Citations

Abstract Concomitant lung transplantation and coronary artery bypass grafting operation became more prevalent over the last decade due to the advanced age of recipients. Median sternotomy approach is traditionally used when internal thoracic artery is utilized. Here we report a technique of harvesting the left internal thoracic artery via a clamshell incision for a combined coronary artery bypass and bilateral lung transplant operation in a 71-year-old male with terminal respiratory failure and coronary artery disease.

The inapplicability of Beer's law to densitometry of dyes in whole blood or other nonhomogeneous media has been long known. When using a densitometer whose output is directly proportional to the light transmitted, a simple transformation— log X = log (x – x0)—can be employed to allow rapid, accurate estimation of dye concentration. This is facilitated by use of an optical density ruler. The transformation, X = x – x0, can be made mechanically, by shifting the infinity position of the ruler with reference to the zero light transmission position, or electrically, by appropriate use of zero suppression in the densitometer circuit. The transformation results in an exponential (logarithmic) relationship between light transmitted and concentration of the dye (indocyanine green). Readings of relative optical density obtained by use of the ruler are multiplied by a calibration constant to calculate dye concentration. The principles of the transformation have been applied to the determination of the optimal zero suppression required for maintenance of constant sensitivity of the densitometer in the presence of various levels of background dye. densitometer calibration; indocyanine green densitometer; calibration of dye-dilution curves; correction of dye-dilution curves Submitted on September 13, 1963

The assumption that the rate of blood flow past the sampling site is constant is basic to the Stewart-Hamilton estimation of cardiac output. Pulsatile flow might be expected to cause random and systematic errors. In this study dye-dilution curves were recorded simultaneously from two or three sites (pulmonary artery, aortic root, thoracic aorta, femoral artery) after injections of dye into the inferior vena cava, right ventricle, pulmonary artery, or left atrium of anesthetized dogs. The color of the indocyanine-protein complex formed after injection of the dye stabilized rapidly. Such stabilization is required for continuous photometric quantitation of dilution curves with juxtaposed injection and sampling sites. Areas of curves from the central circulation did not differ significantly from each other; they averaged 2.5% less than areas of curves recorded simultaneously from the femoral artery. Heart rate had no consistent influence. The large variability in estimates of cardiac output from curves recorded from the pulmonary artery after injection into the right ventricle was diminished with injection farther upstream. Submitted on May 29, 1961

Blood is nonhomogeneous; hence, the relationship between light transmission and increasing concentration of dye in whole blood is never the perfect exponential curve predicted by Beer's law. Instead, as the concentration of indocyanine green is increased to high levels (40 mg/liter) the light transmission decreases exponentially toward an asymptote at 6–8% transmission for nearly monochromatic densitometers (half-band width: 13–20 mμ), but at 30–40% for densitometers using light of wide-band width. Consequently, following recording of a dilution curve, circulating background dye reduces the change in transmission per unit increase in dye concentration in subsequent curves. This decrease in sensitivity cannot be compensated for by a simple increase in the sensitivity of the densitometer or in the intensity of its light source. Compensation can be attained, however, if increasing densitometer sensitivity is associated with the automatic scale expansion provided when a suppressed zero point is used. At correct zero suppression, the deflection for zero output of the densitometer coincides with the asymptotic transmission value mentioned above. indicator-dilution in circulation; blood flow measurement; blood optical density; dye dilution technic; cardiac output measurement Submitted on April 15, 1963

In studies on dogs, blood was sampled as for the recording of dye-dilution curves through monochromatic densitometers. Injection of hypertonic media into the superior vena cava caused transient increases in the optical density of blood in the pulmonary and femoral arteries so as to produce apparent “dye” curves. The injection of hypotonic and hemolyzing media produced negative deflections, representing decreases in the optical density of blood, as did brief ventilation with 5% and 50% carbon dioxide in oxygen. Similar changes were demonstrated in vitro. They were compensated for in vivo by the use of a dichromatic densitometer. The changes observed are attributed to altered physical properties of the erythrocytes, which consequently change their light-transmitting and light-reflecting characteristics. Such nonspecific changes in the optical density of blood may constitute an important source of error in monochromatic densitometry done on whole blood. Submitted on January 11, 1961

In each of 12 mongrel dogs, data for end-diastolic volume, end-systolic volume, and stroke volume of the left ventricle were obtained by two independent methods: the indicator dilution method and a radiographic method. While the values for stroke volume showed good agreement between the two methods, a significant and directionally constant difference was found between values for end-diastolic volume and end-systolic volume calculated by the two different methods. This was observed in dogs with fast heart rates (exceeding 150 beats/min), as well as in dogs with heart rates of about 100 beats/min. The findings strongly suggest that a fundamental error is present in estimations of volume based on the washout of an indicator dye.