Prostacyclin and thromboxane levels in pleural space fluid during cardiopulmonary bypass

Prostaglandins exhibit a variety of cardiovascular actions that may affect the hemodynamic recovery of the ischemic myocardium after cardiopulmonary bypass. We have observed a decrease in the mean arterial pressure on autotransfusion of the accumulated pleural cavity fluid during operation. One aim of this study was to determine the concentrations of prostacyclin and thromboxane A2 in the pleural cavity fluid by measuring their stable metabolites, 6-keto-PGF1α and thromboxane B2, respectively, in 8 consecutive patients undergoing myocardial revascularization, and to compare them with the arterial levels. A second aim was to quantify the hemodynamic effect of the pleural cavity fluid during operation. The concentration of 6-keto-PGF1α in the pleural cavity fluid was significantly higher than the arterial concentration (mean, 21.6 ± 18.2 ng/mL; p < 0.01). The concentration of thromboxane B2 was also raised compared with the arterial concentration (mean, 3.62 ± 5.96 ng/mL; p < 0.2). The percentage fall in the mean arterial pressure was 29.7% ± 8.86% (p < 0.02), which was transient and lasted 1 to 3.5 minutes. The hemoglobin concentration, potassium level, and pH were also measured. This study shows that the pleural cavity fluid during cardiac operations contains significant amounts of endogenous prostacyclin. Considering the potential benefit of prostacyclin on the recovering myocardium, we believe that this fluid should be transfused as a volume replacement, keeping in mind the transient phase of hemodynamic instability.