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CARDIOVASCULAR ANESTHESIA

Increased Plasma Concentrations of the Mature Form of Adrenomedullin During Cardiac Surgery and Hepatosplanchnic Hypoperfusion

Daisuke Yoshikawa, MD^*, Fuminori Kawahara, MD^*, Nobuhiro Okano, MD, Haruhiko Hiraoka, MD^*, Yuji Kadoi, MD^*, Nao Fujita, MD, Toshihiro Morita, MD, and Fumio Goto, MD^*

*Department of Anesthesiology and Reanimatology, Gunma University School of Medicine, Maebashi, Japan; Department of Anesthesiology, Saitama Cardiovascular and Pulmonary Center, Saitama, Japan; and Department of Anesthesiology, Keiyu Orthopedic Hospital, Gunma, Japan

Address correspondence and reprint requests to Daisuke Yoshikawa, MD, Department of Anesthesiology and Reanimatology, Gunma University School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan. Address e-mail to dyossyjp{at}ybb.ne.jp

Adrenomedullin is a potent vasodilatory peptide. Plasma adrenomedullin (AM) concentrations increase during and after cardiopulmonary bypass (CPB). However, the cause of this increase and its site of production have not been identified. We investigated the role of the hepatosplanchnic and cerebral circulations in the increase of plasma AM and investigated whether tissue hypoxygenation is a cause of the AM increase seen during CPB. We measured plasma total AM (AM-T) and the biologically active form of AM, mature AM (AM-m), in seven patients undergoing CPB. Both plasma AM-T and AM-m concentrations increased significantly 60 min after weaning from CPB. At this time point, arterial AM-T and AM-m concentrations were 18-fold and 10-fold larger, respectively, than baseline values measured after the induction of anesthesia. The plasma AM-m concentration and the ratio of AM-m/AM-T in blood from the hepatic vein were significantly larger than those from the radial artery or jugular bulb. The AM-m/AM-T ratio decreased during CPB, suggesting that production of the intermediate form of AM, AM-glycine, is more than that of AM-m. The oxygen tension of the hepatic venous blood (PhvO2) was significantly less during CPB. Plasma AM-m concentrations sampled from the hepatic vein showed a significant negative correlation with PhvO2 at 10 min (r = 0.824; P < 0.02) and 60 min (r = 0.828; P < 0.02) after the onset of CPB. These data suggest that the hepatosplanchnic circulation is an important source of AM-m during CPB. Furthermore, hypoxygenation of the hepatosplanchnic region may be an important cause of this AM-m increase.

IMPLICATIONS: Plasma adrenomedullin has been reported to increase during and after cardiac surgery. We found that the concentration of the biologically active mature form of adrenomedullin in the hepatic vein is significantly larger than in the radial artery or jugular bulb and that it shows a significant negative correlation with oxygen tension and saturation of hepatic venous blood.

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