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At least 973 records · Page 54Linked to original sources
PubMed2005

Effects of adenosine and defibrotide adjunct to a standard crystalloid cardioplegic solution.

AIM: Adenosine has many actions potentially useful as adjunct to a cardioplegia. Defibrotide was recently shown to have protective effects during cardiac arrest. The aim of this study was to compare these 2 substances to delineate their profile of action in the setting of cardioplegic arrest. METHODS: A Langendorff model for isolated rat hearts was employed: 3 groups of 8 hearts each were used, respectively with plain St. Thomas cardioplegia as control (group C), and the same solution added with adenosine (group A) or defibrotide (group D). The hearts had a baseline perfusion for 30 minutes with Krebs-Henseleit solution at 37 degrees C, cardioplegia administration for 3 minutes, then 30 minutes of ischemia without any perfusion and finally 30 minutes of reperfusion with Krebs-Henseleit solution at 37 degrees C. RESULTS: The time to attain heart arrest was 20% shorter in group A, but this difference did not reach statistical significance (A: 13.6+/-1.5; D: 16.8+/-2.7; C: 17.3+/-2.2 s). The heart rate during reperfusion in group A was almost identical to baseline, while in both group C and D it was significantly lower (A: 101%, D: 93.4%, C: 82.4%, p<0.01).A and D decreased significantly the release of creatine phospokinase compared to group C (p=0.006). Lactate dehydrogenase release was lower in both treatment groups, although statistical significance was not reached. Peak positive dP/dT decreased more in controls during reperfusion (A: -23+/-6%, D: -17+/-5%, C: -31+/-5%, p=ns). Negative dP/dT was significantly worse in controls compared to both treatments (A: -19+/-6%, D: -12+/-5%, C: -34+/-7%, p=0.035). CONCLUSIONS: Both adenosine and defibrotide have protective effects in an isolated model of cardioplegic arrest. Adenosine is significantly more active on heart rate while defibrotide is more active on contractily. Further studies are justified in order to test the combination of these 2 drugs.

Adenosine↗
PubMed2002

Intramyocardial troponin-T monitoring with microdialysis in coronary artery bypass surgery.

OBJECTIVE: To investigate the time course of troponin-T release into the extracellular fluid of the myocardium and to distinguish between a rise in troponin-T due to implantation trauma and an increase due to cardiac arrest during coronary surgery. DESIGN: Microdialysis probes were implanted in the heart of seven patients soon after sternotomy. Troponin-T was measured in the microdialysates and in peripheral blood from 3 h before to 24 h after heart arrest. RESULTS: The troponin-T concentration in the microdialysates increased immediately after probe implantation and decreased to baseline within 70 min. This early peak is interpreted to reflect a local trauma. Three hours after cross-clamp release, a second peak of microdialysate troponin-T was recorded; 50 times higher than in serum. Eight to 24 h later a third peak occurred in five patients. Serum troponin-T was below the detection level at the beginning of the operation but increased linearly during the first 3 h of reperfusion and remained at that level thereafter. CONCLUSION: Microdialysis is a safe technique providing more information on myocardial metabolism during and after bypass surgery than can be obtained from peripheral blood. The release of troponin-T in response to cardiac arrest can be distinguished in time from the local tissue response to probe implantation.

Adult↗
PubMed1985

Predictive survival models for resuscitated victims of out-of-hospital cardiac arrest with coronary heart disease.

Resuscitated victims of cardiac arrest with coronary heart disease represent a group of patients with an accelerated mortality rate. Among 227 such patients in our follow-up study, 20% had died at 1 year and 50% were dead in slightly over 3 years. Predictors of death were related to use of digitalis, elevated blood urea nitrogen, cerebral vascular accident, previous myocardial infarction, and age. In a subset of 103 patients in whom ambulatory electrocardiographic recordings were available within 3 months of the arrest event, the presence of complexity and high-frequency ventricular premature beats (VPBs) (greater than or equal to 25/hr) were added to the mortality predictors of digitalis and diuretic therapy and elevated blood urea nitrogen. An almost equal number of patients died suddenly and nonsuddenly. Predictors of sudden death were treatment with quinidine and paired VPBs. Occurrence of arrhythmias was an important addition to the previous mortality predictors related to left ventricular dysfunction.

Actuarial Analysis↗
PubMedDate not supplied

[Pharmacologic effects of mansonine on arrhythmias induced in isolated rat heart].

The effect of 3 x 10(-13) M Mansonine (MSN) was observed on arrythmias induced on isolated rat heart, perfused with either hypopotassic solution, atropine solution, or MacEwen physiological saline at 18 degrees C. Generally the reversal of induced arrythmias was complete with the hypopotassic solution, and partial with the MacEwen solution at 18 degrees C. On the other hand, when atropine and MSN were combined, their effects induced heart arrest, probably due to an intracellular calcium accumulation. In this case, the heart recovery occurred by preventing the calcium influx, either through EDTA chelation, or blockade of calcium channels. It was concluded that MSN probably acts like most cardiac glycosides, by blocking the Na(+)-K+ ATPase. This may activate a calcium influx, which causes the subsequent positive inotropic effect, as well as a negative chronotropic effect due to an increase of the membrane activation set point.

Animals↗
PubMed1994

[Application of PCPS (percutaneous cardiopulmonary support) to the resuscitation of DOA (dead on arrival) patients].

We report three cases of DOA patients who were resuscitated by using PCPS. All had resisted standard advanced life support methods. The conditions responsible for the heart arrest were acute myocardial infarction (AM1) in 2 (case 1 and 3) and subarachnoid hemorrhage (SAH) in the other (case 2). All 3 were resuscitated by PCPS. Case 1 survived with a slight neurological deficit. Case 2 succumbed to SAH 3 days later. Case 3 was transferred to left heart bypass but succumbed to hemorrhagic infarction of the brain 6 days later. Although this system allows rapid and simple deployment and provides a benefit in resuscitation of DOA patients in a state that is refractory to standard cardiopulmonary resuscitation, the problem of indication for resuscitation remains to be solved.

Angioplasty, Balloon, Coronary↗
PubMed1992

Circadian rhythm of heart rate variability in survivors of cardiac arrest.

Reduced heart rate (HR) variability is associated with increased risk of cardiac arrest in patients with coronary artery disease. In this study, the power spectral components of HR variability and their circadian pattern in 22 survivors of out-of-hospital cardiac arrest not associated with acute myocardial infarction were compared with those of 22 control patients matched with respect to age, sex, previous myocardial infarction, ejection fraction and number of diseased coronary arteries. Survivors of cardiac arrest had significantly lower 24-hour average standard deviation of RR intervals than control patients (29 +/- 10 vs 51 +/- 15 ms, p less than 0.001), and the 24-hour mean high frequency spectral area was also lower in survivors of cardiac arrest than in control patients (13 +/- 7 ms2 x 10 vs 28 +/- 14 ms2 x 10, p less than 0.01). In a single cosinor analysis, a significant circadian rhythm of HR variability was observed in both groups with the acrophase of standard deviation of RR intervals and high-frequency spectral area occurring between 3 and 6 A.M. which was followed by an abrupt decrease in HR variability after arousal. The amplitude of the circadian rhythm of HR variability did not differ between the groups. Thus, HR variability is reduced in survivors of cardiac arrest but its circadian rhythm is maintained so that a very low HR variability is observed in the morning after awakening, corresponding to the time period at which the incidence of sudden cardiac death is highest.

Cardiac Catheterization↗
PubMed1991

Effects of barium-induced cardiac contraction on large- and small-vessel intramyocardial blood volume.

We have measured the effects of barium-induced cardiac contraction on the intramyocardial blood volume content of all vessels and have independently measured the blood volume content of vessels with a diameter greater than 100 microns in rat myocardium. Measurements of total intramyocardial blood volume were made by using [125I]albumin as a plasma marker and technetium-99m as a red blood cell marker. In one group of rats (n = 8), diastolic arrest was induced by an intravenous injection of KCl; in a second group (n = 8), systolic arrest was induced by an intravenous injection of BaCl2. In both groups, the hearts were frozen in situ immediately after heart arrest while aortic pressure was decaying from its former physiological level. The left ventricular free wall was sectioned transmurally in a cryomicrotome, and the blood volume within each tissue sample was calculated from its radioactivity. The volume of blood in vessels larger than 100 microns was independently estimated from the exposed cross-sectional area of these vessels in photographs of the frozen tissue taken during tissue sectioning in the cryomicrotome. Total intramyocardial blood volume was found to decrease by about 42% from 8.6 +/- 1.3 ml/100 g (mean +/- SEM) in the KCl group to 5.0 +/- 0.7 ml/100 g in the BaCl2 group (p less than 0.01). Total volume was greater in the epicardial than in the endocardial layers of both groups (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1979

[Changes in the contractile function of the myocardium in various methods of excluding the heart from the circulation during the surgical correction of acquired heart defects].

Changes in myocardial contractile function were studied during 46 operations with extracorporeal circulation on patients with acquired heart diseases; the operations were performed with the use of cold cardioplegia and electrical fibrillation of the heart. The dependence of the decrease in myocardial contractilicy on the method of cardioplegia, the duration of the heart arrest, and the parameters of extracorporeal circulation is analysed. The results obtained are evidence that it is necessary to improve the method for protecting the myocardium during operations with extracorpeal circulation.

Cardiography, Impedance↗
PubMed1999

Pressure volume curves in arrested heterotopic rat heart isografts: role of improved myocardial protection.

BACKGROUND: To minimize decreases in left ventricular (LV) compliance immediately after rat heart transplantation, we tested several different methods of myocardial protection. MATERIALS AND METHODS: Five groups of ACI rat hearts (n = 6 each) were arrested by coronary perfusion with 5 ml of UW (University of Wisconsin), UW-BDM (UW with 2,3-butanedione monoxime), CU (Columbia University), or CU-BDM solution or by LV injection of potassium chloride and Ringer's lactate immersion (KCl/RL). After abdominal isografting and blood reperfusion for 15 min, transplanted hearts (TxH) were arrested and excised. Diastolic LV pressure-volume curves (LVPVCs) were correlated with myocardial water content (MWC). Native hearts (NH) were arrested identically to TxH and maintained at 4 degrees C by immersion. LVPVCs were measured at 15-min intervals for 90 min. RESULTS: In three of four pressure intervals at Time 0, normalized LV volume (LVV) was smaller (P < 0.05, ANOVA) in KCl/RL native hearts than in the four perfusion groups. LVV decreased significantly in NH after 45-75 min; LVV decreased similarly with time in all groups. In TxH, postarrest LVVs were higher with UW-BDM, CU-BDM, and CU than with UW or KCl/RL (P < 0.05, ANOVA). Expressing LVV of TxH as a percentage of NH, UW-BDM, CU, and CU-BDM provided qualitatively better diastolic properties than KCl/RL and UW. CONCLUSIONS: Thus rat LVPVCs can be improved after heart transplantation with alternative strategies of myocardial protection. KCl arrest decreases LV filling volume in this model and should be avoided.

Abdomen↗
PubMed1987

Pertussis toxin inhibits negative inotropic and negative chronotropic muscarinic cholinergic effects on the heart.

We injected rats with pertussis toxin, known to cause ADP ribosylation of the Gi regulatory protein of the adenylate cyclase complex and of another closely related GTP binding protein in the heart, and after 7 days we examined several effects of muscarinic activation on the heart. The negative chronotropic effect of carbamoylcholine on spontaneously beating perfused hearts was conspicuously diminished. While 10(-5) mol/l carbamoylcholine invariably produced heart arrest in control rats, the heart rate did not decrease by more than 20% in the toxin-treated rats even when the concentration of carbamoylcholine was raised to 10(-2) mol/l. The negative inotropic effect of carbamoylcholine examined on electrically paced ventricles perfused with isoproterenol was reduced, while the maximum positive inotropic effect of isoproterenol was substantially increased after toxin treatment. The inhibitory action of carbamoylcholine on the isoproterenol-stimulated accumulation of cyclic AMP in the heart auricles was attenuated. The weakening by pertussis toxin of the negative inotropic effect of carbamoylcholine is probably mainly due to the ADP ribosylation of the Gi regulatory protein and the subsequent loss of influence of muscarinic receptors on adenylate cyclase. The blockade of the negative chronotropic action of carbamoylcholine by pertussis toxin strongly indicates, together with other recently published evidence, that the Gi or another closely related GTP binding protein in the cardiac pacemaker cells is involved in the coupling of muscarinic receptors to the K+ channels.

Adenylate Cyclase Toxin↗
PubMed1988

Coronary flow as a determinant of c-myc and c-fos proto-oncogene expression in an isolated adult rat heart.

Chronic cardiac overload induces quantitative and qualitative changes of the phenotype which finally adapt the myocardium to its new functional requirements (Swynghedauw, 1986). It has been proposed that both stretch and enhanced isometric tension could trigger these modifications (Peterson and Lesch, 1972), but until now no real messenger has been found. In a search for signals which may account for these changes, we decided to investigate the expression of two proto-oncogenes, c-fos and c-myc, coding for nuclear proteins (review in Adamson, 1987) because several of their properties are consistent with their possessing a role in the transduction of extracellular growth signals to the cell interior. We report here that, in adult rat heart, expression of the c-fos and c-myc proto-oncogene was both sequentially and transitorily increased when, in a beating heart but not in an arrested heart, the coronary flow (and/or pressure) was augmented. This was studied in an isolated, coronary perfused heart preparation, a model in which the initial conditions of a cardiac overload may be mimicked in such a way that protein synthesis is stimulated by increasing the coronary perfusion pressure (Kira et al., 1984).

Animals↗
PubMed2001

[Methods of myocardium defense in radical correction of Ebstein anomaly].

Experience of myocardium defence while correcting Ebstein anomaly in 75 patients was analyzed. In 25 patients antegrade pharmacorefrigerating crystalloid cardioplegia based on potassium chloride was applied, in 10--method of Kirsch using miganesiun-aspartate-procaine solution. In 40 patients antegrade pumping of normothermic potassium chloride solution with subsequent antegrade infusion of cooled magnesium-aspartate-procaine solution applied for primary heart arrest. Application of combined defence of myocardium using normothermal crystalloid cardioplegia and refrigerating, of antegrade infusion of magnesium-asparate-procaine cardioplegic solution has advantages in comparison with another methods of myocardium defence, reduces the threat of an acute cardiac insufficiency occurrence in early postoperative period.

Child↗