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eng. Hassanain Ali Lefta Mossa * ,

During an open-heart surgery (such as valve surgery), an extracorporeal (i.e. outside the body) equipment called the heart-lung machine takes over the functions of the heart and lungs, so that the heart can be carefully stopped while the vital organs continue to receive blood and oxygen. The surgeon can then operate in a blood-free surgical field without interference from bleeding or the heart's pumping motion.

The principle of the heart-lung machine (also known cardiopulmonary bypass) is actually quite simple. It permits the heart to be operated on safely by maintaining the circulation of oxygenated blood throughout the cardiovascular system. It represents a continuous loop; as the rich-oxygen blood goes into the body, poor-oxygen blood returns from the body and is drained into the pump completing the circuit.

The machine basically consists of a pump (to replace the heart) and an oxygenator (to replace the lungs). Acting as a mechanical heart and lungs, it keeps oxygen-rich blood flowing throughout the body after the patient's heart has been carefully stopped. In a process called perfusion , the machine receives the patient's blood, removes the carbon dioxide and other waste products, adds oxygen, warms (or cools) the blood and pumps it back through the body. Cooling the blood, in turn, lowers body temperature. This helps protect the body's organs while the heart-lung machine is in use. After the surgery is completed, the heart is restarted, the heart-lung machine is stopped and the machine is disconnected from the patient.

stopped and the ma chine is disconnected from the patient. Once using a heart-lung machine during

Once using a heart-lung machine during open-heart surgery, a powerful anticoagulant, Heparin should be given to the patient in order to reduce the blood's ability to clot, reducing the risk of clots forming in the heart-lung machine and within the tubes connected to the heart.

* B.Sc. in Biomedical Engineering from Baghdad University, Iraq 2000. M.Sc. in Medical Engineering from Al-Nahrain University, Iraq 2004.


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The heart-lung machine can perform other tasks. It can directly deliver medications and anesthetic drugs into the recirculated blood. In this way, medications arrive to the patient almost instantly by simply adding them to the blood within the heart-lung reservoir. It can also minimize blood loss by vacuuming up and recirculating any blood that may get into the surgical field.

any blood that may get into the surgical field. The shown below diagram illustrates a heart-lung

The shown below diagram illustrates a heart-lung machine pump head. This type of mechanism is called a peristaltic pump. The blood to and from the patient's body is carried in a length of sterile, clear plastic (polyvinyl chloride) tubing known as cannulas. These cannulas, with appropriate fittings to accommodate the tubing, are inserted into the vessels to take blood from, and deliver blood to, the patient. Pumping action occurs because the rollers on the rotating arm compress the tubing carrying the blood, forcing the blood ahead of the compressed section. This peristaltic action produces a wave like, pulsatile flow of the blood through the tubing system.

section. This peristaltic action produces a wave like, pulsatile flow of the blood through the tubing

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The heart-lung machine, schematically shown below, uses five pump heads; one for perfusion

of the body, two suckers and two for perfusion of the coronary arteries.

two suckers and two for perfusion of the coronary arteries. The main perfusion system includes pump

The main perfusion system includes pump head 1 and a combination heat exchanger / oxygenator. Some models separate these units, having separate oxygenator and heat exchanger devices. The heat exchanger consists of water coils isolated from, but thermally coupled to, the blood. A temperature controller permits the pump operator to keep the blood at a proper temperature and compensate for heat loss through radiation from the lines. The input port of the oxygenator / exchanger assembly is called the O2 –minus side, while the output port is called the O2 –plus side.

Blood is taken from the patient's venae cava. A cannula is placed into the superior venae cava and another into the inferior venae cava. These lines are joined into a single piece of tubing through a Y-adapter. The blood flows from the venae cavae through the tubing to the O2 minus side of the oxygenator / exchanger assembly. Another length of tubing carries blood from the O2 –plus side of the assembly, through a cannula inserted into the femoral artery. Pump heads 2 and 3 are used as suckers. Pump head 2 has a vent function to perform in the heart, while pump head 3 is shown as a suction device.

The surgeon can use the suction tip to collect blood that pools during surgery; this blood is ordinarily lost unless it is auto-transfused back to the patient. Blood from the suckers is delivered to a reservoir tank, and then transferred into the oxygenator / exchanger assembly on the O2 –minus side. The purpose of pump heads 4 and 5 is to perfuse the coronary arteries.

A piece of tubing is routed from a port on the O2 –plus side of the oxygenator through the

pump heads to the cannulas placed in the coronary arteries.

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The heart-lung apparatus is provided with controls that automatically maintain the proper temperature, maintain the pH of the blood at its correct value and safeguard the patient against unwanted changes in the volume and pressure of the blood.

The temperatures of the patient and the blood are both recorded automatically at frequent intervals. Blood temperature is controlled by a thermostat and electric heater in the recirculation loop. The pH controller measures the pH value of the blood and adjusts the admission of carbon dioxide to the oxygenator so as to maintain the pH near its correct level of (7.38). The maintenance of the correct pH level is essential if the blood is to perform its proper function for oxygen-carbon dioxide transport to and from the tissues of the body.

dioxide transport to and from the tissues of the body. The design of heart-lung machine should

The design of heart-lung machine should involve the four major considerations:


2) The mechanical pumps to replace the heart action in moving the blood from the patient's

low-pressure venous system through the machine and back into the patient's higher- pressure arterial system. 3) The handling of the blood itself, which raises questions of chemistry, materials of

construction and surgical cleanliness. The system of control to provide for as much automatic performance as possible during the course of the operation.


The artificial lung to accomplish the required gas transfer.

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