Goya V. Raikar, MD, Kunikazu Hisamochi, MD, Bao-Lan N

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Presentation transcript:

Nitric oxide inhibition attenuates systemic hypotension produced by protamine Goya V. Raikar, MD, Kunikazu Hisamochi, MD, Bao-Lan N. Raikar, MD, Hartzell V. Schaff, MD The Journal of Thoracic and Cardiovascular Surgery Volume 111, Issue 6, Pages 1240-1247 (June 1996) DOI: 10.1016/S0022-5223(96)70227-1 Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 1 Protocol for in vivo experiments. n, Number of animals studied. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 1240-1247DOI: (10.1016/S0022-5223(96)70227-1) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 2 Effect of protamine-heparin complex on left ventricular developed pressure (LVDP), maximum dp/dt, and heart rate. The protamine group showed a significant decline during the 20-minute experimental period (p < 0.01, one-way analysis of variance). The presence of heparin attenuated protamine's effect. There is a statistically significant difference between the two groups (p < 0.01, two-way analysis of variance). The Journal of Thoracic and Cardiovascular Surgery 1996 111, 1240-1247DOI: (10.1016/S0022-5223(96)70227-1) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 3 Results from the initial response to protamine are designated as control and are compared with the hemodynamic measurements to repeated protamine infusion after treatment with l-NMMA (n = 6) or methylene blue (n = 6). Mean arterial pressure (MAP) and cardiac output (CO) are maintained as compared with control animals receiving only protamine (n = 12) (p < 0.05, Student's t test). Although the systemic vascular resistance (SVR) is not decreased as in hearts receiving only protamine, the difference is not statistically significant. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 1240-1247DOI: (10.1016/S0022-5223(96)70227-1) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 4 Results from the initial response to protamine are shown as control. These are compared with the hemodynamic measurements seen after pretreatment of the dogs with l-NMMA (5 mg/kg) (n = 6). Mean arterial pressure (MAP) and cardiac output (CO) are well preserved in the l-NMMA group, and this difference is statistically significant (p < 0.05 Student's t test). Systemic vascular resistance (SVR) does not decrease as in the control group, but this difference is not statistically significant. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 1240-1247DOI: (10.1016/S0022-5223(96)70227-1) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 5 Results from two dogs are shown. Percent change of mean arterial pressure from baseline is compared in an animal receiving l-arginine (6 mg/kg) to an animal receiving D-arginine (6 mg/kg) to overcome the blockade by l-NMMA pretreatment. The animal receiving l-arginine has profound systemic hypotension (decrease of 55% from baseline) on protamine infusion. The response to protamine is less in the animal receiving D-arginine (decrease of 15% from baseline). The Journal of Thoracic and Cardiovascular Surgery 1996 111, 1240-1247DOI: (10.1016/S0022-5223(96)70227-1) Copyright © 1996 Mosby, Inc. Terms and Conditions