Two cases of noncardiogenic pulmonary oedema following cardiopulmonary bypass are presented. The clinical manifestations, postulated pathogenesis and management are discussed. A recent review of the literature fails to yield a unified explanation of this rare but often disastrous entity.
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References
1.
Olinger GN, Becker RM, Boncheck LINoncardiogenic pulmonary oedema and peripheral vascular collapse following cardiopulmonary bypass. Rare protamine reaction? Ann Thor Surg1980; 29: 20-25.
2.
Culliford AT , Thomas S., Spencer FCFulminating noncardiogenic pulmonary oedema. A newly recognized hazard during cardiac operations. J Thorac Cardiovas Surg1980; 80: 868-75.
3.
Holland CL, Singh AK, McMaster Prb, Fang W.Adverse reactions to protamine sulfate following cardiac surgery. Clin Cardiol1984; 7: 157-62.
4.
Just-Viera JO , Fischer CR, Gagu O., Morris JDAcute reaction to protamine. American Surgeon1984; 50: 52-60.
5.
McCombs RPMedical progress: diseases due to immunologic reactions in the lungs (First of two parts). NEJM1972; 286: 1186-94.
6.
Nordstrom L. , Fletcher R., Pavek K.Shock of anaphylactoid type induced by protamine. A continuous cardiorespiratory record. Acta Anaesthesiol Scand1978; 22: 195-201.
7.
Lakin JD, Blocker TJ, Strong DM, Yocum MWAnaphylaxis to protamine sulphate mediated by a complement-dependent IgG antibody . J Allergy Clin Immunology1978 ; GI: 102-107.
8.
Chenoweth DE , Cooper SW, Hugli TE et al. Complement activation during cardiopulmonary bypass. NEJM1981; 304: 497-503.
9.
Kirklin JK, Chenoweth DE, Naftel DC et al. Effects of protamine administration after cardiopulmonary bypass on complement, blood elements and the haemodynamic state. Ann Thorac Surg1986; 41: 193-99.
10.
Cavarocchi NC, Schaff HV, Orszulask TA et al. Evidence for complement activation by protamine-heparin interaction after cardiopulmonary bypass. Surgery1985; 98: 525-530.
11.
Iglesias A. , Nunez L.Pulmonary oedema: letter to the editor. Ann Thorac Surg1982; 304.
12.
Watson RA, Ansbacher R., Barry M.Allergic reaction to protaminc: a late complication of elective vasectomy ? Urology1983; 22: 493-95.
13.
Latson TW, Kickler TS, Baumgartner WAPulmonary hypertension and noncardiogenic pulmonary oedema following cardiopulmonary bypass associated with an antigranulocyte antibody. Anesthesiology1986; 64: 106-11.
Hammerschmidt DE, Stroncek DF, Bowers TK et al. Complement activation and neutropenia occurring during cardiopulmonary bypass. J Thorac Cardiovasc Surg1981; 81: 370-77.
16.
Frater Rwm, Oka Y., Yong Y., Tsubo T., Loubser PG, Masone R.Protamine-induced circulatory changes. J Thorac Cardiovasc Surg1984; 87: 687-692.
17.
Utley JR, Manoj AB, Stephens DB, Kelley HGReversal of protamine reaction with heparin. Perfusion1986; 1: 63-64.
18.
Hashim SW, Kay HR, Hammond GL, Kopf GS, Geha ASNoncardiogenic pulmonary oedema after cardiopulmonary bypass. An anaphylactic reaction to fresh frozen plasma. Am J Surgery1984; 147: 560-64.
19.
Campbell FW, Goldstein MF, Atkins PCManagement of the patient with protamine hypersensitivity for cardiac surgery . Anesthesiology1985; 61: 761-64.
20.
Jackson SH, Wuerflein RD, Gerbo B.An alternate method to manage patients with protamine hypersensitivity for cardiac surgery. Anesthesiology1985; 61: 761-64.
21.
Knape Jta, Schuller JL, DeHaan P., DeJong A., Bovill JGAn anaphylactic reaction to protamine in a patient allergic to fish . Anesthesiology1981; 55: 324-25.
22.
Stoelting RK , Brown JW, Winn BA, Jallad MSProtamine-induced allergic reaction following cardiopulmonary bypass. JECT1984; 16: 37-40.
23.
Westaby S., Turner MW, Stark J.Complement activation and anaphylactoid response to protamine in a child after cardiopulmonary bypass. Br Heart J1985; 53: 574-76.
24.
Lowenstein E., Johnston WE, Lappas DG et al. Catastrophic pulmonary vasoconstriction associated with protamine reversal of heparin. Anesthesiology1983; 59: 470-73.