atrial-natriuretic-factor and Aortic-Aneurysm

Chronic renal failure (CRF) is related to cardiac diseases. Cardiac surgery is also related to postoperative acute kidney injury (AKI). It means heart and kidney have close relationship. We analyzed recent published data to understand how to manage CRF patients undergoing cardiovascular surgeries. We compared endovascular surgery and open procedure for aortic aneurysm, especially about contrast media-related renal damage, On or Off CABG or PCI for ischemic heart disease. We also discussed the relation between cardiopulmonary bypass and AKI and the risk factors causing AKI after CPB. Finally, we discussed prevention and treatment options of CPB related AKI, including furosemide, hANP mannitol, and statin. Published evidence in this area is still insufficient, but many studies are still carried out focusing on postoperative AKI. In the future we may be able to find the best answer for managing CRF patients undergoing cardiovascular surgeries.

Topics: Acute Kidney Injury; Aortic Aneurysm; Atrial Natriuretic Factor; Cardiopulmonary Bypass; Cardiovascular Diseases; Cardiovascular Surgical Procedures; Contrast Media; Coronary Artery Bypass; Furosemide; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Mannitol; Myocardial Ischemia; Percutaneous Coronary Intervention; Perioperative Care; Postoperative Complications; Renal Insufficiency, Chronic; Thoracic Surgical Procedures

An 84-year-old woman was hospitalized in hemodynamic shock due to type A acute aortic dissection (AAD) complicated by pulseless tamponade. She was treated conservatively as her family refused emergency surgery. In spite of warning her family that lack of intervention may possibly lead to an early death, she gradually improved and went home without any further problems. Emergency surgery for octogenarians remains controversial, however. We report the first surviving, non-operative case of an octogenarian with pulseless shock due to aortic dissection.

Topics: Aged, 80 and over; Aortic Aneurysm; Aortic Dissection; Atrial Natriuretic Factor; Cardiac Tamponade; Cardiotonic Agents; Diuretics; Dopamine; Female; Humans; Norepinephrine; Pulse; Tomography, X-Ray Computed; Treatment Outcome; Treatment Refusal

The suprarenal abdominal aortic cross-clamping during aortic aneurysm repair causes renal dysfunction after surgery. Atrial natriuretic peptide (ANP), a hormone synthesized by the cardiac atria, induces diuresis-natriuresis and increases glomerular filtration rate. Therefore, we tested the hypothesis that prophylactic ANP infusion could limit the development of acute renal failure after aortic cross-clamping.. Prospective, comparative, experimental study.. Laboratory at a university hospital.. Twelve male beagle dogs (10-13 kg) with mechanical ventilation under pentobarbital anesthesia.. A catheter was inserted into the femoral vein, and lactated Ringer solution (10 mL/kg/hr) was administered throughout the study period. Two groups of animals were studied: the control group (n = 6), which received saline vehicle before and after suprarenal abdominal aortic cross-clamping for 1.5 hrs; and the ANP group (n = 6), which received ANP (1 microg/kg/min) for 5 hrs, starting from 10 mins before suprarenal abdominal aortic cross-clamping until the end of procedure.. Changes in systemic and renal hemodynamics, blood gases, and renal function were measured at baseline and 1, 2, 3, 4, and 5 hrs after aortic cross-clamping. After aortic cross-clamping, urine volume, renal blood flow, and creatinine clearance significantly (p <.01) decreased, and serum creatinine concentrations significantly (p <.01) increased, but these effects were limited by continuous ANP infusion.. The present study shows that ANP infusion preserved renal function after suprarenal abdominal aortic cross-clamping in dogs. These results justify a trial of ANP infusion in humans during aortic aneurysm repair.

Topics: Acute Kidney Injury; Animals; Aorta, Abdominal; Aortic Aneurysm; Atrial Natriuretic Factor; Cardiac Surgical Procedures; Constriction; Dogs; Hemodynamics; Infusions, Intravenous; Kidney Function Tests; Male; Prospective Studies; Renal Circulation; Reperfusion Injury