This study was undertaken to evaluate the effects of alpha-tocopherol and ascorbic acid on markers of myocardial reperfusion injury and myocardial contractile function after coronary artery surgery. Forty-eight patients were divided into 4 groups; 300 mg/day alpha-tocopherol was given orally to the patients in group I for 14 days. In groups II and III, 4g of ascorbic acid was administered intravenously prior to induction and in the cardioplegic solution, respectively. Group IV was the control group. Blood samples were taken to determine the concentrations of creatine phosphokinase MB isoenzyme, malondialdehyde, uric acid, ascorbic acid and alpha-tocopherol in the perioperative period. Left ventricular functions were determined by means of MUGA scans and echocardiography preoperatively and on the 3rd and 7th days, postoperatively. The changes in serum creatine phosphokinase MB and malondialdehyde were significantly lower in study groups. when compared with the control group. We observed no significant changes in ventricular function, requirement for (+) inotropic agents and the incidence of ventricular arrhythmias among the groups, postoperatively. Biochemical findings are consistent with the free radical hypothesis. But we could not confirm these data with hemodynamic findings. This is probably due to the population of low-risk elective coronary surgery patients in this study.

Horseshoe lung is an uncommon congenital malformation in which the bases of the right and the left lungs are fused to each other by a narrow isthmus posterior to the cardiac apex. So far 22 cases have been described: most of these were associated with right lung hypoplasia and the scimitar syndrome. A horseshoe lung anomaly with left lung hypoplasia is described.The term horseshoe lung was first used by Spencer in 1962 to describe a malformation in which an isthmus of pulmonary parenchyma extends from the right lung base across the midline behind the pericardium and fuses with the base of the left lung.' After this first reported case, 21 more were reported.2 Most of these cases were associated with hypoplasia of the right lung, dextrarotation of the apex of the heart, and abnormal drainage of the right pulmonary veins into the right atrium.We describe our experience with a 2 l/2 year old girl who had horseshoe lung with left lung hypoplasia, a ventricular septal defect, and severe pulmonary hypertension. Because of persistent severe infection and rapid deterioration of the patient an emergency left posterolateral thoracotomy was performed. At thoracotomy the left hemithorax was completely occupied by the heart. In the left retrocardiac space atelectatic pulmonary tissue 1-5 cm in diameter was observed. After the surrounding tissues had been dissected abnormally lobulated lung tissue was identified. This could be pulled into the left hemithorax through the inferoposterior cardiac space. There were no hilar structures that belonged to this lung tissue with its abnormal origin. Because full expansion of this atelectatic lung tissue was maintained with positive pressure ventilation resection was not carried out. Instead the lung tissue was fixed to the left hemithorax and pericardium. In the early postoperative period the cyanosis disappeared, blood gas values improved, and a chest radiograph showed that mediastinal shift was nearly corrected and atelectatic segments were re-expanded (fig 2). Two weeks after the operation angiography and cardiac catheterisation were performed to investigate the heart murmur. During angiography the left pulmonary artery was not observed, but small collaterals arising from main pulmonary artery were seen. There were also some collaterals originating from the right pulmonary artery, supplying the left lung (fig 3). During angiography a ventricular septal defect and a patent foramen ovale were

Psychiatric disturbances due to cardiopulmonary bypass, especially postoperative delirium syndrome, are among the immediate complications of open-heart surgery. In a series of 32 male and 18 female patients the prevalence of such disorders was investigated and search was made for possible risk factors for their occurrence. Psychiatric, neurologic and electroencephalographic evaluation was made pre- and postoperatively, in addition to haemodynamic, echocardiographic, angiographic and regional cerebral blood flow studies. Nine of the 50 patients had significantly reduced perfusion of certain cerebral lobes in single photon emission computed tomography, and in six of them the psychiatric tests indicated postoperative delirium; three of these six also had moderate electroencephalographic changes. The cerebral hypoperfusion persisted on day 15 in four patients, while psychiatric tests were negative. The study showed possible risk factors to be patient age, long aortic cross-clamp time, high-dose inotropic support and excessive transfusion of blood or blood products.

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SUMMARYCardiopulmonary bypass is associated with a reduction in plasma thyroid hormone concentrations in patients undergoing cardiac surgery. However, studies of the effects of cardiopulmonary bypass on thyroid function are limited and many studies report conflicting data concerning only the period of cardiopulmonary bypass.In this study, we tried to clinically determine the effects of cardiopulmonary bypass on concentrations of thyroid hormones by comprehensive thyroid function tests in 10 patients before and after surgery, and observed the benefits of triiodothyronine supplementation after global ischemia on myocardial function experimentally in guinea pigs. In patients undergoing surgery, concentrations of total triiodothyronine and free triiodothyronine decreased progressively on the institution of cardiopulmonary bypass and remained below normal levels until 24 hours postoperatively.In the guinea pig hearts studied in a Langendorf perfusion apparatus, T3 supplementation enhanced percentage recovery of ventricular contractile force, heart work and heart rate with respect to other groups receiving no T3 supplementation or T3 supplementation without any ischemic interval. (Jpn Heart J 35: 443-454, 1994)