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PubMedDate not supplied

Enhancement of myocardial energy potentials in man by glucose-insulin treatment before and after ischaemic heart arrest.

Thirty-six patients undergoing aortic valve replacement were investigated to ascertain whether the addition of glucose-insulin before and after ischaemic heart arrest could aid to the functional recovery of hearts following global ischaemia. One group of patients (n = 14) received glucose plus insulin from the onset of anaesthesia until crossclamping of the aorta (1 g + 1.5 U/kg bw X h). A second dose (0.5 g + 1.0 U/kg bw) was given at the end of ischaemia. 22 patients, serving as control received glucose in the same manner but without insulin. Needle biopsies from the left ventricular apex region were obtained: before starting cardiopulmonary bypass; at the end of ischaemia; and after 10 minutes of reperfusion and analyzed for its content of ATP, CP ADP and lactate. In both groups ATP and CP were significantly decreased after ischaemia and increased after reperfusion. ADP and lactate levels were elevated after ischaemia and decreased after reperfusion in the insulin-group but not in the control-group. During the total investigation period ATP- and CP-concentrations in the insulin-group were higher compared to the control-group, whereas ADP and lactate of the control-group were above the insulin-group.

Adenosine Diphosphate↗
PubMed1990

[Use of artificial heart ventricles in cardiovascular insufficiency of extreme degree and in heart arrest].

Experiments were conducted on 26 mongrel dogs and 10 calves to evaluate the effect of uni- and biventricular bypass created by means of artificial heart ventricle on hemodynamics in acute cardiovascular insufficiency (ACVI) and heart arrest (HA). The use of unilateral right-ventricular (RVB) and left-ventricular bypass (LVB) was shown to be equivocal: in sufficient functional reserve of the left-ventricular myocardium the volume blood flow in the aorta was increased to a greater degree by RVB (to 2.1 +/- 0.3 l/min) than by LVB (to 2.0 +/- 0.5 l/min). Experiments during HA allowed the authors to evaluate selectively the bypasses in maintenance of the systemic blood flow. It was found that in univentricular bypass the other half of the heart had an effect on hemodynamics, which depended on the initial hemodynamic parameters of the divisions of circulation with high and low pressure, the filling of the heart cavities with blood, and the effect produced through the interventricular septum. The increase of the volume blood flow in the aorta in RVB to 0.6 +/- 0.1 l/min is linked to a great measure by the authors with the conducted artificial ventilation of the lungs. It was noted that the greatest difficulties in maintaining the systemic blood flow in ACVI were associated with the development of disproportion of the contractile function of the right and left parts of the heart. With consideration for this circumstance, the indications for univentricular bypass are determined. A clinical case with prolonged use of LVB (8 days) is discussed.

Animals↗
PubMed1989

[Assessment of myocardial oxygen consumption during hypothermic perfusion on arrested heart with perfluorochemical and blood cardioplegia].

Perfluorochemicals (PFC) have been utilized attempting to improve the myocardial protective effect of hypothermic cardioplegia (CP). This study was performed to evaluate the efficacy of PFC against blood in oxygen utilization under hypothermic continuous perfusion of chemically arrested heart and to estimate the maximum oxygen consumption (max MVO2) under unlimited oxygen delivery. Canine hearts isolated hemodynamically were perfused continuously using either PFC-CP or blood-CP. In experiment A (n = 8 in PFC-CP, 7 in blood-CP), perfusion temperature was dropped from 25 to 4 degrees C at a constant perfusion pressure of 40 mmHg at aortic root. MVO2 showed gradual falls as temperature dropped in both groups, and significant difference in MVO2 between two groups was obtained at 10 degrees C (PFC-CP 15.0 +/- 6.5 (SD), blood-CP 9.7 +/- 4.3 microliters/min/g dry wt, p less than 0.05) and 4 degrees C (PFC-CP 11.3 +/- 3.7, blood-CP 7.6 +/- 3.3 microliters/min/g dry wt, p less than 0.05). There was no significant difference in MVO2 between two groups at 25 degrees C (PFC-CP 24.6 +/- 3.5, blood-CP 24.0 +/- 6.6 microliters/min/g dry wt) and 20 degrees C (PFC-CP 19.9 +/- 4.7, blood-CP 18.6 +/- 4.9 microliters/min/g dry wt). In experiment B, the perfusion temperature was kept constant at either 20 degrees C (n = 6 in PFC-CP, 6 in blood-CP) or 4 degrees C (n = 8 in PFC-CP, 7 in blood-CP), and oxygen delivery was increased until the plateau in MVO2 was obtained by increasing the perfusion flow. The asymptote in a hyperbolic relation between oxygen delivery and MVO2 was estimated and considered as max MVO2. At 20 degrees C, max MVO2 was 20.4 microliters/min/g dry wt with PFC-PC and 21.4 microliters/min/g dry wt with blood-CP, without significant difference. At 4 degrees C, max MVO2 was significantly higher (p less than 0.05) in PFC-CP (20.8 microliters/min/g dry wt) than blood-CP (13.9 microliters/min/g dry wt). In conclusion, there seems no significant fall in maxMVO2 below 20 degrees C under unlimited oxygen delivery by PFC-CP and the superiority in oxygen utilization by PFC-CP can be obtained at the myocardial temperature less than 20 degrees C.

Animals↗