Effects of a phosphodiesterase III inhibitor on circulating blood volume after cardiopulmonary bypass

Hamada, Yusuke; Kawachi, Kanji; Nakata, Tatsuhiro; Tsunooka, Nobuo; Takano, Shinji; Kohtani, Takashi

doi:10.1007/s003800070034

Cited by 5 publications

(9 citation statements)

References 12 publications

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“…Although several methods exist for measuring circulating blood volume, using for example hydroxyethyl starch or a radioactive isotope, 10,20 pulse dye densitometry is noninvasive and reliable. 6 The combination of these 2 methods enables a simple and straightforward determination of capillary leakage.…”

Section: Discussionmentioning

confidence: 99%

“…The ICG concentration was plotted semilogarithmically and extrapolated back to the mean transit time point to determine the initial ICG concentration, from which blood volume was calculated. 6 Blood volume was determined preoperatively, immediately after surgery, 2, 4, 6, 12, and 24 hours postoperatively, and on the 7 th postoperative day.…”

Section: Methodsmentioning

confidence: 99%

“…5 The effect of microvascular leakage is most prominent at the end of surgery, when the circulating blood volume may decrease. 6 These patients may have some degree of myocardial dysfunction as well and are likely to be hemodynamically unstable. Therefore, knowledge of the pattern of change in capillary leakage following cardiac surgery with CPB could be valuable for early postoperative management.…”

Section: Introductionmentioning

confidence: 99%

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Capillary Leakage in Cardiac Surgery with Cardiopulmonary Bypass

Hamada

Kawachi

Tsunooka

et al. 2004

Asian Cardiovasc Thorac Ann

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Cardiopulmonary bypass causes a systemic inflammatory response, which can lead to capillary leak syndrome. In 15 adults undergoing elective cardiac surgery with cardiopulmonary bypass, we determined the volume and peak time of capillary leakage from the measurements of extracellular fluid volume and circulating blood volume taken preoperatively, at various intervals up to 24 hours after surgery, and on the 7th postoperative day. Extracellular fluid volume rose from 15.5 +/- 2.7 L preoperatively to a peak 4 hours after surgery of 18.3 +/- 3.2 L and remained elevated at 24 hours. Circulating blood volume fell from 4.10 +/- 0.68 L preoperatively to 3.20 +/- 0.58 L at the end of surgery. Fluid administered intraoperatively did not raise the circulating blood volume. Intraoperative fluid balance was positive at 2.62 +/- 0.72 L but negative at all time points postoperatively. There was significant postoperative capillary leakage, increasing from 4.7% +/- 2.3% of body weight at the end of surgery to a peak 4 hours later of 5.4% +/- 2.0% and falling to 2.8% +/- 3.3% at 24 hours. This knowledge of the pattern of change in capillary leakage after cardiac surgery with cardiopulmonary bypass might serve as a valuable guide for postoperative management.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Capillary Leakage in Cardiac Surgery with Cardiopulmonary Bypass

Hamada

Kawachi

Tsunooka

et al. 2004

Asian Cardiovasc Thorac Ann

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“…Milrinone (0.5 µg·kg -1 ·min -1 infusion, no loading) may also be effective in restoring peripheral circulation after cardiac surgery [125] . A single bolus (1 or 1.5 mg/kg) of amrinone was sufficient to improve ventricular function [126] and maintain circulating blood volume [127] follow ing cardiopulmonary bypass. More recently, a prospective double-blind study involving 234 patients found that amrinone (1.5 mg/kg loading followed by 10 µg· kg -1 ·min -1 infusion) given upon release of aortic cross-clamp was successful in weaning more patients off of the cardiopulmonary bypass as compared with controls (21% vs 7%) [128] .…”

Section: Clinical Applications Of Pde3 Inhibitorsmentioning

confidence: 99%

Pivotal effects of phosphodiesterase inhibitors on myocyte contractility and viability in normal and ischemic hearts

Rao

2008

Acta Pharmacol Sin

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Phosphodiesterases (PDEs) are enzymes that degrade cellular cAMP and cGMP and are thus essential for regulating the cyclic nucleotides. At least 11 families of PDEs have been identified, each with a distinctive structure, activity, expression, and tissue distribution. The PDE type-3, -4, and -5 (PDE3, PDE4, PDE5) are localized to specific regions of the cardiomyocyte, such as the sarcoplasmic reticulum and Z-disc, where they are likely to influence cAMP/cGMP signaling to the end effectors of contractility. Several PDE inhibitors exhibit remarkable hemodynamic and inotropic properties that may be valuable to clinical practice. In particular, PDE3 inhibitors have potent cardiotonic effects that can be used for short-term inotropic support, especially in situations where adrenergic stimulation is insufficient. Most relevant to this review, PDE inhibitors have also been found to have cytoprotective effects in the heart. For example, PDE3 inhibitors have been shown to be cardioprotective when given before ischemic attack, whereas PDE5 inhibitors, which include three widely used erectile dysfunction drugs (sildenafil, vardenafil and tadalafil), can induce remarkable cardioprotection when administered either prior to ischemia or upon reperfusion. This article provides an overview of the current laboratory and clinical evidence, as well as the cellular mechanisms by which the inhibitors of PDE3, PDE4 and PDE5 exert their beneficial effects on normal and ischemic hearts. It seems that PDE inhibitors hold great promise as clinically applicable agents that can improve cardiac performance and cell survival under critical situations, such as ischemic heart attack, cardiopulmonary bypass surgery, and heart failure.

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“…2 Although fluid balance is negative thereafter, BV increases with time. 3 Thus, while BV is an important perioperative measurement in cardiac patients, it has not been reported in those undergoing valve operations. Specific perioperative management for each type of valvular disorder is essential.…”

Section: Introductionmentioning

confidence: 99%

Perioperative Circulating Blood Volume and Cardiac Function in Valve Disease

Tsunooka

Hamada

Takano

et al. 2006

Asian Cardiovasc Thorac Ann

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Circulating blood volume is important in managing fluid balance and cardiac function after surgery under cardiopulmonary bypass. Appropriate management differs among the valve disorders, but perioperative blood volume has not yet been considered. From February 2001 to March 2003, perioperative blood volume, fluid balance, cardiac index, and left ventricular stroke work index were measured in 31 patients: 10 with aortic stenosis, 9 with aortic regurgitation, 3 with mitral stenosis, and 9 with mitral regurgitation. All immediate postoperative blood volume measurements were less than preoperative values, and gradually returned to baseline. At all time points, blood volume in patients with aortic or mitral regurgitation was high, whereas it was low in those with stenosis, especially mitral stenosis. Fluid balance was positive in all patients. Postoperatively, there was a positive correlation between cardiac index and blood volume in all groups. The left ventricular stroke work index in the mitral regurgitation group was significantly higher than other groups, the aortic stenosis group was slightly lower, the mitral stenosis and mitral regurgitation groups were higher than the baseline, and the aortic regurgitation group was essentially unchanged. Thus, it is necessary to consider blood volume perioperatively in different valvular diseases to manage water balance.

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Effects of a phosphodiesterase III inhibitor on circulating blood volume after cardiopulmonary bypass

Cited by 5 publications

References 12 publications

Capillary Leakage in Cardiac Surgery with Cardiopulmonary Bypass

Capillary Leakage in Cardiac Surgery with Cardiopulmonary Bypass

Pivotal effects of phosphodiesterase inhibitors on myocyte contractility and viability in normal and ischemic hearts

Perioperative Circulating Blood Volume and Cardiac Function in Valve Disease

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