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Department of Anesthesiology and Critical Care Medicine and Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287-8711
Received 4 November 1996; accepted in final form 3 January 1997.
Zanaboni, Paul, Paul A. Murray, Brett A. Simon, Kenton Zehr,
Kirk Fleischer, Elaine Tseng, and Daniel P. Nyhan. Selective endothelial dysfunction in conscious dogs after cardiopulmonary bypass.
J. Appl. Physiol. 82(6):
1776-1784, 1997.
It has previously been demonstrated that
cardiopulmonary bypass (CPB) causes prolonged pulmonary vascular
hyperreactivity (D. P. Nyhan, J. M. Redmond, A. M. Gillinov, K. Nishiwaki, and P. A. Murray. J. Appl.
Physiol. 77: 1584-1590, 1994). This
study investigated the effects of CPB on endothelium-dependent
(acetylcholine and bradykinin) and endothelium-independent (sodium
nitroprusside) pulmonary vasodilation in conscious dogs. Continuous
left pulmonary vascular pressure-flow (LP-
) plots were generated in conscious dogs before CPB and again in the same animals 3-4 days post-CPB. The dose of U-46619 used to acutely preconstrict the pulmonary circulation to similar levels pre- and
post-CPB was decreased (0.13 ± 0.01 vs. 0.10 ± 0.01 mg · kg
1 · min
1,
P < 0.01) after CPB. Acetylcholine,
bradykinin, and sodium nitroprusside all caused dose-dependent
pulmonary vasodilation pre-CPB. The pulmonary vasodilator response to
acetylcholine was completely abolished post-CPB. For example, at left
pulmonary blood flow of 80 ml · kg
1 · min
1
acetylcholine (10 µg · kg
1 · min
1)
resulted in 72 ± 15% reversal (P < 0.01) of U-46619 preconstriction pre-CPB but caused no change
post-CPB. However, the responses to bradykinin and sodium nitroprusside
were unchanged post-CPB. The impaired pulmonary vasodilator response to
acetylcholine, but not to bradykinin, suggests a selective endothelial
defect post-CPB. The normal response to sodium nitroprusside indicates that cGMP-mediated vasodilation is unchanged post-CPB.
pulmonary circulation; endothelium-dependent vasodilation; endothelium-independent vasodilation; chronic instrumentation; pressure-flow plots
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