Efficiency of methods of pulmonary protection of patients having high pulmonary hypertension when correcting valve cardiac disorders

V.V. Pichugin, V.V. Bober, S.E. Domnin, V.O. Nikolskiy, A.P. Medvedev, A.V. Bogush, V.A. Chiginev
Keywords: pulmonary artery perfusion, breathing lungs, alprostadil
Medicinskij al'manah, 2017, issue 3, pages 130-136.

The aim of the study was to evaluate the effectiveness of lung protection methods in patients with high
pulmonary hypertension during heart valves surgery in conditions of cardiopulmonary bypass. Material and
methods. The study included 90 patients of both sexes, mean age 56,6±1,4 who underwent heart valve
operations and combined interventions. The mean pulmonary artery pressure was 41,2±1,6 mm Hg. All
patients were divided into four groups: the first (27 patients) – control; the second (24 patients) – during
CPB pulmonary artery perfusion with oxygenated blood and lungs ventilation were performed; the third
(16 patients) – during CPB pulmonary artery perfusion with nonoxygenated blood and lungs ventilation
were performed; the fourth (23 patients) consistently administered alprostadil (vasaprostan) at a dose of
0,002–0,003 μg/kg/min and pulmonary artery perfusion with oxygenated blood and lungs ventilation were
performed during CPB. A comparative evaluation was performed on the basis of changes in the functional
parameters of the lungs. In addition, for the morphological study, lung biopsies were taken. Results. The
behavior of the pulmonary artery perfusion in combination with lungs ventilation during CPB effectively
preserved the oxygenating function of the lungs, pulmonary compliance, reduced the intrapulmonary shunting
of the blood after CPB. There was no significant difference in the effectiveness of lung protection,
depending on the perfusion of the pulmonary arteries with oxygenated or non-oxygenated blood. The use
of alprostadil (vasoprostane) in combination with pulmonary artery perfusion/ventilation during CPB
reduced the intrapulmonary shunting of the blood compared to the only perfusion / ventilation method.
Morphological study showed that the use of the perfusion / ventilation technique during CPB preserved
their airiness and blood filling of the microcirculatory bed. The airiness of the lung tissue did not differ from
initial after 30 minutes of the restoration of blood circulation, and the blood filling of the microcirculatory bed
increased even more than the baseline in the series with vasaprostan. Conclusion. The pulmonary artery
perfusion and lungs ventilation during CPB greatly increase the effectiveness of lung protection in patients
with pulmonary hypertension. The additional use of alprostadil provided a reduction in the mean pulmonary
artery pressure at all stages of the operation and significantly reduced intrapulmonary shunting of the blood.

1. Gabriel E.A., Salerno T.A. Principles of Pulmonary Protection in Heart Surgery.
Springer-Verlag London Limited. 2010. 453p.
2. Magnusson L., Zemgulis V., Tehling A., Wernlund J., Tydеn H., Thelin S.,
Hedenstierna G. Use of a vital capacity maneuver to prevent atelectasis after
cardiopulmonary bypass. Anesthesiology. 1998. Vol. 88 (1). P. 134-142.
3. Carvalho E.M., Gabriel E.A., Salerno T.A. Pulmonary protection during
cardiac surgery: systematic literature review. Asian. Cardiovasc. Thorac. Ann.
2008. Vol. 16 (6). P. 503-507.
4. Ng C.S., Wan S., Yim A.P., Arifi A.A. Pulmonary dysfunction after cardiac
surgery. Chest. 2002. Vol. 121. P. 1269-1277.
5. Asimakopoulos G., Smith P.L., Ratnatunga C.P. Lung injury and acute
respiratory distress syndrome after cardiopulmonary bypass. Ann. Thorac. Surg.
1999. Vol. 68. P. 1107-1115.
6. Fowler A.A., Hamman R.F., Good J.T. Adult respiratory distress syndrome: risk
with common predispositions. Ann. Intern. Med. 1983. Vol. 98. P. 593-597.
7. Messent M., Sullivan K., Keogh B.F. Adult respiratory distress syndrome
following cardiopulmonary bypass: incidence and prediction. Anaesthesia. 1992.
Vol. 47. P. 267-268.
8. Schlensak C., Doenst T., Preusser S., Wunderlich M., Kleinschmidt M.,
Beyersdorf F. Bronchial artery perfusion during cardiopulmonary bypass does not
prevent ischemia of the lung in piglets: assessment of bronchial artery blood flow
with fluorescent microspheres. Eur. J. Cardiothorac. Surg. 2001. Vol. 19 (3).
P. 326-331; discussion 331-332.
9. Macedo F.I., Carvalho E.M., Gologorsky E., Salerno T. Gas Exchange during
lung perfusion/ventilation during cardiopulmonary bypass: preliminary results of a
pilot study. Open Journal of Cardiovascular Surgery. 2010. Vol. 3. P. 1-7.
10. Friedman M., Sellke F.W., Wang S.Y., Weintraub R.M., Johnson R.G.
Parameters of pulmonary injury after total or partial cardiopulmonary bypass.
Circulation. 1994. Vol. 90 (5 pt 2). P. 262-268.
11. Massoudy P., Piotrowski J.A., van de Wal H.C.J.M. Perfusing and ventilating the
patient’s lungs during bypass ameliorates the increase in extravascular thermal volume
after coronary bypass grafting. Ann Thorac Surg. 2003. Vol. 76. P. 516-521.
12.Martynyuk T.V., Masenko V.P., Chazova I.E., Belenkov Yu. N. Endotelial’naya
disfunkciya u bol’nykh s lyogochnoy gipertenziey. Kardiologiya. 1997. № 10.
S. 25-29.
13. Higgenbotam T. Pathology of pulmonary hypertension. A role of endothelial
dysfunction. Chest. 1994. Vol. 15 (suppl. 1). P. 7-12.
14. Klepetko W., Mayer Е., Sandoval J. Interventional and surgical modalities of
treatment for pulmonary arterial hypertension. J. Am. Coll. Cardiol. 2004. Vol. 43
(suppl. S). P. 73-80.
15. Strange J. W., Wharton J., Phillips P. G. Recent insights into the
pathogenesis and therapeutics of pulmonary hypertension. Clin Sci. 2002. Vol.
102. P. 253-268.
16. Kuhn К. P., Byrne D. W., Arbogast P. G. Outcome in 91 consecutive patients
with pulmonary arterial hypertension receiving epoprostenol. Am. J. Respir. Crit.
Care Med. 2003. Vol. 167. P. 580-586.
17. Bolevich S., Mukhin N., Popova E., Fomin V. Vazaprostan (Alprostadil,
Prostaglandin E1) v lechenii lyogochnoy gipertenzii. Vrach. 2007. № 1.
S. 42-47.
18. Pichugin V.V., Mel’nikov N.Yu., Medvedev A.P., Gamzaev A.B., Chiginev
V.A., Pichugin M.V., Sandalkin E.V. Tekhnologiya «b’yuscheesya serdce i
dyshaschie legkie» pri khirurgicheskikh vmeshatel’stvakh na klapanakh
serdca. Medicinskiy al’manakh, 2013. № 4 (28). S. 21-26.

V.V. Pichugin, V.V. Bober, S.E. Domnin, V.O. Nikolskiy, A.P. Medvedev, A.V. Bogush, V.A. Chiginev Efficiency of methods of pulmonary protection of patients having high pulmonary hypertension when correcting valve cardiac disorders. Medicinskij al'manah 2017; (3): 130–136, http://dx.doi.org/10.21145/2499-9954-2017-3-130-136