The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Oct 1988
Effects of antegrade cardioplegic infusion with simultaneously controlled coronary sinus occlusion on preservation of regionally ischemic myocardium after acute coronary artery occlusion and reperfusion.
This study was conducted to assess the protective effects of antegrade infusion of cardioplegic solution with simultaneously controlled coronary sinus occlusion on regionally ischemic myocardium after acute coronary occlusion and reperfusion. Twelve sheep were subjected to 1 hour of occlusion of the distal left anterior descending coronary artery. Sheep in group I (n = 6) were subjected only to infusion of potassium crystalloid cardioplegic solution into the aortic root, whereas in group II (n = 6) a stitch was snared around the proximal coronary sinus for its subsequent occlusion during antegrade infusions of cardioplegic solution. ⋯ Animals treated by the technique of antegrade infusion combined with coronary sinus occlusion had more homogeneous myocardial cooling during cardioplegic infusions and better recovery of the first derivative of left ventricular pressure and regional segment shortening at 90 and 270 minutes of reperfusion than those treated with antegrade infusion alone (p less than 0.01 and p less than 0.05, respectively). The group treated by antegrade infusion of cardioplegic solution combined with coronary sinus occlusion had an area of necrosis/area at risk ratio of 40.5% +/- 1.2%; the antegrade infusion group, 58.3% +/- 4.1% (p less than 0.01). These data suggest that antegrade infusion combined with coronary sinus occlusion may be an improved method of global and regional myocardial protection in the presence of an occluded coronary artery.
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J. Thorac. Cardiovasc. Surg. · Sep 1988
Inferior and superior vena caval blood flows during cross-clamping of the thoracic aorta in pigs.
Changes in blood flow through the inferior and superior venae cavae during cross-clamping of the thoracic aorta just above the diaphragm were studied in 28 miniature pigs anesthetized with enflurane titrated to maintain systemic arterial blood pressure close to normal values. Surgical preparation included sternotomy with subsequent placement of a noncannulating electromagnetic probe around the ascending aorta and a cannulating electromagnetic probe in the transected inferior vena cava. Superior vena caval flow was calculated as the difference between aortic flow and inferior vena caval flow. ⋯ The oxygen content in mixed venous blood significantly (p less than 0.05) increased from 9.5 +/- 1.1 to 13.4 +/- 1.8 ml.dl-1 in animals undergoing clamping of the thoracic aorta only, but did not change significantly in animals subjected to simultaneous clamping of the aorta and inferior vena cava. The study demonstrates a substantial increase in superior vena caval flow during cross-clamping of the thoracic aorta. Further studies elucidating the mechanism of the observed changes are required.
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J. Thorac. Cardiovasc. Surg. · Sep 1988
Bronchopleural fistula. A novel type of window thoracostomy.
Bronchopleural fistula usually associated with chronic empyema after lung operations continues to occur in modern surgical practice. Successful treatment depends to a large extent on adequate dependent drainage of the empyema space. ⋯ Window thoracostomy as currently performed is effective but unnecessarily extensive. We describe a simpler procedure, triangular window thoracostomy, for use as a permanent pleurocutaneous stoma or as an interim measure before definitive surgical treatment.
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J. Thorac. Cardiovasc. Surg. · Sep 1988
Intraoperative autotransfusion in cardiac operations. Effect on intraoperative and postoperative transfusion requirements.
The Southern Arizona Regional Red Cross Blood Program, in cooperation with two cardiac surgery groups, examined the effect of intraoperative autotransfusion on red cell, plasma, and platelet usage during and after cardiac operations. The study evaluated whether intraoperative autotransfusion influenced intraoperative or postoperative blood usage and whether regular use was more effective than selective use. The study demonstrated that intraoperative autotransfusion reduces intraoperative and postoperative blood use and that regular use of intraoperative autotransfusion is more effective than selective use.
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J. Thorac. Cardiovasc. Surg. · Sep 1988
Protection of the immature myocardium. An experimental evaluation of topical cooling, single-dose, and multiple-dose administration of St. Thomas' Hospital cardioplegic solution.
Low cardiac output in infants after cardiac operations continues to be a problem, yet little experimental work has been done to evaluate the various methods of protecting the immature myocardium. In this study, we have used an isolated working heart model to test three methods of myocardial protection in 3- to 4-week-old rabbit hearts: (1) topical cooling, (2) single-dose cardioplegia plus topical cooling, and (3) multiple-dose cardioplegia plus topical cooling. Myocardial temperature was maintained at 10 degrees C during ischemia, and St. ⋯ After 90 and 120 minutes of ischemia, the percent recovery of aortic flow (expressed as mean +/- standard error of the mean) was lower in hearts protected with multiple-dose cardioplegia plus topical cooling (61.5% +/- 4.8%, 50.7% +/- 14.2%) than in those protected with topical cooling (92.4% +/- 5.7%, 94.3% +/- 12.8%) or single-dose cardioplegia plus topical cooling (86.4% +/- 5.3%, 90.2 +/- 3.6%). However, adenosine triphosphate, creatine phosphate, and glycogen levels were adequately preserved in all groups. Both topical cooling and single-dose cardioplegia provide effective protection for the immature rabbit heart during ischemia, but multiple-dose cardioplegia plus topical cooling results in inadequate preservation of hemodynamic function, despite adequate preservation of myocardial high-energy phosphate stores.