1 From the Department of Anesthesiology, Division of Endocrinology and Internal Medicine, and Section of Thoracic, Cardiovascular and General Surgery of the Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55901.
Cellular energy substrates and metabolites, electrolytes, oxygenation, and acid-base balance, in arterial and coronary sinus blood of seven adult patients who died after valvular replacements, were studied and compared with these measurements from five patients having aortic replacement who survived. Six of the patients were in New York Heart Association class IV. All but one died within 24 hr of acute circulatory failure, with excessive bleeding being a contributing factor. Plasma potassium and osmolality remained higher in the first postoperative hours in nonsurvivors. Ketone bodies, growth hormone, and lactate levels rose precipitously as shock became severe. Increased arterial blood osmolality and potassium, plus a still-rising lactate concentration, were evident 2 hr after operation in patients who died in the next 24 hr. Low cardiac output, hyperosmolality, and the degree of lactic acidosis were the only early changes predicting the fatal outcome.
Submitted on January 8, 1971
© 1971 American Heart Association, Inc.
Myocardial and Body Metabolism in Fatal Cardiogenic Shock after Valvular Replacement
Key Words: Energy metabolism • Postoperative mortality • Lactic acidosis • Open-heart surgery
Accepted on April 12, 1971