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Insulin secretion after open-heart surgery with particular respect to pathogenesis of low cardiac output state.

1971; BMJ; Volume: 33; Issue: 1 Linguagem: Inglês

10.1136/hrt.33.1.6

1468-201X

P A Majid, P Ghosh, Brojesh C. Pakrashi, Mihai Ionescu, J. R. W. Dykes, S. H. Taylor,

Renal function and acid-base balance

Insulin secretion tests, and measurements of systemic arterial free fatty acids, pyruvate, and lactate were carried out before operation in 6 patients undergoing open-heart surgery for valve replacement.The measurements were serially repeated after operation and the results were related to the clinical state of the patient.In patients developing the clinical picture of a low cardiac out- put state, the systemic arterial free fatty acid, lactate, and pyruvate levels were all greatly in- creased and the secretion of insulin severely suppressed.These variables gradually returned to their preoperative levels in parallel with improvement in the clinical state in each patient.The therapeutic implications of these findings are discussed in relation to the use of insulin in the post- operative management of patients undergoing open-heart operation.The low cardiac output syndrome is a major hazard of the early postoperative period after open-heart surgery, and its onset is associated with a high mortality.Correction of hypovolaemia and the counteraction of de- pressed left ventricular function by inotropic agents and vasodilator drugs have greatly im- proved the outlook, but some patients still fail to respond adequately to these measures.The primary fault is one of pumping failure of the heart, and in this respect it is similar to the heart failure associated with naturally occur- ring disease.The pumping failure associated with cardiogenic shock after myocardial in- farction and that associated with severe congestive heart failure have both been found to be accompanied by suppression of insulin secretion (Taylor et al., I969; Sharma et al., 1970).The following investigation was, there- fore, designed to measure the facility with which insulin was released in patients under- going open-heart operations for valve replace- ment. Subjects and methodsClinical details Six patients undergoing open- heart surgery for mitral or aortic valve replace-