RESUMO

The effects of extracorporeal membrane oxygenation (ECMO) on cardiac function and its determinants (preload, afterload, contractility, and heart rate) are largely unknown, although some evidence exists that function may decrease. To determine whether cardiac function decreases and what changes in the determinants take place during and after ECMO, we observed 26 newborn infants with persistent pulmonary hypertension. Serial echocardiograms were performed before ECMO, during maximum cardiopulmonary bypass, and after ECMO. Cardiac function was assessed by using standard echographic ejection phase indices (shortening fraction and cardiac output). Heart rate, preload (left ventricular end-diastolic dimension and area), afterload (left ventricular end-systolic wall stress), and contractility (relationship between velocity of circumferential fiber shortening and wall stress) were also measured. Ejection phase indices significantly decreased during ECMO (shortening fraction 33% to 25%, cardiac output 205 to 113 ml/kg/min; p less than 0.05) and returned to normal after ECMO (shortening fraction 26% to 34%, cardiac output 107 to 240 ml/kg/per minute; p less than 0.05). Heart rate also significantly decreased during ECMO (158 to 118 beats/min; p less than 0.05). Preload significantly increased after ECMO (left ventricular end-diastolic dimension 1.4 to 1.6 cm, left ventricular end-diastolic area 1.9 to 2.2 cm2; p less than 0.05). There were no significant changes in contractility and afterload during any study period. We conclude that, although left ventricular ejection phase indices and heart rate decreased during ECMO, these changes were transient and resolved when bypass was terminated. Contractility and afterload did not appear affected by bypass.

Assuntos

Oxigenação por Membrana Extracorpórea , Coração/fisiopatologia , Hipertensão Pulmonar/terapia , Infecções Bacterianas/fisiopatologia , Pressão Sanguínea/fisiologia , Débito Cardíaco/fisiologia , Ponte Cardiopulmonar , Permeabilidade do Canal Arterial/fisiopatologia , Ecocardiografia , Ecocardiografia Doppler , Feminino , Frequência Cardíaca/fisiologia , Humanos , Hipertensão Pulmonar/fisiopatologia , Recém-Nascido , Masculino , Contração Miocárdica/fisiologia , Função Ventricular Esquerda/fisiologia

RESUMO

A Brewster polarizer in this study is any dielectric plane reflecting surface reflecting light at or near the Brewster angle of incidence. In this paper, we consider an interesting phenomenon observed when we use an extended source of light or a cone of light with its axis incident on the plane surface at the Brewster angle. The resulting reflected light is viewed (a) through an ordinary sheet polarizer and (b) after reflection from another Brewster polarizer. The extinction pattern of light by such a system is in the form of an elongated black shadow in (a) and a nearly circular shadow in (b), respectively. These shadows are explained on the basis and use of the familiar Fresnel equations at a plane interface between two dielectric media. Photographs of the shadows are also presented.