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Vasodilation and Cardiopulmonary Bypass : The Role of Bradykinin and the Pulmonary Vascular Endothelium

Vincent R. Conti, MD, FCCP; Christopher McQuitty, MD
Author and Funding Information

Affiliations: Galveston, TX 
 ,  Dr. Conti is Professor and Chief, Division of Cardiothoracic Surgery, Department of Surgery; and Dr. McQuitty is Associate Professor, Divisions of Cardiac Anesthesiology and Cardiology, Departments of Anesthesiology and Internal Medicine, University of Texas Medical Branch.

Correspondence to: Vincent R. Conti, MD, FCCP, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555-0528; e-mail: vconti@utmb.edu



Chest. 2001;120(6):1759-1761. doi:10.1378/chest.120.6.1759
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Low systemic vascular resistance (SVR) commonly occurs during and early after cardiopulmonary bypass (CPB), and is easy to accept as a bothersome side effect of bypass since it is usually transient and easy to treat. Occasionally, patients have a more severe and persistent fall in SVR, referred to as postoperative vasodilatory shock.1 Treatment is frequently required to maintain adequate perfusion pressure during CPB and to establish satisfactory hemodynamics when ready to separate the patient from bypass. This has usually entailed counteracting the effect of the vasodilatory mediators by administering adrenergic vasoconstrictor drugs such as phenylephrine or norepinephrine. Although usually effective and safe, these drugs can redistribute blood flow in such a way as to compromise the splanchnic and renal circulations.2 Another etiology of low SVR that has been described1,3 is abnormally low vasopressin levels that respond quite well to low-dose vasopressin infusion even when the usual vasoconstrictor drugs are not effective in restoring vascular tone. There are a number of known responsible mediators, including bradykinin, produced during CPB, many of which are related to the systemic inflammatory response elicited by blood contactwith the extracorporeal circuit and the physiologic changes in the circulation with CPB.4

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