title: Prevention of cellular edema directly caused by hypothermic cardioplegia: studies in isolated human and rabbit atrial myocytes.
abstract: OBJECTIVE
  This study tested the hypothesis that edema during hypothermic cardioplegia is caused by the hypotonicity of the perfusate at cold temperatures.
  
  
  METHODS
  The volume of isolated human and rabbit atrial myocytes was measured by video microscopy under nonischemic conditions. Each cell served as its own control.
  
  
  RESULTS
  After equilibration in 37 degrees C physiologic buffer (Tyrode's solution), exposure to 9 degrees C St. Thomas' Hospital solution for 20 minutes caused human atrial cells to swell by 20% and rabbit atrial cells to swell by 10%. Cell volume fully recovered on rewarming in 37 degrees C physiologic solution. Cell swelling was due to the composition of St. Thomas' Hospital solution rather than hypothermia alone. Exposure to 9 degrees C physiologic solution did not significantly affect cell volume. Swelling of myocytes was largely prevented by replacing most of the Cl- in St. Thomas' Hospital solution with an impermeant anion so that the product of the concentrations of K+ and Cl- were the same as in the physiologic solution.
  
  
  CONCLUSIONS
  This study suggests that cell swelling during hypothermic cardioplegia is caused in part by the composition of the cardioplegic solution. The volume of cardiac myocytes appears to follow a Donnan equilibrium in the cold, and the perfusate KCl product determines water movement. Thus, the tonicity of hyperkalemic cardioplegic solutions can be adjusted to a physiologic value by replacing most Cl- by an impermeant anion. Following this simple principle, a reformulation of cardioplegic solutions may be able to minimize iatrogenic myocardial edema.
authors.affiliation: Department of Physiology, Medical College of Virginia, Virginia Commonwealth University, Richmond, USA.
authors.forename: R F
authors.initials: RF
authors.lastname: Shaffer
authors.forename: C M
authors.initials: CM
authors.lastname: Baumgarten
authors.forename: R J
authors.initials: RJ
authors.lastname: Damiano
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D001639:Bicarbonates / Q000009:adverse effects; D002122:Calcium Chloride / Q000009:adverse effects; D002314:Cardioplegic Solutions / Q000009:adverse effects*; D048429:Cell Size / Q000187:drug effects; D004487:Edema / Q000139:chemically induced / Q000473:pathology / Q000517:prevention & control*; D005260:Female; D006324:Heart Arrest, Induced; D006325:Heart Atria / Q000187:drug effects / Q000473:pathology*; D006801:Humans; D007036:Hypothermia, Induced; D007038:Hypotonic Solutions / Q000009:adverse effects; D007091:Image Processing, Computer-Assisted; D007552:Isotonic Solutions / Q000494:pharmacology; D008274:Magnesium / Q000009:adverse effects; D008297:Male; D018715:Microscopy, Video; D008875:Middle Aged; D011189:Potassium Chloride / Q000009:adverse effects; D011817:Rabbits; D012965:Sodium Chloride / Q000009:adverse effects
chemical_list: D001639:Bicarbonates; D002314:Cardioplegic Solutions; D007038:Hypotonic Solutions; D007552:Isotonic Solutions; C041711:St. Thomas' Hospital cardioplegic solution; C037692:Tyrode's solution; D012965:Sodium Chloride; D011189:Potassium Chloride; D008274:Magnesium; D002122:Calcium Chloride