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Ann Thorac Surg 1996;62:950
© 1996 The Society of Thoracic Surgeons

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Correspondence

Prostacyclin for Spinal Cord Protection During Aortic Occlusion

S. Fehmi Katirciolu, MD, Murat Bayazit, MD, Ouz Tademir, MD, Kemal Bayazit, MD

Cardiovascular Surgery Clinic, Türkiye Yüksek htisas Hastanesi, 06100 Sihhiye, Ankara Turkey

To the Editor:

We have read Simpson and associates' [1] article about nitroglycerin and spinal cord ischemia with great interest. They declared that nitroglycerin, like sodium nitroprusside, is harmful to the spinal cord because these agents act through the nitrous oxide system, which has been shown to play a role in excitatory amino-acid–induced neurologic injury and they lead to steal phenomenon.

Pharmacological dilation or shunt procedures do not always increase spinal cord blood flow, even if the distal pressure is increased significantly. Shunt procedures do not increase the blood flow to the thoracic spinal cord because of the high resistance of the anterior spinal artery above the arteria radicularis magna, which supplies the lower thoracic spinal cord. A shunt or pharmacologic vasodilation (nitroglycerin) does not always guarantee the adequacy of perfusion to the lower thoracic spinal cord. Therefore, to protect the lower thoracic spinal cord, the artery supplying this segment must be specifically dilated by pharmacologic means; otherwise, the lower thoracic spinal cord must be preserved with the use of hypothermia. Paraplegia cannot occur if the anterior spinal artery is large or dilated enough to satisfy the metabolic needs of this segment. In a previous study, papaverine was used to increase spinal cord blood flow because it reverses the basilar artery spasm observed during subarachnoid hemorrhage [2], and intrathecally administered papaverine reduces the risk of paraplegia [3]. We [4] and Grabitz and colleagues [5] also demonstrated that prostaglandins have the ability to decrease the risk of spinal cord injury. Prostaglandins have antiaggregant and cytoprotective effects during reperfusion [6]. Our belief is that that any vasodilator agent that increases the cyclic adenosine monophosphate level reduces the incidence of neurologic injury.

References

1. Simpson JI, Eide TR, Schiff GA, et al. Effect of nitroglycerin on spinal cord ischemia after thoracic aortic cross-clamping. Ann Thorac Surg1996;61:113–7.
2. Ogata M, Marshall BM, Lougheed WM. Observations on the effects on the effects of intrathecal papaverine in experimental vasospasm. J Neurosurg1973;38:20–5.[Medline]
3. Svensson LG, Von Ritter CM, Groeneveld HT, et al. Cross-clamping of the thoracic aorta. Ann Surg1986;204:38–47.[Medline]
4. Katirciolu SF, Küçükaksu DS, Küplülü , et al. Effects of prostacyclin on spinal cord ischemia: an experimental study. Surgery1993;114:36–9.[Medline]
5. Grabitz K, Freye E, Sandmann W. Somatosensory evoked potential, a prognostic tool for the recovery of motor function following malperfusion of the spinal cord. J Clin Monitoring1993;9:191–5.[Medline]
6. Katirciolu SF, Küçükaksu DS, Bozdayi M, et al. Beneficial effects of prostacyclin treatment on reperfusion of the myocardium. Cardiovasc Surg1995;4:405–8.

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Murat Bayazit Kemal Bayazit Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by KatircioGlu, S. F. Articles by Bayazit, K. Search for Related Content PubMed PubMed Citation Articles by KatircioGlu, S. F. Articles by Bayazit, K.