J.Jpn. Surg. Soc.. 94(8): 853-862, 1993

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Original article

CLINICAL AND EXPERIMENTAL STUDY OF HEMODYNAMIC CHANGES DURING AORTIC SURGERY

To clarify the influence of clamping of aorta on ischemic heart, 235 patients who underwent abdominal aorticsurgery from 1980 to 1989 were studied. One hundred and twenty patients underwent resection of abdominal aortic aneurysm, and 115 patients underwent operation for aortoiliac occlusive disease. Myocardial infarction occurred in 8 patients, and 4 patients died. The onsets of the myocardial infarction were later than the 3rd post operative day in every patient but one. There were no significant differences in the incidence of myocardial infarction between the patients of nonruptured abdominal aortic aneurysm and of aortoiliac occlusive disease.
To clarify the hemodynamic changes during abdominal aortic procedure, following experiments were performed using dogs. The dogs were divided into 6 groups, Groups 1, 3, 5 ; normal control groups, Group 2, 4, 6 ; groups with coronary stenoses. The infrarenal aorta were cross-clamped in groups 1, 2, 3, 4. In groups 3 and 4, PGE1 were administrated continuously into the infrarenal aorta below the clamping sites. In groups 5 and 6, descending thoracic aorta were cross-clamped. In group 6, one dog developed ventricular fibrillation at 60 minites after aortic cross-clamping. Moreover ECG of the other dog of group 6 demonstrated myocardial ischemia during aortic clamping. But there were no significant differences in hemodynamic variables between groups, 1, 3, 5 and 2, 4, 6. These results indicate that aortic clamping can induce the myocardial ischemia, but that ischemia is not the chief cause of postoperative myocardial infarction.

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