If blood passes through extracorporeal circuits, platelets are activated even if the patient is fully heparinized.1 These activated thrombocytes begin to adhere, cluster, release their granular constituents, and within minutes of the institution of cardio pulmonary bypass a sheath of platelet and fibrin aggregates will line all components of the extracorporeal circuit.2,3,4 This process endangers the patient in two ways: (1) The lining of aggregates on the "down side" to the arterial filter may fragment and cause a shower of microemboli. (2) Intra-bypass platelet aggregation depletes the number of circulating thrombocytes, thus increases the possibility of post-operative bleeding.5,6,7
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References
1.
Longmore DB, Bennett JG, Guerriero D., et al: Prostacyclin: A solution to some problems of extracorporeal circulation. LancetI: 1002-1005, 1979 .
2.
Addonizio VP , Macarak EJ, Niewiarowski S., et al:Preservation of human platelets with prostaglandin E1 during in vitro simulation of cardiopulmonary bypass. Circ Res44:350-357, 1979.
3.
McKenna R., Bachmann F., Whittaker B., et al: The hemostatic mechanism after open heart surgery. II . Frequency of abnormal platelet functions during and after extracorporeal circulation . J Thorac Cardiovasc Surg70:298-308, 1975.
4.
Beurling-Harbury C. and Galvan CA: Acquired decrease in platelet secretory ADP associated with increased postoperative bleeding in post-cardiopulmonary bypass patients and in patients with severe valvular heart disease. Blood52:13-23, 1978.
5.
Bick RL, Schmolhorst WR, Arbegast NR: Alterations of hemostasis associated with cardiopulmonary bypass. Thrombosis Res8:285-302, 1976.
6.
McKenzie SG, Frew R., Bar HP: Effects of adenosine and related compounds on adenylate cyclase and cyclic AMP levels in smooth muscle. Eur J Pharmacol41:193-203, 1977.
7.
Parker-Williams EJ: Platelets in prostheses and pumps. Clinics in Haematology1(2):413-423, 1972.
8.
Masters TN, Born Gvr, Robicsek F.: Platelet anti-aggregating and hemodynamic effects of adenosine and prostaglandin E1 . (Under Publication)
9.
Masters TN, Citron S., Duncan GD, et al: Platelet preservation with adenosine during in vitro cardiopulmonary bypass simulation. (Under Publication)
10.
Robicsek F. , Masters TN, Svenson RH, et al: The application of thermography in the study of coronary blood flow. Surgery84:858, 1978.
11.
Robicsek F. , Masters TN, Svenson RH, Daniel WG: Experimental observations of coronary blood flow using the thermographic camera. Collected Works on Cardio-Pulmonary Disease22:57-63, 1979.
12.
Arora MV, Partney KL, Ferrari HA, et al: Thermographic evidence of the effects of nitroglycerine on myocardial perfusion. CriticalCare Med6:99, 1978.
13.
Daniel WG, Svenson RH, Masters TN, Robicsek F.: Electrophysiologic effects of partial coronary flow reduction in the exposed canine heart. Circulation58:670, 1979.
14.
Reynolds EW , Van der Ark CR, Johnston FD: Effects of acute myocardial infarction in electrical recovery and transmural temperature gradient in left ventricular wall of dogs. Circ Res8:730, 1960.
Drury AN, Szent-Gyorgyi A.: The physiological activity of adenine compounds with especial reference to their action upon mammalian heart. J Physiol, London68:213-227, 1929.
17.
Berne RM: Cardiac nucleotides in hypoxia: Possible role in regulation of coronary blood flow. Amer J Physiol204:317-322, 1963.
18.
Berne RM and Rubio: Role of adenosine, adenosine triphosphate and inorganic phosphate in resistance vessel vasodilatation. In: Mechanism of Vasodilatation, ed. by Vanhoutte PM, Leusen I.BaselKarger WG 106 M486, 1978, pp. 214-221.
19.
Katori M. and Berne RM: Release of adenosine from anoxic hearts. Relationship to coronary flow. Circ Res19:420-425, 1966.
20.
Richman HG and Wyborny L.: Adenine nucleotide degradation in the rabbit heart. Amer J Physiol207:1139-1145, 1964.
21.
Rubio R., Berne RM, Katori M.: Release of adenosine in reactive hyperemia of the dog heart. Am J Physiol216:56-62, 1969.
22.
Gerlach E., Deuticke B., Dreisbach RH: Der nucleotid abbau im hermuskel by sauerstoffmangel und seine magliche bedeuting fur die cornardurchblu-tung. Naturwissenschaften50:228, 1963.
23.
Imai S., Riley AL, Berne RM: Effect of ischemia on adenine nucleotides in cardiac and skeletal muscle. Circ Res15:443-450, 1964.
24.
Afonso S.: Inhibition of coronary vasodilating action of dipyridamole and adenosine by aminophylline in the dog. Circ Res26:743-752, 1970.
25.
Schaumann W., Juhran W., Dietmann K., Arzneim F.: Antagonismus der kreislauf wirkungen von adenosin druch theophyllin. Drug Res20:372, 1970.
26.
McNay JL: Antagonism of cardiovascular effects of adenosine by caffeine. Fed Proc24:614, 1965.
27.
Scholtholt J., Nitz RE, Schraven E.: On the mechanism of the antagonistic action of xanthine derivates against adenosine and coronary vasodilators. Arzneim Forsch (Drug Res) 22:1255, 1972.
28.
Spickermann GP, Hellberg K., Kettler D., et al: Pflugers Arch ges Physiol319:R25, 1970.
