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PubMed1981

[Cardiac arrest].

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Heart Arrest↗
PubMed1998

Superior recovery of hypertrophied rat myocardium after cardioplegic arrest.

BACKGROUND: Although cardioplegic protection of the hypertrophied heart remains a clinical challenge, we have previously observed enhanced recovery in rat hearts with pressure-overload hypertrophy induced by aortic banding. We investigated whether this unexpected result is found in other models of hypertrophy. METHODS: Hearts with hypertrophy induced by aortic banding or administration of desoxycorticosterone acetate were each compared with age-matched sham-operated and nonoperated controls. Spontaneously hypertensive rats and Wistar-Kyoto controls were also compared. We evaluated left ventricular isomyosin distribution by gel electrophoresis and recovery of isolated working rat hearts arrested at 8 degrees C for 2 hours. RESULTS: The percentage of V3 isomyosin in hearts with hypertrophy from aortic banding or administration of desoxycorticosterone acetate was increased compared with the control groups. Recovery of aortic flow in all three groups of hypertrophied hearts was at least as good or better than their respective controls. There were no significant differences in ATP or glycogen between hypertrophied and control hearts before or after arrest. CONCLUSIONS: Enhanced recovery of hypertrophied hearts is not specific to a single model. This level of recovery may be supported by induction of a "fetal genetic program," exemplified in the rat by the shift in isomyosin from predominantly V1 to the more efficient V3 isoform, which occurs in pressure-overloaded hearts.

Adenosine Triphosphate↗
PubMed1991

[Intracardiac repair in left ventricular rupture following mitral valve replacement].

Rupture of the left ventricle is one of the major lethal complications of mitral valve replacement. We have encountered 11 cases of this complication over a period of 19 years (1971, Apr.-1990, Mar.). Five of 8 cases of intraoperative rupture survived but no patient survived a delayed rupture. In the patients with intraoperative rupture external repair was performed in 6 cases, resulting in 3 survivors, two in type II and one in type I with formation of left ventricular false aneurysm. For selection of surgical treatment accurate recognition of types of rupture is important but the location and size of the endocardial and epicardial defects do not always correspond. Attempts to suture a ventricular rupture on the pressure-loaded beating heart were always unsuccessful and frequently extended the tear. Repair should be accomplished with aid of cardiopulmonary bypass on the decompressed and arrested heart. Recently, we chose internal repair with arrested heart in 2 cases of type I rupture, that is, reopening of the left atrial closure and repair from within the cardiac chamber with removal of the prosthetic valve. Both cases survived. In conclusion, we emphasized importance of intracardiac repair with removal of the replaced prosthetic valve in left ventricular rupture of type I and III following mitral valve replacement for better exposure, more secure repair, and prevention of injury to the circumflex artery.

Adult↗
PubMedDate not supplied

[Acid hydrolase activity and permeability of lysosomal membranes of cardiomyocytes and hepatocytes in extreme states].

Activity of some lysosomal enzymes was studied in the primary heart cell culture of newborn rats under conditions of hypoxia and in isolated ischemic perfused heart, in liver and heart tissues of dogs after traumatic shock and after experimental myocardium infarction as well as in liver tissue of rats after 10 min experimental heart arrest and during the postresuscitation period. Decrease in cAMP and elevation in cGMP levels, impairment of the adenylate cyclase hormonal regulation, decrease in activity of cAMP-dependent protein kinases were shown to correlate distinctly with an increase of acid hydrolases free activity in liver and heart cell cytoplasm of dogs with traumatic shock and with experimental myocardium infarction. Free activity of acid phosphatase was increased in primary heart cell culture under conditions of hypoxia and in isolated ischemic perfused rat heart. Intraperitoneal administration of cAMP-containing liposomes into the rats with 10 min heart arrest led to stabilization of liver lysosomal membranes within 1 hr of 4 hrs of the post-resuscitation period. The mechanisms involved in stabilization of lysosomal membranes are discussed.

Acid Phosphatase↗
PubMed1994

Effect of magnesium and calcium on myocardial protection by cardioplegic solutions.

The cardioprotective effect of the magnesium and calcium content of hyperkalemic cardioplegic solutions was investigated using isolated rat hearts subjected to hypothermic ischemic arrest. Hearts were arrested for 180 minutes at 20 degrees C by administering a 3-minute infusion of cardioplegic solution containing various concentrations of magnesium and calcium. Treatment groups received solution with either 0, 8, or 16 mmol/L magnesium. For each of these magnesium concentrations, 0.1, 0.6, or 1.2 mmol/L calcium was also present in the solution. At each concentration of magnesium, the percentage recovery of aortic flow was dependent on the calcium concentration. The maximum percentage recovery of aortic flow was 67.9% +/- 2.3% (mean +/- standard error of the mean) in the Mg-free, 0.1 mmol/L Ca group, whereas it was 65.1% +/- 2.7% in the 8 mmol/L Mg, 0.1 mmol/L Ca group and 70.0% +/- 3.5% in the 16 mmol/L Mg, 0.6 mmol/L Ca group. No significant differences in the recovery of cardiac function and creatine kinase leakage were observed between the three groups. The findings suggested that the cardioprotective effect was dependent on the relative concentration of both magnesium and calcium, and that it is important to maintain an appropriate ionic balance in cardioplegic solutions.

Animals↗
PubMed1984

[Polyradiculomeningoencephalitis caused by Epstein-Barr virus infection--description of a case with fatal outcome].

A 21 years old high school student, who, since early childhood, suffered from complete spinal paraplegia of unknown cause at D 10, suddenly, after a three week period with influenca -like prodromal symptoms, presented with acute polyradiculomeningoencephalitis . Positive reactions following Paul-Bunnell- Davidsohn -test and tests for specific antivirus IgG as well as specific IgM revealed acute Epstein-Barr-Virus infection, although no glandular signs could be found. The clinical findings consisted of peripheral sensory-motor tetraparesis, ataxia, nystagmus and disturbances of the caudal cranial nerves. Initially, the diagnosis of Fisher's syndrome was made. The orbicularis oculi reflex, however, indicated a circumscribed brainstem lesion in the medial reticular formation. This finding lead to the additional clinical diagnosis of encephalitis. Shortly after admission, a heart-arrest occurred, and, after successful reanimation, the patient presented with a "locked-in syndrome". On the 12th day after admission, he succumbed during a sudden drop of blood-pressure. Necropsy revealed septic shock as the cause of death, due to perforation of a duodenal ulcer. In the lower thoracic spinal cord a neurocytoma was found, which once lead to the paraplegia. Additionally, moderate inflammatory infiltrations were found in the basal leptomeninges, in the walls of several subcortical vessels and in the hypoglossal nerve. The infiltrations, at some sites, contained a large number of atypical lymphoid cells in the inflammatory meningeal exsudate . Microglial proliferation with satellitosis was found in the inferior olives, thus confirming the clinical diagnosis of polyradiculomeningoencephalitis . This case report should emphasize special features of EBV-infection with neurological complications: (1) in inflammatory diseases of the peripheral and central nervous system, infectious mononucleosis should always be drawn into the diagnostic considerations, even if heterophil antibodies and glandular symptoms are lacking. (2) In Guillain-Barré-syndrome, a transient external heart stimulator should be administered, in order to prevent heart arrest from acute autonomic neuropathy.

Adult↗
PubMed2004

The ESTECH remote access perfusion cannula in minimally invasive cardiac surgery.

INTRODUCTION: Peripheral access cardiopulmonary bypass (CPB) and endoclamping of the aorta are prerequisites for performance of minimal access or totally endoscopic cardiac surgery on the arrested heart. We present our experience with the ESTECH remote access perfusion (RAP) cannula in arrested-heart totally endoscopic coronary bypass grafting (AHTECAB) and atrial-septal defect (ASD) repair via minithoracotomy and totally endoscopic ASD repair. PATIENTS AND METHODS: Remote access CPB was performed in 30 patients (17 male), with a median age of 56 years (range, 21-70 years) using the ESTECH RAP cannula. Preoperatively all patients received a thoracic and abdominal CT scan. Operations were 20 AHTECAB, 5 ASD repair via minithoracotomy, and 5 robotically assisted totally endoscopic ASD repairs. Intraoperatively the patients were monitored by transesophageal echocardiography and bilateral radial artery pressure lines for correct placement of the balloon in the ascending aorta. RESULTS: Neither vascular perforation nor dissection of the aorta occurred during these surgeries. Full CPB was achieved in all patients. Because of location in a supraaortic branch fluoroscopic visualization of the guide wire was necessary in 2 of 30 cases. Once the aortic occlusion balloon was placed, repositioning was required in none of our cases. In one AHTECAB case rupture of the balloon occurred before starting the anastomosis. The cannula was replaced and the AHTECAB could be finished without complications. In one patient inguinal wound infection occurred, which was successfully revised surgically. No perioperative myocardial ischemia, stroke, or critical leg ischemia occurred, and no hospital death occurred. CONCLUSIONS: CPB and cardiac arrest can adequately be performed via a femoral access in minimally invasive cardiac surgery using the ESTECH RAP system. Intense preoperative patient evaluation and intraoperative monitoring are absolute prerequisites for safe application of the technique.

Adult↗
PubMed2001

Ultrastructural study of mouse renal glomeruli under various hemodynamic conditions by an "in vivo cryotechnique".

Three-dimensional ultrastructure of mouse renal glomeruli under various hemodynamic conditions was studied by scanning electron microscopy with an "in vivo cryotechnique" followed by freeze-substitution. These results were also compared with those of conventionally fixed glomeruli at different perfusion pressures. Some kidneys of anesthetized mice were directly frozen in vivo under normal blood flow condition. Others were frozen in the same way after ligation of the lower abdominal aorta or their heart arrest. The frozen specimens were routinely freeze-substituted, freeze-dried and ion-sputtered for SEM. For another conventional fixation method, some kidneys were perfused with glutaraldehyde at pressures of 150 cm or 250 cm water, and other renal cortical tissues were routinely immersion-fixed with glutaraldehyde. In freeze-substituted specimens with the in vivo cryotechnique, interdigitating foot processes of podocytes exhibited smooth surface contours with less shrinkage and their surfaces were arranged more tightly than those seen by the conventional fixation method. In the anesthetized mice, filtration slits between the foot processes were found to be narrow after the heart arrest, but they were wide under the normal blood flow condition. After the aorta ligation, the filtration slits became wider and the foot processes were more elongated. The ultrastructure of capillary loops in functioning renal glomeruli were revealed to be dynamically changing in the living state, depending on various hemodynamic conditions.

Animals↗
PubMed2006

Microwave ablation for atrial fibrillation: dose-response curves in the cardioplegia-arrested and beating heart.

BACKGROUND: Microwave ablation has been used to replace the traditional incisions used in the surgical treatment of atrial fibrillation. However, dose-response curves have not been established in surgically relevant models. The purpose of this study was to develop dose-response curves for the Flex 10 (Guidant, Inc) microwave device in both the acute cardioplegia-arrested heart and on the beating heart. METHODS: Twelve domestic pigs (40 to 45 kg) were subjected to microwave ablation in either the arrested (n = 6) or beating heart (n = 6). The cardioplegia-arrested heart was maintained at 10 degrees to 15 degrees C while six atrial endocardial and seven right ventricular epicardial lesions were created in each animal. On the beating heart, six right atrial and seven ventricular epicardial lesions were created. Ablations were performed for 15, 30, 45, 60, 90, 120, and 150 seconds (65 W, 2.45 GHz). The tissue was stained with 2,3,5-triphenyl-tetrazolium chloride, and sectioned at 5-mm intervals. Lesion depth and width were determined from digital micrographs. RESULTS: Mean atrial wall thickness was 2.8 mm (range, 1 to 8 mm). In the arrested heart, 94% of atrial lesions were transmural at 45 seconds and 100% were transmural at 90 seconds. In the beating heart, only 20% of atrial lesions were transmural despite prolonged ablation times (90 seconds). Ventricular lesion width and depth increased with duration of application, and were similar on the arrested and beating hearts. CONCLUSIONS: Microwave ablation produces linear dose-response curves. Transmural lesions can be reliably produced on the arrested heart, but not consistently on the beating heart.

Acute Disease↗
PubMed1990

A miniature voltmeter for monitoring small amplitude electrical activity in the hypothermic arrested myocardium.

A measurement system which is capable of detecting microfibrillation in the hypothermic, arrested heart has been developed. It is shown that this system can reliably measure microfibrillation signals as low as 10 microV in amplitude. Using this system, it has been shown that even after the heart has been rendered visibly arrested using cold potassium, it may still be producing a low level of electrical activity. It has also been shown that the presence of this microfibrillation during the period of the cold potassium administration and visible arrest, is very highly correlated with the decrease in high energy phosphates (ATP), mitochondrial injury, and a decreased cardiac function post-operatively. Using the information obtained from this first measurement system, a miniature, battery powered voltmeter has been designed and fabricated. This voltmeter has been tested using the initial measurement system as reference and produces the same information concerning the small signal electrical activity (i.e.: same waveform and RMS value). Because this voltmeter is battery powered and is, therefore, completely isolated from all electrical equipment in the operating theatre, it can be used to monitor the presence, or absence, of microfibrillation in the human heart. Of greatest importance, however, is the fact that the voltmeter can serve as a monitoring device which will indicate when the potassium should be administered in order to render the heart both mechanically and electrically arrested.

Animals↗