الفهرس 
INTRODUCTION AND AIM OF THE WORKOnly 14 pages are availabe for public view
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Abstract
Introduction: Pulsatile flow is a physiological flow and theoretically has benefits. Dozens of experimental and clinical researches proved that pulsatile flow has benefits over non-pulsatile flow. Most of these researches documented the superiority of pulsatile over non-pulsatile flow as regard improved microcirculatory perfusion, increased tissue oxygenation, decreased vasopressin, catecholamines release, and decreased systemic vascular resistance. Some researches documented no difference as regard these previous aspects. Aim of work: The aim of the work is to compare between the effect of pulsatile and non pulsatile mode of perfusion during cardiopulmonary bypass in patients with rheumatic mitral regurge regarding arterial and venous oxygen saturation, arterial and venous oxygen content, arteriovenous oxygen content difference, whole body oxygen consumption, brain recovery time, extubation time, overall mortality and postoperative hospital stay and to compare between both types of flow regarding major postoperative neurological defects. Patients and methods: Between May 2005 and August 2007, fifty patients who had mitral regurge underwent mitral valve replacement in the Cardiothoracic Surgery Department, Mansoura University Hospitals, using cardiopulmonary bypass. The patients were randomized for using two types of flow, non pulsatile and pulsatile. The patients were divided into 2 groups: Non pulsatile flow (NPF) group: Included 25 patients in which continuous flow was used. Pulsatile flow (PF) group: Included 25 patients in which pulsatile flow was used. All patients in our study survived in the perioperative and the postoperative periods. There were no statistically significant difference between both groups in preoperative or intraoperative parameters as age, sex, body surface area, cross-clamp time, CPB time, flow rates, temperature, systolic blood pressure, diastolic blood pressure and mean blood pressure. Results: Our results showed increased intraoperative urine output 1316.0 vs 1168.0 ml (P = 0.004), lower systemic vascular resistance 987.75 vs 1157.86 dyne/sec/cm–5 (P = 0.01), increased venous oxygen saturation 63.26 vs 58.94% (P = 0.008), decreased arteriovenous oxygen content difference 6.10 vs 7.26 gm% (P = 0.001), decreased whole body oxygen consumption 136.30 vs 189.02 ml/min/m2 (P = 0.02), shorter extubation time 358.00 vs 433.60 min. (P = 0.01) and shorter ICU stay 3.48 vs 4.56 days (P = 0.01), with statistically significant difference in PF group versus NPF group respectively. There was increased platelet count depletion, RBCs depletion with PF. Conclusions: from the previous information, we can conclude that PF carry more benefits to patients with renal problems but carried hazards to patients with hematological problems. Also, we can conclude that the benefits and hazards of PF cannot be exactly weighted, neither PF nor NPF is preferable over the other and so each type of flow matches with a type of patient and to confirm this opinion we advice more researches to be done in this field but in selected group of patients as in patients with COPD, patients with renal problems and old age patients.