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The Journal of Thoracic and Cardiovascular Surgery, Vol 79, 413-424, Copyright © 1980 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
W Flameng, M Borgers, W Daenen and G Stalpaert
We report observations on ultrastructural and cytochemical changes in the
myocardium after hypothermic protection in 21 patients who underwent
cardiac operation. Two general categories of hypothermic protection were
studied. (1) topical cooling during anoxic arrest and moderate general
hypothermia (10 patients with aortic valve replacement, Group 1) and (2)
intermittent perfusion during moderate general hypothermia combined with
topical cooling (11 patients with multiple valve replacement, Group II).
Transmural left ventricular biopsies were taken at the start of the
cardiopulmonary bypass and shortly after the end of aortic cross-clamping.
In Group I (cross-clamp time, 51 +/- 12 minutes) only minor pathologic
changes of the myocardial fine structure were found, with no differences
among the left ventricular layers. In most mitochondria, structure remained
intact but the mitochondrial granules disappeared. Cytochrome-c-oxidase
activity was unchanged. In Group II (total cross-clamp time, 83 +/- 16
minutes) the subendocardium was well preserved. Slight subcellular damage
comparable with that of resulting from topical cooling was seen in all
hearts even after a total cross-clamp period of 106 minutes.
Cytochrome-c-oxidase activity was unchanged. In the subepicardium, however,
a positive correlation was found between the severity of ultrastructural
damage and total cross-clamp time (p less than 0.05). Matrix clearing,
damage to the cristae and the mitochondrial membranes, and nuclear
abnormalities occurred when the aorta was cross-clamped for morethan 60
minutes. Cytochrome-c-oxidase activities decreased in these samples. It is
concluded that: (1) no significant subcellular injury was found in hearts
cooled topically during 1 hour of anoxic arrest; and (2) in hearts
protected by intermittent perfusion during moderate general hypothermia and
additional external cooling, the subendocardium was well preserved for
anoxic periods of up to 106 minutes. However, after 60 minutes of aortic
cross-clamping subcellular damage increased progressively in the
subepicardium.
ARTICLES
Ultrastructural and cytochemical correlates of myocardial protection by cardiac hypothermia in man
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