• Giorgio Stefanutti, Paisarn Vejchapipat, Stephen R Williams, Agostino Pierro, and Simon Eaton.
• Department of Paediatric Surgery, Institute of Child Health, London, England, UK.
• J. Pediatr. Surg. 2004 Feb 1; 39 (2): 179-83; discussion 179-83.

Background/PurposeMultiple organ failure subsequent to intestinal ischaemia and reperfusion (I/R) includes cardiac failure, but little is known about heart energy metabolism in this setting. This study investigates the effects of intestinal I/R on heart energy metabolism and evaluates the effects of moderate hypothermia.MethodsAdult rats underwent intestinal ischaemia for 60 minutes followed by 120 minutes of reperfusion. Animals were maintained at either normothermia (36 degrees to 38 degrees C) or moderate hypothermia (30 degrees to 32 degrees C). In experiment A, 2 groups were studied: (1) sham at normothermia; (2) I/R at normothermia. After death, the heart was removed. Cardiac phosphoenergetics were assessed by 31P magnetic resonance spectroscopy; data are expressed as micromoles per gram. In experiment B, 4 groups were studied: (1) sham at normothermia, (2) I/R at normothermia, (3) sham at hypothermia, (4) I/R at hypothermia. At the end of the experiment, the heart was harvested. The activity of carnitine palmitoyl transferase I (CPT I), an important enzyme in the control of fatty acid oxidation, was measured; data are expressed as nanomoles per minute per unit citrate synthase. Results are expressed as mean +/- SEM.ResultsIn experiment A, there were no differences between the 2 study groups in cardiac phosphocreatine, inorganic phosphate, adenosine triphosphate (ATP), or in the ratio of inorganic phosphate to ATP. In experiment B, CPT I activity was decreased significantly after I/R at normothermia compared with normothermic sham, but this enzyme inhibition was prevented by hypothermia (3.9 +/- 0.2; v I/R).ConclusionsThese results suggest that although cardiac ATP supply was maintained during intestinal I/R at normothermia, the balance of substrate utilisation was shifted from fatty acid oxidation to carbohydrate utilisation. However, moderate hypothermia modified these changes. The beneficial effect of moderate hypothermia on cardiac metabolism during intestinal I/R has potential clinical application in various surgical conditions.

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