Systemic Inflammatory Response Syndrome (SIRS) is a new concept of entry criteria for sepsis. This concept, when applied to area of Multiple Organ Failure (MOF), is considered to be a preparatory state for MOF. To study the significance of SIRS state at cardiac surgery, we measured the body temperature, white blood cell count, respiratory rate and heart rate of 18 patients who underwent elective cardiac surgery, from the 1st post-operative day to the 7th post-operative day. We also measured Interleukin-6 and 8 (IL-6 and IL-8) to understand the relationship between the SIRS state and inflammatory cytokines just after cardiopulmonary bypass (CPB), at the 1st, 3rd and 6th postoperative day. The result was as follows: Patients with CPB more than 120 minutes have more frequency and longer duration of SIRS than patients with CPB less than 120 minutes. Serum levels of IL-8 at SIRS state were revealed statistically higher than at non-SIRS case. Duration of SIRS state was related to CPB time and serum levels of IL-6 and IL-8 just after CPB. We concluded that SIRS state is an indication for anti-cytokine therapy to prevent MOF, and it is important to shorten CPB time in order to decrease the duration of SIRS.
Hypertrophied hearts may be more susceptible to ischemia/reperfusion during cardiac surgery than normal hearts, so we designed to compare the alterations in left ventricular function after ischemia/reperfusion, in hypertrophied hearts (Group H) with those in normal hearts (Group C), using a rabbit heart model of hypertrophy induced by banding of the ascending thoracic aorta. The pre and postischemic left ventricular developed pressure (LVDP), left ventricular end-diastolic pressure (LVEDP), positive and negative dP/dt, and coronary flow were measured. The percent recovery of coronary flow and negative dP/dt were significantly lower in Group H than in Group C (p < 0.05). The LVEDP was significantly greater in Group H, and the LVEDP increased significantly from the base line value in Group H (p < 0.05). There was no significant difference in other value between two groups. These findings demonstrated that LV diastolic dysfunction rather than LV systolic dysfunction occurred in the early ischemic stage, especially to hypertrophied hearts, indicating that better protection is required for these hearts.
We report on a 74-year-old woman with an absence of right superior vena cava in visceroatrial situs solitus who underwent mitral valve plasty for severe mitral regurgitation. Preoperative three-dimensional computed tomography revealed an absent right and persistent left superior vena cava that drained into the right atrium by way of the coronary sinus. Perioperaively, placement of pulmonary artery catheter, site of venous cannulation, and management of associated rhythm abnormalities were great concern. Obtaining the information about this central venous malformation preoperatively, we performed mitral valve plasty without any difficulties related to this anomaly.
