Prediction of Prognosis in Open-Heart-Surgery by Regional Difference in Leg Surface Temperature Shuji SEKI, Tsuneyuki ITANO, Hiroshi SUOATA, Masayuki TANIZA~:I, M a m o r u TAOO, Shigeru TERAMOTO and Terutake SUNADA A B S T R A C T : Change of the surface temperature of the leg during openheart-surgery was determined in five patients, in whom either side of the femoral artery was ligated for cannulation. While the surface temperature at the patella was least influenced, that at the ankle paralleled closely the changes in the core body temperature and blood supply to the leg. Their difference(P-A difference) was studied to see if they can be used to predict prognosis of patients undergoing open-heart surgery. The P-A difference was followed for several hours after the open-heart surgery. It was marked positive when the surface temperature at the patella was higher than that at the ankle. Total of 54 patients were studied. Only one out of 29 patients with negative P-A difference succumbed. This is in sharp contrast to the 25 remaining patients with positive P-A difference, from whom as m a n y as 12 died. In addition, the postoperative course of the 13 survivors from the latter group was more eventful. Since P-A difference seemed to indicate accurately cardiac output by reflecting the state of the peripheral circulation, it can be used as a useful parameter in prediction of the prognosis in open-heart surgery. K E Y W O R D S : peripheral circulation, open-heart surgery, ischemia of the lower extremity, prediction of prognosis, dopamine for low cardiac output, cardiogenic shock, patella-ankle difference (P-A difference). INTRODUCTION

L o w cardiac output constitutes one of the major risks in heart surgery and its early detection and management are of paramount importance. The change in peripheral circulation has been thought to provide a clue in detecting low cardiac output. Clinical application of the principle necessitates the monitoring of peripheral circulation to be done continuously, if necessary, repeatedly and such apparatus should be readily available at the reasonable price. The purpose of this study is to show the regional difference in skin temperature of the leg can be used for the early detection of a low cardiac output and for prediction of the prognosis following open-heart surgery. The method of monitoring skin temperature being used is described. MATERIALS AND METHODS

Patients studied varied in age from 8 months to 66 years. Among 54 patients studied 22 patients underwent radical correction for tetralogy(18) or pentalogy(4) of Fallot, 4 for

From the Department of Surgery, Okayama UniversitySchool of Medicine, Okayama 700, Japan. Mailing address: Dr. Shuji Seki, Department of Surgery, Okayama UniversitySchool of Medicine, Shikata-cho, Okayama 700, Japan. JAPANESEJOURNAL OF SURGERY, VOL. 5, No. 2, pp 65-72, 1975

Seki, et al.

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Jap. J. Surg. June 1975

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