CO
2 was converted to bicarbonate by the systemic infusion of trihydroxymethylamino methane (THAM); generated bicarbonate was removed by hemodialysis. Blood flow rate of ECC was 15ml/kg/min. Volume of CO
2 removed from blood was about 30ml/dl during ECC. This method caused depletion of bicarbonate, and infusion of THAM was required.
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[in Japanese]
1989 Volume 18 Issue 2 Pages
1029
Published: April 15, 1989
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K. HOSHINO, K. TANISHITA
1989 Volume 18 Issue 2 Pages
1030-1033
Published: April 15, 1989
Released on J-STAGE: October 07, 2011
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Mortensen (1987) suggested the use of an Intravenacaval Blood Gas Exchange Device (IVCBGE) for assisting the acute respiratory failure, and the membrane lung inserted in the superior vena cava enables to perform the gas exchange as a cross-flow blood oxygenator. The woven tubes membrane oxygenator can potentially suit this method and we have been investigating the oxygen transfer performance of cross-flow woven tubes oxygenator in order to see the feasibility of woven tubes used for IVCBGE. The gas transfer performance in blood turns out to be sufficiently improved to meet the requirement of IVCBGE.
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M. YANAGISAWA, N. HOSOYA, R. ISHIBASHI, T. OHMURA, K. KUWANA, H. NAKAN ...
1989 Volume 18 Issue 2 Pages
1034-1037
Published: April 15, 1989
Released on J-STAGE: October 07, 2011
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We clarified gas tansport in inside and outside blood flow oxygenators with and without pulsatile flow pump from the standpoint of boundary layer resistance. Pulsatile flow is of Beat 60 cycle/min and Duratlon 60%. Blood flow rate of inside blood flow oxygenator ranged from 1.0 to 4.0l/mln, while that of outside blood flow oxygenator ranged from 1.5 to 6.7l/min. Pulsatile flow is superior to nonpulsatile flow in gas exchange efficfency because of marked differences in the destruction of boundary layer resistance. We examined differences in gas exchange efficiency at the inner position of the module. The outer position of the module is superior to the inner position in gas exchange efficiency.
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H. ABE, T. OKADA, S. KAMADA, S. HINATA, T. MIETA, M. HOSON, T. KAWADA, ...
1989 Volume 18 Issue 2 Pages
1038-1042
Published: April 15, 1989
Released on J-STAGE: October 07, 2011
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We analyzed the serial changes of various hematological parameters during early atage of cardiopulmonary bypass (CPB) in order to evaluate the difference of hematological compatibility between extra- (Group 1) and intracapillary type hollw fiber oxygenator (Group 2). No significant difference of qualitive and quantitative changes of platelet were noted between two groups, however, in Group 2, the accentuation of platelet release reaction was significantly suppressed in the early stage of CPB. In Group 1, the plasma levels of FPA and FPB β showed temporal elevations 5 minutes after initiation of CPB. It is concluded that extracapillary type hollow fiber oxygenator is superior to intracapillary type in regard to the hematological compatibility in the early stage of CPB.
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A. SOHMA, S. NYU, K. NISHIYAMA, T. KAWAI, Y. KANKI, Y. WADA, S. SIRAKA ...
1989 Volume 18 Issue 2 Pages
1043-1046
Published: April 15, 1989
Released on J-STAGE: October 07, 2011
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Continuous monitoring of circulating blood volume become possible using
51Cr. Adding that, intracorporeal volume and extracorporeal volume are respectively measured. We can also measure hematocrit, using impedance method, and plasma colloid osmotic pressure, using semipermeable membrane. It is well known that edema occurs after cardiopulmonary bypass. Edema can be explained fluid shift from intravascular space to perivascular space. And this driving force is summarized by the Starling's hypothesis. According to this new method, we can measure the intravascular Starling's force continuously, and also actual volume of fluid shift.
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[in Japanese]
1989 Volume 18 Issue 2 Pages
1047
Published: April 15, 1989
Released on J-STAGE: October 07, 2011
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K. ONISHI, Y. NONAMI, Y. MAEO, A. TAKAHASHI, H. NISHIMORI, T. TAMIYA
1989 Volume 18 Issue 2 Pages
1048-1051
Published: April 15, 1989
Released on J-STAGE: October 07, 2011
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Plasma renin activity, Angiotensin I, Angiotensin II, Aldosterone, Angiotensin-converting enzyme of the blood were determined with adult mongrel dogs undergoing non-pulsatile and pulsatile extracorporeal circulation (ECC) to classify humonal and neural regulation of renin-angiotensin-aldosterone (R-A-A) system. Effects of cervical division of automatic nerves below carotid bodies were also evaluated. The blood was sampled from inferior aorta, cervical, pulmonary, renal, portal and hepatic vein to analyze activation of R-A-A system in brain, lung, kidney, portal system organs and liver. Results were as follows; 1) Activation of R-A-A system was observed in lung, kidney, and brain during ECC, and it was stronger during non-pulsatile ECC than during pulsatile ECC. 2) R-A-Asystem was dominantly influenced by division of automatic nerves at a cervical level.
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N. HANDA, S. KYO, A. SEKIGUCHI, K. UEDA, S. KIMURA, Y. YOKOTE, R. OMOT ...
1989 Volume 18 Issue 2 Pages
1052-1055
Published: April 15, 1989
Released on J-STAGE: October 07, 2011
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In order to predict liver dysfunction after cardiopulmonary bypass (CPB), we measured acetoacetate (ACA), -hydroxybutyrate, total keton body concentrations, and keton body ratio (KBR) in 31 patients before, during, and after CPB. These four parameters of Group 1 (GPT>100IU/L, n=8) were compared to those of Group 2 (normal liver function, n=23). ACA and KBR of Group 1 at aortic declamp were significantly smaller than those of Group 2. None of those four parameters was affected by either rectal temperature or perfusion pressure. In conclusion, KBR and ACA at aortic declamp appear to be useful parameters for predicting GPT elevation after CPB.
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A. MURAKAMI, M. AIBA, K. SAIDA, H. YOKOKAWA, M. FUNAMI, T. TAKABA
1989 Volume 18 Issue 2 Pages
1056-1058
Published: April 15, 1989
Released on J-STAGE: October 07, 2011
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This study investigates the clinical evaluation of the relationships, using γ-GT, β
2-m and Ccr, between the urine volume during extracorporeal circulation (ECC) using the membrane oxygenator and post operative renal function. Thirty patients were devided into three groups according to urine volume (UV) during ECC: Group I, 7 patients, UV<5ml/min, Group II, 8 patients, 5<UV<10ml/min, Group III, 15 patients 10ml/min<UV. γ-GT levels had a pattern of change similar to that of β
2-m. I group demonstrated higher levels of γ-GT and significantly slower recovery of Ccr as compared with II, III groups. This study showed the γ-GT was a good marker of tubular function, and in order to maintain the renal function, it was thought to be very important to secure the UV levels at least over 10ml/min from the early stage of ECC.
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M. AIBA, A. MURAKAMI, M. FUNAMI, T. TAKABA
1989 Volume 18 Issue 2 Pages
1059-1062
Published: April 15, 1989
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Renal function on extracoporeal circuration (ECC) was evaluated by urinary microalubumin (U-Alb) that was seen to be reflected early renal glomerular damage, on 21 patients who were undergone open heart surgery. Changes of U-Alb and AlbI (u-AlbI/U-Cr) were evaluated. The patients were divided into two groups, according to AlbI levels. U-Alb levels decreased during ECC and increased after operation, then decreased gradually. AlbI increased remarkably during and after ECC, and after operation. The effects of factors concering to operation and ECC on U-Alb excretions were evaluated, but there were no relationships with them. The cases that kept AlbI above mean levels to 12 hours after operation, also had indicated AlbI above mean level before operation, and of ten complicated Diabetis Melitis. Increase of U-Alb excretion during ECC thought to be mainly due to functional damage of renal glomeruli, but the cases that already have had renal dysfunction before ECC should be taken care of after operative management, because organic change might be taken after ECC.
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T. KURATANI, H. MATSUDA, Y. SIMAZAKI, [in Japanese], Y. SAWA, H. TAKAM ...
1989 Volume 18 Issue 2 Pages
1063-1066
Published: April 15, 1989
Released on J-STAGE: October 07, 2011
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In the experimental study, unilateral pulmonary artery (PA) of rabbits (n=5) was occluded for 3hrs during partial ECC and then reperfusing it for 1hr. The lung biopsy specimens taken from lung with PA occlusion [PAO (+)] and without occlusion [PAO (-)] every 30 minutes were reviewed for ultrastructural assessment. Basement membrane thickness (BMT) with point count method were measured. In PAO (+), BMT after reperfusion (REP) was significantly higher than during ECC. And after REP, PAO (+) had a siqnificantly higher BMT compared to PAO (-). In Clinical study with lung specimens taken after ECC in 15 patients with Congenital cardiac disease, a positive linear correlation was found between BMT and CPB time.
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[in Japanese]
1989 Volume 18 Issue 2 Pages
1067
Published: April 15, 1989
Released on J-STAGE: October 07, 2011
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[in Japanese]
1989 Volume 18 Issue 2 Pages
1069
Published: April 15, 1989
Released on J-STAGE: October 07, 2011
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