Principles of Pulmonary Protection in Heart Surgery, 2010

Over the past ?fty years, advanced techniques and strategies have arisen in the ?eld of myocardial protection. Meticulous trials, focusing on pulmonary protection during heart surgery requiring cardiopulmonary bypass (CPB), have been missing. This te- book is intended to serve as a useful tool to spread information on strategies for lung protection during heart surgery with CPB. Emphasis on pulmonary protection will be turned to lung perfusion as an adjunct for minimizing the deleterious effects of pulmonary ischemia-reperfusion injury in heart surgery. Many renowned authors have contributed by presenting their expe- ence on lung perfusion in basic research and clinical trials. Furthermore, they have enlightened the quality of this textbook with new ideas, concepts, and future perspectives. The scope of this textbook is of interest to different professionals, such as card- vascular surgeons, pulmonary surgeons, transplantation physicians, cardiothoracic anesthesiologists, intensive care physicians, cardiothoracic fellows, radiologists, basic sciences physicians, cardiologists, pulmonary medicine physicians, perfusi- ists, nurses, students, and researchers. This textbook has 7 sections, aimed at addressing general and speci?c aspects of pulmonary protection during heart surgery with CPB. The ?rst section on general concepts provides information about anatomic, physiologic, histologic, molecular, and radiologic considerations regarding the lungs. The second section focuses on ischemia-reperfusion injury and is composed of several interesting chapters, addressing the basic science aspects of pulmonary p- tection, as well as experimental and clinical experiences from different heart surgery centers worldwide.

General Concepts – (Lung Anatomy, Lung Physiology, Histological Features of the Lung, Cell and Molecular Aspects of the Lung, Imaging of the Lung). Pulmonary Ischemia and Reperfusion Injury – (Ischemic Preconditioning and Lung Preservatio, The role of acetilcholin, The role of nitric oxide). Cardiopulmonary bypass and pulmonary ischemia-reperfusion injury –( Role and Characteristics of Arterial Bronchial Flow, Hemodynamic Variables, Gas Exchange Features, Inflammatory Repercussions). Lung Perfusion: technique and principles – (Types of Solution, Establishment of Hemodynamic Parameters, Extracorporeal System Pathways for Lung Perfusion, Cardioplegic Arrest and Beating Heart Surgery, Hemodynamic Performance , Quality of Gas Exchange, Inflammatory Cell Markers, Cytokines and Cellular Adhesion Molecules, Lactic Acidosis and Enzyme Activity, Alterations in Surfactant Membrane, Macroscopical and Microscopical Findings, Tomographic Findings). Lung Perfusion with Arterial Blood. Lung Perfusion with Venous Blood. Lung Perfusion with Protective Solutions. Lung perfusion and Ultrafiltration. Lung Perfusion and Mechanical Ventilation. Continuous and Intermittent Lung Perfusion. Pulmonary Hemodynamic Profile and Brain Natriuretic Peptide. Lung Perfusion in Heart Surgery – (Coronary Artery Bypass Graft, Valve Surgery, Aortic Surgery, Congenital Disease Surgery, Heart and Lung Transplantation). Lung Perfusion and ECMO. Lung Perfusion: New Paradigm to Future