Ischemia monitoring in off-pump coronary artery bypass surgery using intravascular near-infrared spectroscopy

BACKGROUND: In off-pump coronary artery bypass surgery, manipulations on the beating heart can lead to transient interruptions of myocardial oxygen supply, which can generate an accumulation of oxygen-dependent metabolites in coronary venous blood. The objective of this study was to evaluate the reliability of intravascular near-infrared spectroscopy as a monitoring method to detect possible ischemic events in off-pump coronary artery bypass procedures. METHODS: In 15 elective patients undergoing off-pump myocardial revascularization, intravascular near-infrared spectroscopic analysis of coronary venous blood was performed. NIR signals were transferred through a fiberoptic catheter for signal emission and collection. For data analysis and processing, a miniature spectrophotometer with multivariate statistical package was used. Signal acquisition and analysis were performed before and after revascularization. Spectroscopic data were compared with hemodynamic parameters, electrocardiogram, transesophageal echocardiography and laboratory findings. RESULTS: A conversion to extracorporeal circulation was not necessary. The mean number of grafts per patient was 3.1 ± 0.6. An intraoperative myocardial ischemia was not evident, as indicated by electrocardiogram and transesophageal echocardiography. Continuous spectroscopic analysis showed reproducible absorption spectra of coronary sinus blood. Due to uneventful intraoperative courses, clear ischemia-related changes could be detected in none of the patients. CONCLUSION: Our initial results show that intravascular near-infrared spectroscopy can reliably be used for an online intraoperative ischemia monitoring in off-pump coronary artery bypass surgery. However, the method has to be further evaluated and standardized to determine the role of spectroscopy in off-pump coronary artery bypass surgery

Hydrologic fragmentation-induced eutrophication in Dove Sound, Upper Florida Keys, USA

Anthropogenic impacts to island systems can have deleterious effects on coastal aquatic ecosystems. These effects can alter water quality, primary production as well as habitat. Land development often fragments hydrologic connectivity within aquatic ecosystems forcing alterations in nutrient transport and increases the potential for eutrophication. Dove Sound, a tidal lagoon located in the Upper Florida Keys on Key Largo, has been subjected to anthropogenic influences of land development during the last century. To investigate these influences a short sediment core was collected from within Dove Sound and investigated using 210Pb dating, stable isotopes of carbon and nitrogen, and sedimentary pigments. Results indicated that Dove Sound has undergone eutrophication and the primary producer community structure has shifted from dominantly macrophytic to a system that supports substantial algal production. While septic waste was a possible source for eutrophication, low δ15N did not support this conclusion. However, the timing of the shifts in Dove Sound along with indicators of anoxia leads to the conclusion that fragmentation caused by the construction of a railroad was the root cause. The hydrologic fragmentation reduced the flushing rates, thereby enhancing anoxic conditions in the system and increasing the internal nutrient loading