Ultrastructural study of the myocardium using cardioplegic crystalloid solution with and without procaine in patients undergoing aortic valve replacement.
OBJECTIVE
The aim of this study was to assess whether the presence of procaine in crystalloid cardioplegic solution increases myocardial protection at the ultra structural level.


METHODS
Eighteen patients that underwent aortic valve replacement in the Hospital de Clínicas de Porto Alegre over a 10-month period were studied. They were randomly allocated into two groups: group A--eight patients receiving cardioplegia without procaine; group B--ten patients receiving cardioplegia with procaine. Myocardial biopsies were performed in three different periods: 1st--before ischemic arrest, 2nd--at the end of ischemic arrest, and 3rd--15 minutes after reperfusion.


RESULTS
The ultra structural analysis comparing the groups in the three moments did not show any statistically significant difference. The mean score in group A at moment I, II and III was 0.1 +/- 0.2; 0.4 +/- 0.3; 0.4 +/- 0.4, and group B 0.2 +/- 0.2; 0.4 +/- 0.3; 0.7 +/- 0.2. Comparative analysis of CK-MB was similar. The spontaneous return to sinus rhythm after aortic declamping in group B occurred in 70% and in group A 12.5% (p=0.024).


CONCLUSIONS
Both cardioplegic solutions tested were equally effective in myocardial preservation, and we could not demonstrate at the ultrastructural level any benefit when procaine was added. The spontaneous return to sinus rhythm after aortic declamping was significantly greater when procaine was added.
Dussin
Luiz Henrique
LH
Hospital de Clínicas de Porto Alegre, UFRGS. dussin@ig.com.br
Moura
Leandro de
Ld
Gib
Marcelo Curcio
MC
Saadi
Eduardo Keller
EK
Barbosa
Gilberto Venossi
GV
Wender
Orlando Carlos Belmonte
OC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000494:pharmacology; D001021:Aortic Valve / Q000601:surgery*; D002314:Cardioplegic Solutions / Q000494:pharmacology*; D016009:Chi-Square Distribution; D000077324:Crystalloid Solutions; D005260:Female; D006324:Heart Arrest, Induced / Q000379:methods; D006329:Heart Conduction System / Q000503:physiopathology; D006349:Heart Valve Diseases / Q000601:surgery*; D006801:Humans; D007552:Isotonic Solutions / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control*; D009206:Myocardium / Q000201:enzymology / Q000648:ultrastructure*; D011343:Procaine / Q000494:pharmacology*; D012075:Remission, Spontaneous; D013997:Time Factors; D055815:Young Adult
D000779:Anesthetics, Local; D002314:Cardioplegic Solutions; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D011343:Procaine