Summary
In previous studies white retinal emboli have been observed during open heart surgery in patients who postoperatively developed neurological complications and in patients who failed to survive (Williams, 1973). In the present study similar white retinal emboli were experimentally produced in dogs undergoing total cardiopulmonary bypass and were shown to comprise blood platelets. Trypsin digest flat preparations of the retina showed multiple capillary occlusions, some having characteristics of denatured cellular material and fat, others resembling silicone grease in vessels. The incidence of experimentally produced emboli comprising blood platelets and other cellular material was significantly reduced by adding dipyridamole (Persantin-Boehringer Ingelheim) a substance which impairs aggregation and adhesiveness of platelets, to the perfusate.
Zusammenfassung
In früheren Veröffentlichungen wurden weiße Emboli der Netzhautgefäße bei offenen Herzoperationen beobachtet, bei Patienten, die neurologische Komplikationen zeigten oder solchen, die den Eingriff nicht überlebten (Williams, 1973). In der vorliegenden Veröffentlichung wird über ähnliche weiße Retinaemboli bei Hunden berichtet, deren Kreislauf ganz über eine Herz-Lungen-Maschine geleitet wurde. Es zeigte sich, daß diese Emboli aus Thrombocyten bestanden. Trypsinbehandelte Flachpräparationen der Retina wiesen multiple capilläre Verschlüsse auf, von denen einige durch denaturiertes Zellmaterial und Fett charakterisiert waren, während andere aussahen, als sei Silikonfett in den Blutgefäßen. Das Auftreten von experimentell ausgelösten Emboli aus Thrombocyten und anderen Zellmaterialien war signifikant seltener, wenn dem Kreislaufsystem Dipyridamol (Persantin®-Boehringer/Ingelheim) zugefügt wurde. Diese Substanz wirkt der Aggregation und Verklebung der Thrombocyten entgegen.
Similar content being viewed by others
References
Aguilar, M. J., Gerbode, F., Hill, J. D.: Neuropathologic complications of cardiac surgery. J. thorac. cardiovasc. Surg.61, 676–685 (1971)
Allardyce, D. B., Yoshida, S. H., Ashmore, P. G.: The importance of microembolism in the pathogenesis of organ dysfunction caused by prolonged use of the pump oxygenator. J. thorac. cardiovasc. Surg.52, 706–716 (1966)
Dow Corning (personal communication from Silas Braley of Dow Corning Corporporation)
Emmons, P. R., Harrison, M. J. G., Honour, A. J., Mitchell, J. R. A.: Effect of dipyridamole on human platelet behaviour. Lancet1965 II, 603–606
Jeyasingham, K., Althaus, U., Berg, E., Albrechtsen, O.: Alterations in the plasma proteins and lipids in human and canine blood in bubble and disc oxygenators. Scand. J. thorac. cardiovasc. Surg.6, 172–177 (1972)
Jorgensen, L., Hovig, T., Roswell, H. C., Mustard, J. F.: Adenosine diphosphate induced platelet aggregation and vascular injury in swine and rabbits. Amer. J. Path.61, 161–170 (1970)
Kuwabara, T., Cogan, D.G.: Studies of retinal vascular patterns. 1. Normal architecture. Arch. Ophthal.64, 904–911 (1960)
Rozenberg, M.C., Ledwidge, C.M., Wilcken, D.E.L., McKeon, M.: The inhibition of adensosine phosphorylation in platelets by dipyridamole. J. Lab. clin. Med.77, 88–96 (1971)
Sullivan, J.M., Harken, D.E., Gorlin, R.: Pharmacologic control of thromboembolic complications of cardiac-valve replacement. New Engl. J. Med.284, 1391–1394 (1971)
Williams, I. M.: Intravascular changes in the retina during open-heart surgery. Lancet1971 II, 688–691
Williams, I.M.: Fundus oculi findings associated with cardiopulmonary bypass procedures. Trans. Asia Pacific Acad. Ophthal. 72–76 (1972)
Williams, I.M.: Central nervous system dysfunction with open-heart operations. Proc. Aust. Ass. Neurol. (1973 in press)
Williams, I.M., Stephens, J.F., Brunckhorst, L.E., Brodie, G.: Identification of silica in retinal capillaries by electron probe xray microanalysis. (unpublished)
Author information
Authors and Affiliations
Additional information
Supported in part by the National Health and Medical Research Council of Australia and the Alfred Hospital Research Scholarship Fund.
Rights and permissions
About this article
Cite this article
Williams, I.M., Farmer, S. & Fixon, J. Effect of dipyridamole on retinal embolism associated with cardiopulmonary bypass surgery in the dog. Albrecht von Graefes Arch. Klin. Ophthalmol. 189, 251–263 (1974). https://doi.org/10.1007/BF02384853
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF02384853