HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by McDonagh, P. F. Articles by Laks, H. Search for Related Content PubMed PubMed Citation Articles by McDonagh, P. F. Articles by Laks, H.

The Journal of Thoracic and Cardiovascular Surgery, Vol 84, 609-618, Copyright © 1982 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Use of cold blood cardioplegia to protect against coronary microcirculatory injury due to ischemia and reperfusion

PF McDonagh and H Laks

The effect of cold blood cardioplegia in preventing microvascular injury owing to myocardial ischemia and reperfusion was studied. Two groups of eight dogs each were placed on cardiopulmonary bypass with separate coronary perfusion at 80 mm Hg. Microcirculatory function was assessed by measuring the extraction and permeability surface area product (PS) for inulin and albumin. These changes were correlated with the transport and extraction of oxygen, coronary blood flow, and morphologic studies of the microvasculature. In Group I, ischemic hearts were kept normothermic for 45 minutes. In Group II, 250 ml of cold (4 degrees C) blood cardioplegic solution (potassium chloride 30 mEq/L) was infused and the infusion repeated at 15 and 30 minutes. Reperfusion resulted in marked reactive hyperemia for Group I (p less than 0.05) but no hyperemic response in Group II. In Group I, but not II, ischemia-reperfusion caused a significant decrease in PS inulin (0.47 +/- 0.10 ml/min/gm) compared to the preischemic value (1.04 +/- 0.23) (p less than 0.05). There was a threefold decrease in the PS inulin/PS albumin ratio with reperfusion in Group I, indicating increased vascular permeability to albumin. There was also a significant decrease in myocardial oxygen consumption (from 5.1 +/- 0.7 to 3.4 +/- 0.5 ml/min/100 gm, p less than 0.05) for Group I. These did not decrease for Group II. Histologic studies showed diffused areas of no reflow in the unprotected hearts. The wet/dry weight ratio for Group I (4.97 +/- 0.09) was significantly greater than for Group II (4.49 +/- 0.07) (p less than 0.001). The results indicate that in the unprotected heart, ischemia-reperfusion caused microcirculatory injury resulting in increased permeability to albumin, edema, a reduction in surface area, and areas of no reflow. In contrast, in the hearts protected with cold blood cardioplegia, no evidence of microcirculatory injury occurred.

This article has been cited by other articles:

				M Buyukates, S Acikgoz, O Kandemir, E Aktunc, E Ceylan, and M Can Use of warm priming solution in open heart surgery: its effects on hemodynamics and acute inflammation Perfusion, March 1, 2008; 23(2): 89 - 94. [Abstract] [PDF]

				S. C. Gale, J. Y. Hokama, L. S. Ritter, G. D. Gorman, J. G. Copeland, and P. F. McDonagh Pentoxifylline reduces coronary leukocyte accumulation early in reperfusion after cold ischemia Ann. Thorac. Surg., April 1, 2001; 71(4): 1305 - 1311. [Abstract] [Full Text] [PDF]

				N. Matsuda, M. Tofukuji, K. G. Morgan, and F. W. Sellke Coronary microvascular protection with Mg2+: effects on intracellular calcium regulation and vascular function Am J Physiol Heart Circ Physiol, April 1, 1999; 276(4): H1124 - H1130. [Abstract] [Full Text] [PDF]

				D. F Larson, L. B Gatewood, M. Bowers, G. Sethi, and J. G Copeland Assessment of left ventricular compliance during heart preservation Perfusion, January 1, 1998; 13(1): 67 - 75. [Abstract] [PDF]

				M. Tofukuji, A. Stamler, J. Li, M. D. Hariawala, A. Franklin, and F. W. Sellke Comparative Effects of Continuous Warm Blood and Intermittent Cold Blood Cardioplegia on Coronary Reactivity Ann. Thorac. Surg., November 1, 1997; 64(5): 1360 - 1367. [Abstract] [Full Text]

				A. Stamler, S. Y. Wang, D. E. Aguirre, R. G. Johnson, and F. W. Sellke Cardiopulmonary Bypass Alters Vasomotor Regulation of the Skeletal Muscle Microcirculation Ann. Thorac. Surg., August 1, 1997; 64(2): 460 - 465. [Abstract] [Full Text]

				S. Y. Wang, A. Stamler, M. Tofukuji, T. E. Deuson, and F. W. Sellke Effects of Blood and Crystalloid Cardioplegia on Adrenergic and Myogenic Vascular Mechanisms Ann. Thorac. Surg., January 1, 1997; 63(1): 41 - 49. [Abstract] [Full Text]

				G. Noera, C. Massini, R. Lodi, and G. Baggio Normothermic blood cardioplegia reperfusion plus nifedipine after cardioplegic arrest: experimental study with a new delivery set Perfusion, July 1, 1987; 2(3): 185 - 194. [Abstract] [PDF]