Myocardial protection in the hypertrophied right ventricle.
Hypertrophied right ventricle presents a sensitive state that may not be adequately protected by modern cardioplegic methods. Cardiac metabolism, performance, and ultrastructure were measured in response to 1 hour of cardioplegic arrest in 15 pigs with right ventricular hypertrophy using intermittent hypothermic crystalloid, blood, and Flusol DA 20%-based cardioplegia. Reperfusion time was 1 hour. One hour after a 60-minute cross-clamp period, there were no differences in light microscopy. Total energy stores increased in 4 of 5 animals given blood cardioplegia compared with 1 of 5 for each of the other groups. Cardiac performance data also showed better results for animals treated with blood cardioplegia. After 30 minutes of reperfusion, animals receiving blood cardioplegia recovered 131% +/- 42% of preoperative systolic performance compared with 106% +/- 49% for Fluosol-treated animals and only 82% +/- 27% recovery for the crystalloid-treated group. After 60 minutes of reperfusion, the blood group showed 119% +/- 20% recovery compared with 89% +/- 23% and 85 +/- 50% recovery for Fluosol- and crystalloid-treated hearts, respectively. In conclusion, blood cardioplegia provided better protection than did crystalloid or Fluosol DA 20% cardioplegia when animals with right ventricular hypertrophy underwent 1 hour of cardioplegic arrest. It may have repaired damaged myocardium, leaving better hearts after cross-clamping than before.
Cusimano
R J
RJ
Division of Cardiovascular Surgery, St. Michael's Hospital, Toronto, Ontario, Canada.
Ashe
K A
KA
Chin
I D
ID
Chi
P
P
Abel
J G
JG
Lichtenstein
S V
SV
Salerno
T A
TA
D000227:Adenine Nucleotides / Q000378:metabolism; D000818:Animals; D006332:Cardiomegaly / Q000378:metabolism / Q000503:physiopathology*; D002314:Cardioplegic Solutions / Q000008:administration & dosage*; D000077324:Crystalloid Solutions; D004338:Drug Combinations; D005466:Fluorocarbons; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D015428:Myocardial Reperfusion Injury / Q000378:metabolism / Q000503:physiopathology*; D009206:Myocardium / Q000378:metabolism; D010952:Plasma Substitutes; D013552:Swine; D016277:Ventricular Function, Left
D000227:Adenine Nucleotides; D002314:Cardioplegic Solutions; D000077324:Crystalloid Solutions; D004338:Drug Combinations; D005466:Fluorocarbons; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes; C017323:glucose, glycerol, hydroxyethyl starch, perfluorodecalin, perfluorotripropylamine, pluronic F-68, salts, yolk phospholipids drug combination