Article

Pulmonary Complications of Open-Heart Operations: Their Pathogenesis and Avoidance

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Abstract

PULMONARY complications, acidosis, and overoxygenation are three stumbling blocks to the success of open-heart operations. In one previous report1 the problem of acidosis, its recognition, avoidance, and therapy, was discussed. In another report2 the use of the Clark polarograph to avoid overoxygenation of blood in oxygenators was described. In this report, we shall present the thesis that temporary overloading of the pulmonary circulation with blood is the most important single factor in the initiation of capillary damage that marks the beginning of severe pulmonary complications after open-heart operations.

Methods

During the open-heart operation the patient’s circulation was maintained by one of four types of pump oxygenators previously described: disposable membrane,3 Melrose,4 Björk,5 Kay and Cross.6 In many patients the heart was stopped with potassium citrate according to Melrose’s technic.7,8 During the usual postoperative care,9 chest roentgenograms were made about three hours postoperatively, that night, and during the following days if necessary. If indicated, respiration was aided with positive pressure, during inspiration only, providing a mixture of air and oxygen or pure oxygen with a Bennett Respirator.* This was done via a cuffed tracheotomy tube when the need for more than several hours of respiratory assistance was anticipated.

Pathogenic Factors in Pulmonary Complications

1. Pre-existing pulmonary vascular disease, often present with long-standing pulmonary hypertension, seems to predispose to the occurrence of pulmonary complications after open-heart surgery. In the last 50 consecutive patients treated with the heart-lung machine at the Cleveland Clinic Hospital, some degree of pulmonary difficulty occurred 11 times. Of. . .


 

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