• Journal of Chest Surgery
• /
• v.33 no.9
• /
• pp.707-715
• /
• 2000

Background: Cold blood cardioplegic solution has been used to protect myocardium during open heart surgery with the hypothesis stating that it provides more oxygen supply to myocardium compared to crystalloid caridoplegic solution. We repeatedly infused cold blood cardioplegic solution to achieve myocardial protection. We biopsied a small portion of papillary muscle of patients with mitral valve replacement or double valve replacement during aortic cross-clamp time and evaluated the method of myocardial protection through the observation of changes in ultrastructure. We then analysed the relationship between changes in ultrasructure and peak postoperative CK-MB value and SGOT value. Material and method: We report observation on changes of myocardial ultrastructure, postoperative CK-MB and SGOT, and electrocardiogram in 31 patients who underwent cardiac operation. There were 11 males and 20 females, and they ranging in age from 28 to 69 years(mean score was 2.08$\pm$0.560, it was 2.37$\pm$0.558 at 40 minutes, and it was 2.36$\pm$0.523 at 70minutes. Mitochondrial score increased significant at 40 minutes. Mean value of postoperative peak CK-MB and SGOT were 37.3$\pm$17.061IU, 144.5$\pm$125.5IU respectively. We were not able to find any new Q were in EKG after the operation. There was no significant relationship between myocardium mitochondrial score and mean value of postoperative peak CK-MB and SGOT. Conclusion: In conclusion, with this study the cold blood cardioplegic solution was incomplete in preserving ultrastructure of myocardium even with satisfactory results in serum enzyme and EKG evaluation.

• Journal of Chest Surgery
• /
• v.13 no.3
• /
• pp.186-197
• /
• 1980

We attempted to evaluate the effectiveness of cold blood potassium cardioplegia [Group B] compared with that of intermittent aortic cross clamp with topical hypothermia [Group A] in each six dogs. The studies were performed under the extracorporeal circulation with moderate hypothermia by using Mongrel dogs. 1. In Group A [6], it was difficult to maintain the temperature below 20?. but in Group B [6], it was possible to maintain the temperature. 2. In blood pressure and myocardial recovery ability, Group B was more excellent than Group A. 3. There was no significant difference in Na+, Ca++ and Cl- between both groups, but in K+ level, Group A was mild decreased and Group B was nearly normal level. 4. In serum LDH level, Group A was higher than Group B, but in SGOT level there was no significance between both groups. 5. On electromicroscopical study, Group A showed severe change in mitochondria, but Group B was nearly normal view. Thus we suggest that cold blood potassium cardioplegia would be more effective than intermittent aortic cross clamp with topical hypothermia for myocardial protection in open heart surgery.

• Journal of Chest Surgery
• /
• v.22 no.6
• /
• pp.936-943
• /
• 1989

We underwent 21 cases of orthotopic heart transplantation in the mongrel dogs from May, 1988, to April, 1989. The preoperative hematologic and hemodynamic results were similar to those of the previous reports except glucose and albumin. The exposure of operative field was excellent under the median sternotomy. All the cases died within 48 hours and the mean survival time excluding 4 operative deaths was 11.23*9.36 hours [\ulcorner.D., range 0.3-35.5 hours] We speculated the main cause of death was low cardiac output due to the myocardial failure. At autopsy, there was feature of intramyocardial hemorrhage and coagulation necrosis suggesting poor myocardial protection. Now our team is ready to do heart transplantation in man but we need more precise experiences, especially on the immunosuppression and myocardial protection. Recently we continue further experiments with improving results.

• Journal of Chest Surgery
• /
• v.25 no.2
• /
• pp.131-136
• /
• 1992

The effect of temperature of cardioplegic solution on myocardial preservation was studied using isolated rat heart perfusion technique. Twenty Sprague-Dawley rats, weighing 120~140gm, were pretreated with intraperitoneal injection of heparin sodium[300u/kg] and then the hearts were excised after cervical herniation 30 minutes later. The hearts were perfused in isolated working heart apparatus with oxygenated modified Tyrode solution at 37oC. After 10 minutes of non working heart perfusion, the hearts were subjected to arrest for 30 minutes by administration of 5cc cardioplegic solution at the temperature of 4oC [Group I ], 15oC [Group II], 25oC [Group III], 37oC[Group IV]. At the same time, the topical cooling of heart was performed using ice saline. After arrest, the hearts were reperfused by non working heart perfusion for 1 hour with modified Tyrode solution at 37oC. The CPK, GOT and LDH in reperfusate were measured at 5,20,40,60 minutes after start of reperfusion. With the values of those, we compared the effect of temperature of cardioplegic solution on myocardial preservation. The results were as follows; 1. The enzyme values in reperfusate were highest at 5 minute and after then declined. 2. At 5 minutes after reperfusion, the enzyme values in Group I were lower than those in other Groups. These results suggest that the cardioplegic solutions using for cardiac arrest and myocardial protection can be working better at 4oC than at any other temperature.

• Journal of Chest Surgery
• /
• v.21 no.2
• /
• pp.231-239
• /
• 1988

Currently numerous methods are in use for myocardial hypothermia as a myocardial preservation modality for cardiac operation. During cardiac ischemia after crystalloid cardioplegia[4C GIK solution], topical cold saline[Group I, a=9], topical ice slush[Group II, n=9] and topical ice chip[Group III, a=10] have been compared for myocardial surface cooling in the isolated rat heart model of cardiopulmonary bypass. During postischemic period, hemodynamic functions[aortic flow, coronary flow, peak aortic pressure and heart rate], biochemical enzymatic activities and cellular injuries with electron microscope were evaluated in this isolated rat heart perfusion model. Postischemic aortic flow, cardiac output and peak aortic pressure in Group I and Group II recovered better than Group III.[p< 0.05] Postischemic creatine kinase and lactate dehydrogenase leakages in Group II and Group III increased more than Group l and postischemic mitochondrial swelling in Group III was more severe than Group I, and Group II.[p< 0.05] These results suggest that topical cold saline was the better method than topical ice slush or topical ice chip as a myocardial preservation modality in the isolated rat heart model of cardiopulmonary bypass.

• Journal of Chest Surgery
• /
• v.21 no.2
• /
• pp.246-253
• /
• 1988

An in vitro model providing with a recirculating perfusion apparatus using an isolated canine heart and its autogenous blood, which was prepared for study of myocardial protection method. This apparatus was easily used by quick connect system and maintained well heart function for about 2 hours. The Langendorff perfusion was initiated for a 10 minute period by introducing perfusate at 37` into the aorta from aortic reservoir located 100 cm above the heart. The isolated perfused working canine heart model was a left heart preparation in which oxygenated perfusion medium [at 37K] entered the cannulated left atrium at a constant flow rate [900ml/ min] under 20 mmHg overflow system and was spontaneously ejected[no electrical pacing] via an cannula against a hydrostatic pressure of 80 cm H2O. During this working period, various indices of cardiac function were measured. The cardiac functions were stable for over 2 hours with perfusion of Krebs-Henseleit solution and autologous blood[1:1] mixture in volume and maintained heart rate ]]3-122/bpm peak systolic pressure 109-113 mmHg, cardiac output 900 ml / min and left atrial mean pressure 8-9 mmHg. In this model, the efficiency of myocardia] protection could be easily measured by means of functional, enzymatic, biochemical and ultrastructural assessment. And also, we believe this model to be a useful assessment screening model of recovery state after long duration of myocardial preservation of donor heart without difficult transplantation procedures.

• Journal of Physiology & Pathology in Korean Medicine
• /
• v.16 no.5
• /
• pp.955-959
• /
• 2002

To test the protective effect of herbal medicine on myocardial damage against oxygen free radical-induced myocardiotoxicity, cytotoxicity was examined using MTT, Beating rate and TSARS assay in the presence of water extract of Rhizoma Coptidis. Myocardial toxicity was evaluated in neonatal rat myocardiocytes in cultures. The results of these experiments were obtained as follows: Xanthine oxydase/hypoxanthine resulted in a decrease in viability, beating rate and in a increase in lipid peroxidation in Cultured myocardial cells. Rhizoma Coptidis water extract shows effects of protection from the cardiocyte toxicity induced by xanthine oxydase/hypoxanthine treatment such as increases in beating rate. Rhizoma Coptidis water extract shows effects of protection from the cardiocyte toxicity induced by xanthine oxydase/hypoxanthine treatment such as decreases in lipid peroxidation. These results show that xanthine oxydase/hypoxanthine elicits toxic effects. in cultured myocardial cells derived from neonatal rat, and suggest that water extract of Rhizoma Coptidis is very effective in the prevention of xanthine oxydase/hypoxanthine-induced cardiotoxicity.

• Journal of Physiology & Pathology in Korean Medicine
• /
• v.16 no.6
• /
• pp.1117-1121
• /
• 2002

To test the protective effect of herbal medicine on myocardial damage against oxygen free radical-induced myocardiotoxicity, cytotoxicity was examined using MTT, Beating rate and DNA synthesis assay in the presence of water extract of three kinds of Radix Rehmanniae. Myocardial toxicity was evaluated in neonatal rat myocardiocytes in cultures. The results of these experiments were obtained as follows : Xanthine oxydase/hypoxanthine resulted in a decrease in viability, beating rate and DNA synthesis in cultured myocardial cells. Radix Rehmanniae Recens(生地黃, RRR) water extract shows effects of protection from the cardiocyte toxicity induced by xanthine oxydase/hypoxanthine treatment such as increases in beating rate. Radix Rehmanniae Preparat(熟地黃, RRP) water extract shows effects of protection from the cardiocyte toxicity induced by xanthine oxydase/hypoxanthine treatment such as increases in DNA synthesis. These results show that xanthine oxydase/hypoxanthine elicits toxic effects in cultured myocardial cells derived from neonatal rat, and suggest that water extract of three kinds of Radix Rehmanniae is very effective in the prevention of xanthine oxydase/hypoxanthine-induced cardiotoxicity.

• Journal of Chest Surgery
• /
• v.18 no.4
• /
• pp.759-770
• /
• 1985

This study was experimentally undertaken to evaluate the effect of hypothermic oxygenated cardioplegic solution on myocardial protection during prolonged aortic cross clamping under cardiopulmonary bypass. Dogs were divided into two groups control group [received hypothermic unoxygenated cardioplegic solution] and experimental group [received hypothermic oxygenated cardioplegic solution]. Coronary sinus effluent was obtained at once and 30, 60, 90 minutes after cross-clamping for the determination of pH, PCO2,PO2 and lactate level during the infusion of cardioplegic solution and myocardial biopsies were obtained after cessation of 90 minutes of aortic cross-clamping. The results obtained were as follows: 1. There was no significant differences in the pH and PCO2 between the oxygenated and unoxygenated cardioplegic solution but the PO2 of the oxygenated solution was 4 times greater than unoxygenated solution, and also the oxygenated solution had a significantly greater oxygen content [2.020.05 ml 02/min] and had much more oxygen delivery than unoxygenated solution. 2. The myocardial oxygen consumption and the myocardial oxygen extraction in oxygenated group were 1.63 ml 02/100 ml and 67.32% respectively, which was greater than those in unoxygenated group. 3. Regarding to pH and PCO2 of coronary sinus effluent, there was no significant differences between two groups in early period of infusion of cardioplegic solution, but the pH shifted to acidosis from 60 minutes, PCO2 increased from 90 minutes of aortic cross-clamping, and PO2 markedly decreased from 90 minutes of aortic cross-clamping in unoxygenated group. 4. The lactate concentration of coronary sinus effluent revealed relatively normal in both groups, but showed slight increase up to 27.54.56 mg/100 ml at 90 minutes of aortic cross-clamping in unoxygenated group. 5. On electron microscopic study, the ultrastructural integrity of myocardial cells in oxygenated group was well preserved within 90 minutes. Slight swelling and deformity of mitochondria, interfibrillar widening, and disarrangement of myofibrils were observed at 90 minutes after aortic cross-clamping in unoxygenated group. From these results, the use of hypothermic oxygenated cardioplegic solution seemed to be effective and better method for the preservation of ischemic myocardium during the prolonged aortic cross-clamping.

• Journal of Chest Surgery
• /
• v.33 no.8
• /
• pp.630-637
• /
• 2000

Backgroud: There are well-known problems in the management of low weight neonates or infants with congenital heart defects. In the past, because of a perceived high risk of operations using cardiopulmonary bypass(CPB) in these patients, there was a tendency for staged palliation without the use of CPB. However, the recent trend has been toward early reparative surgery using CPB, with acceptable mortality and good long-term survival. Therefore we reviewed our results of the operations in infants weighing less than 3kg and considered the technical aspect of conducting the CPB including myocardial protection. Material and Method: Between Jan. 1995 and Jul. 1998, 28 infants weighing less than 3kg underwent open heart surgery for many cardiac anomalies with a mean body weight of 2.7kg(range; 1.9-3.0kg) and a mean age of 41days(range; 4-110days). Preoperative management in the intensive care unit was needed in 20 infants and preoperative ventilator support therapy in 11. Total correction was performed in 23 infants and the palliative procedure in 5. Total circulatory arrest was needed in 11 infants(39%). Result: There were seven hospital deaths(25%) caused by myocardial failure(n=3), surgical failure(n=2), multiorgan failure(n=1), and sudden death(n=1). The median duration of hospital stay and intensive care unit stay were 13days(range; 6-93days) and 6days(range; 2-77days) respectively. The follow-up was achieved in 21 patients and showed three cases of late mortality(15%) and a one-year survival rate of 62%. No neurologic complications such as clinical seizure and intracranial bleeding were noticed immediately after surgery and during follow-up. Conclusion: The early and late mortality rate of open heart surgery in our infants weighing less than 3 kg stood relatively high, but the improved outcomes are expected by means of the delicate conduct of cardiopulmonary bypass including myocardial protection as well as the adequate perioperative management. Also, the longer follow-up for the neurologic development and complications are needed in infants undergoing circulatory arrest and continuous low flow CPB.