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The Journal of Thoracic and Cardiovascular Surgery, Vol 91, 858-866, Copyright © 1986 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
ME Faymonville, G Deby-Dupont, R Larbuisson, C Deby, L Bodson, R Limet and M Lamy
To study the effect of lung bypass on the production of prostaglandin E2,
prostacyclin, and thromboxane A2, we measured simultaneously arterial and
venous plasma concentrations of prostaglandin E2, 6-keto- prostaglandin F1
alpha (stable metabolite of prostacyclin), and thromboxane B2 (stable
metabolite of thromboxane A2) before, during, and after cardiopulmonary
bypass. Seventeen patients (age range 46 to 69 years) undergoing
aorta-coronary bypass grafts were investigated. The prostaglandin E2
production rose sharply immediately after the onset of bypass (baseline:
9.7 +/- 2.9 pg/ml to 85 +/- 16.6 pg/ml in venous and 87 +/- 12 pg/ml in
arterial plasma, p less than 0.03) and rapidly decreased after pulmonary
reperfusion (53 +/- 6.4 and 57 +/- 20 pg/ml, respectively, in venous and
arterial plasma at the end of bypass). The increase in prostaglandin E2 was
influenced by the heart- lung machine itself (as demonstrated by a closed
"bypass" circuit) and by lung bypass. Pulmonary metabolism of prostaglandin
E2 was maintained after bypass. The prostacyclin production rose
significantly at the beginning of bypass (154 +/- 26 pg/ml venous prebypass
level to 361 +/- 94 pg/ml after aortic clamping, p less than 0.03).
Prostacyclin decreased progressively during rewarming of the patient,
pulmonary reperfusion, and discontinuation of bypass. When prostacyclin
decreased, thromboxane B2 production rose significantly and reached peak
arterial levels when the lungs were reperfused (112 +/- 33 pg/ml prebypass
levels to 402 +/- 101 pg/ml, p less than 0.01). Except for prostaglandin
E2, there were no significant differences between arterial and venous
plasma levels of these substances. The same prostanoids were also measured
in five patients undergoing major orthopedic operations, and no significant
changes in prostanoids were observed. Our data demonstrate significant
production of prostaglandin E2 in the systemic circulation during
cardiopulmonary bypass in humans. They further indicate that lung bypass
disturbs the plasma prostaglandin/thromboxane balance.
ARTICLES
Prostaglandin E2, prostacyclin, and thromboxane changes during nonpulsatile cardiopulmonary bypass in humans
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