- Email: [email protected]
Response to Proposed Mechanism for “Air” in the Aorta
Author's Accepted Manuscript
Letter in Reply Paul S. Pagel MD, PhD
PII: DOI: Reference:
S1053-0770(15)00398-5 http://dx.doi.org/10.1053/j.jvca.2015.05.114 YJCAN3301
To appear in:
Journal of Cardiothoracic and Vascular Anesthesia
www.elsevier.com/locate/buildenv
Cite this article as: Paul S. Pagel MD, PhD, Letter in Reply, Journal of Cardiothoracic and Vascular Anesthesia, http://dx.doi.org/10.1053/j.jvca.2015.05.114 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Letter in Reply
Paul S. Pagel MD PhD
From the Anesthesia Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin. This work was supported entirely by departmental funds. The authors have no conflicts of interest pursuant to this report.
Running Title: Letter in reply
Key Words: cardiopulmonary bypass; contrast echocardiography; gas solubility; microbubble; priming solution
Submit all correspondence to: Paul S. Pagel MD PhD, Clement J. Zablocki Veterans Affairs Medical Center, Anesthesia Service, 5000 W. National Avenue, Milwaukee, Wisconsin 53295. Phone: (414) 384-2000, extension 42417; Facsimile: (414) 384-2939; Electronic mail: [email protected]
Letter in Reply
To the Editor-in-Chief,
I would like to thank Dr. Jones for his thoughtful letter1 about our recent diagnostic dilemma2. He proposes that the temperature-dependence of gas solubility is an alternative explanation for transient echogenicity in the aortic arch and proximal descending thoracic aorta that we observed during testing of aortic cannula integrity in our patient undergoing aortic valve replacement2. In our institution, the cardiopulmonary bypass priming fluid is warmed to normal body temperature before the arterial and venous lines are separated, thereby minimizing any potential temperature difference between the prime and the patient’s blood. However, the bypass tubing containing the priming fluid is exposed to room temperature for a short period of time during which aortic purse string sutures are placed and the aorta cannula is inserted. Thus, cooling of the priming fluid contained within the tubing may have created a modest temperature gradient between the prime and the patient’s blood. From my perspective, the gray granular echocardiographic appearance of the microbubbles more closely resembles a blood-agitated saline contrast agent3, 4, but it is certainly quite possible that both phenomena may have contributed to our observations.
References 1. Jones PM: In reference to "Air" in the Aortic Arch After Cannulation for Cardiopulmonary Bypass: Devastating Complication or Benign Explanation? J Cardiothorac Vasc Anesth 29:(In press), 2015. 2. Pagel PS, Klinger JE, Colwell EM, Rashid ZA: "Air" in the aortic arch after cannulation for cardiopulmonary bypass: devastating complication or benign explanation? J Cardiothorac Vasc Anesth 29:542-544, 2015. 3. Fan S, Nagi T, Luo H, et al: Superiority of the combination of blood and agitated saline for routine contrast enhancement. J Am Soc Echocardiogr 12:94-98, 1999. 4. Jeon DS, Luo H, Iwami T, et al: The usefulness of a 10% air-10% blood-80% saline mixture for contrast echocardiography: Doppler measurement of pulmonary artery systolic pressure. J Am Coll Cardiol 39:124-129, 2002.
Letter in Reply Paul S. Pagel MD, PhD
PII: DOI: Reference:
S1053-0770(15)00398-5 http://dx.doi.org/10.1053/j.jvca.2015.05.114 YJCAN3301
To appear in:
Journal of Cardiothoracic and Vascular Anesthesia
www.elsevier.com/locate/buildenv
Cite this article as: Paul S. Pagel MD, PhD, Letter in Reply, Journal of Cardiothoracic and Vascular Anesthesia, http://dx.doi.org/10.1053/j.jvca.2015.05.114 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Letter in Reply
Paul S. Pagel MD PhD
From the Anesthesia Service, the Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin. This work was supported entirely by departmental funds. The authors have no conflicts of interest pursuant to this report.
Running Title: Letter in reply
Key Words: cardiopulmonary bypass; contrast echocardiography; gas solubility; microbubble; priming solution
Submit all correspondence to: Paul S. Pagel MD PhD, Clement J. Zablocki Veterans Affairs Medical Center, Anesthesia Service, 5000 W. National Avenue, Milwaukee, Wisconsin 53295. Phone: (414) 384-2000, extension 42417; Facsimile: (414) 384-2939; Electronic mail: [email protected]
Letter in Reply
To the Editor-in-Chief,
I would like to thank Dr. Jones for his thoughtful letter1 about our recent diagnostic dilemma2. He proposes that the temperature-dependence of gas solubility is an alternative explanation for transient echogenicity in the aortic arch and proximal descending thoracic aorta that we observed during testing of aortic cannula integrity in our patient undergoing aortic valve replacement2. In our institution, the cardiopulmonary bypass priming fluid is warmed to normal body temperature before the arterial and venous lines are separated, thereby minimizing any potential temperature difference between the prime and the patient’s blood. However, the bypass tubing containing the priming fluid is exposed to room temperature for a short period of time during which aortic purse string sutures are placed and the aorta cannula is inserted. Thus, cooling of the priming fluid contained within the tubing may have created a modest temperature gradient between the prime and the patient’s blood. From my perspective, the gray granular echocardiographic appearance of the microbubbles more closely resembles a blood-agitated saline contrast agent3, 4, but it is certainly quite possible that both phenomena may have contributed to our observations.
References 1. Jones PM: In reference to "Air" in the Aortic Arch After Cannulation for Cardiopulmonary Bypass: Devastating Complication or Benign Explanation? J Cardiothorac Vasc Anesth 29:(In press), 2015. 2. Pagel PS, Klinger JE, Colwell EM, Rashid ZA: "Air" in the aortic arch after cannulation for cardiopulmonary bypass: devastating complication or benign explanation? J Cardiothorac Vasc Anesth 29:542-544, 2015. 3. Fan S, Nagi T, Luo H, et al: Superiority of the combination of blood and agitated saline for routine contrast enhancement. J Am Soc Echocardiogr 12:94-98, 1999. 4. Jeon DS, Luo H, Iwami T, et al: The usefulness of a 10% air-10% blood-80% saline mixture for contrast echocardiography: Doppler measurement of pulmonary artery systolic pressure. J Am Coll Cardiol 39:124-129, 2002.