J.Jpn. Surg. Soc.. 60(7): 1195-1213, 1959

---

STUDIES ON THE CARBOHYDRATE AND PHOSPHATE METABOLISM IN VARIOUS CONDITIONS OF CARDIAC OCCLUSION FOR INTRACARDIAC SURGERY WITH SPECIAL REFERENCES TO CEREBRAL METABOLISM.
PART Ⅱ. CARBOHYDRATE AND PHOSPHATE METABOLISM IN EXTRACORPOREAL CIRCULATION.

After preliminary expeiment of "Azygos Factor Principle" on dogs, the author investigated the changes of intermediary carbohydrate and phosphate products in arterial and cerebral venous blood and cerebral and hepatic tissues of dogs undergoing extracorporeal circulation with autogenous lung oxygenation and modified Dewall and Lillehei Type artificial heart and lung machine, with varying rate and duration of perfusion.
And on 11 clinical cases of intracardiac surgery with extracorporeal ciaculation, studies were made on arterial and jugular venous blood samples.
The results were summarized as follows :
1) In "Azygos Factor Principle" (cardiac output of about 10 cc/kg/min), severe degree of anerobic metabolic process was observed in cerebral and hepatic tissues showing remarkable decrease of high energy phosphate comound and increase of inorganic phosphate and lactic acid after 20 minutes, less remarkable in brain than in liver.Comparing with chemical changes of cerebral tissues of dogs after 5 minute occlusion in normothermia, 15 minutes were considered to be a safety limit under these low flow circulation.
2) In autogenous lung oxygenation method, varying perfusion rate of 10-30cc/kg/min. were employed for 30 minute cardiac bypass. In each flow rate, hyperglycemia and lactacidosis and increase of L/P ratio were observed remarkably, and the changes of cerebarl high energy phosphate and lactic acid concentgation were minimal in the group of 30/cc/kg/min. flow rate.
3) In extracorporeal circulation employing artificial heart and lung mechine with flow range of 10-63cc/kg/min., similar chemical changes were observed in blood and cerebral and hepatic tissues. In the group of the perfusion rate above 30cc/kg/min., cerebral chemical constituents were relatively well maintaind and brain metabolism under these conditions seemed to be in good functional state.
As to the etiologic factor of the metabolic acidosis in the perfusion, tissue hypoxia was considered to be predominant in case of below 20cc/kg/min. flow rate, and the stimulation of the sympathetic nervous system in case of above 30cc/kg/min. flow rate.
4) The findings of the study of 11 clinical cases under total body perfusion were essentially similar to those of animal experiments, and brain metabolism seemed not irreverively impaired under these conditions.
5) After perfusion, the lactate concentration of arterial blood showed a tendency to decrease in general, but in severe cases, it still remaind on increased level after 3 hours after perfusion. It is surmised, therefore, that the atitude of arterial lactate concentration is an index to predict the prognosis of the perfused animals or patients.
(author's abstract)

---

---

To read the PDF file you will need Adobe Reader installed on your computer.