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J Thorac Cardiovasc Surg 1997;113:1100-1108
© 1997 Mosby, Inc.

CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

DEOXYGENATED BLOOD MINIMIZES ADHERENCE OF SONICATED ALBUMIN MICROBUBBLES DURING CARDIOPLEGIC ARREST AND AFTER BLOOD REPERFUSION: EXPERIMENTAL AND CLINICAL OBSERVATIONS WITH MYOCARDIAL CONTRAST ECHOCARDIOGRAPHY

Supported in part by grants (R01-HL48890 and R29-HL43787) from the National Institutes of Health, Bethesda, Md., and Molecular Biosystems Inc., San Diego, Calif. Drs. Lindner and Ismail are recipients of Fellowship Training Grants from the Virginia Affiliate of the American Heart Association and Dr. Kaul is an Established Investigator of the National Center of the American Heart Association, Dallas, Tex.

Received for publication July 17, 1996 revisions requested August 29, 1996; revisions received Oct. 25, 1996 accepted for publication Dec. 27, 1996. Address for reprints: William D. Spotnitz, MD, Division of Thoracic and Cardiovascular Surgery, Box 181, Medical Center, University of Virginia School of Medicine, Charlottesville, VA 22908.

Abstract

Both administration of cardioplegic solution and blood reperfusion result in endothelial dysfunction. The transit rate of albumin microbubbles during myocardial contrast echocardiography may reflect endothelial injury. Accordingly, we performed myocardial contrast echocardiography in 12 dogs undergoing cardiopulmonary bypass and measured the myocardial transit rate of microbubbles injected into the aortic root during delivery of cardioplegic solutions containing arterial and venous blood and delivery of pure crystalloid cardioplegic solution. The myocardial transit rate of ^99mTc-labeled red blood cells was measured and perfusates were sampled for biochemical analysis at each stage. The microbubble transit rate was markedly prolonged during delivery of crystalloid cardioplegic solution and improved significantly during infusion of blood cardioplegic solution (p < 0.001); venous compared with arterial blood in the solution resulted in a greater rate (p < 0.001). The microbubble transit rate did not correlate with pH, oxygen tension or carbon dioxide tension values, or K⁺ concentration. The red blood cell transit rate remained constant regardless of the cardioplegic perfusate infused. Myocardial contrast echocardiography was also performed in 12 patients undergoing coronary artery bypass who underwent sequential arterial and venous reperfusion after cardioplegic arrest. The microbubble transit rate was faster with venous than arterial blood reperfusion (p = 0.01), although this gain was diminished when arterial blood reperfusion preceded venous blood reperfusion (p = 0.05). Our results indicate that endothelial dysfunction after cardioplegic arrest may be ameliorated by reperfusion with venous rather than arterial blood. (J Therac Cardiovasc Surg 1997;113:1100-8)

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