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PubMed1995

Advantages of continuous noncardioplegic warm blood retrograde perfusion over antegrade perfusion during proximal coronary anastomoses.

Retrograde perfusion via the coronary sinus supplies vascular beds distal to coronary stenoses and has been used for administration of cardioplegia. An additional application is to supply noncardioplegic retrograde perfusion while performing proximal anastomoses (a time when cardiac arrest is not critical). The aim of this study was to determine the safety of this technique and to study the metabolic changes with antegrade versus retrograde warm blood perfusion. Sixty-six patients, with good left ventricular function, underwent distal coronary bypass in a similar fashion. Proximal anastomoses were done with 1) partial occlusion clamp (n = 29) or 2) cross-clamp on and continuous, warm, noncardioplegic retrograde blood perfusion (n = 37). In an additional 10 patients, metabolism was assessed with antegrade and retrograde perfusion during proximal anastomoses. Despite longer cross-clamp times (96.4 +/- 6.2 vs 80.8 +/- 3.1 min, p < 0.05) with retrograde perfusion, the total duration of cardiopulmonary bypass was significantly less (119.6 +/- 6.2 vs 136.6 +/- 4.6 min, p < 0.05). There was superior postbypass, intraoperative hemodynamics (cardiac index) with retrograde perfusion (4.0 +/- 0.2 vs 3.6 +/- 0.1 L/min/m2). The incidence of postoperative dysrhythmia was not significantly different between groups. Oxygen and glucose utilization was more efficient with retrograde perfusion. Retrograde perfusion during proximal anastomoses is a safe technique. There is diminished risk of aortic dissection, atheroembolism, delayed aneurysm formation, or rupture due to avoidance of application of partial occlusion clamps. There is evidence of superior substrate utilization.

Aged↗

PubMed1996

Intrahepatic blood flow distribution in the perfused rat liver: effect of hepatic artery perfusion.

Variations in blood flow to different sinusoids within the liver can prevent uniform uptake of solutes from plasma and contribute to cellular ischemia in low-flow states. However, the degree of variability and the role of hepatic artery perfusion in maintaining uniform flow are poorly defined. We used an indicator dilution technique to compare the distribution of sinusoidal transit times in isolated rat livers perfused through the portal vein alone with livers perfused using both portal vein and hepatic artery. Physiological flow rates were used in each case (1.2 +/- 0.3 ml.min-1.g liver-1), but the second group received 32% of flow through the hepatic artery. Intralobular flow heterogeneity was further assessed by gamma counting of small (approximately 100 mg) pieces of the liver after bolus injection of approximately 5 mCi of a highly extracted compound ([125I])triiodothyronine) into the portal vein. Hepatic artery perfusion had no significant effect on mean sinusoidal transit time or intrahepatic distribution volume for 51Cr-labeled red blood cells or 125I-albumin. Analysis of the outflow profiles indicated that hepatic artery perfusion did not affect transit time dispersion. However, heterogeneity of flow to individual portions of the liver, measured as the coefficient of variation, increased from 19 to 30%. These results indicate relatively uniform perfusion of the sinusoids in the portally perfused rat liver and that additional perfusion of the hepatic artery does not further improve hemodynamics. These results have significance for the design and interpretation of transport studies with the use of the perfused rat liver model.

Animals↗

PubMed1990

[Optimal perfusion criteria for deep hypothermic selective cerebral perfusion in patients with aortic aneurysm involving aortic arch].

Although selective cerebral perfusion (SCP) might be an useful supportive method for aortic arch surgery, its optimal perfusion criteria has not been established. We studied the relationship between the oxygen saturation of superior vena cava or internal jugular vein (SvO2) and the perfusion hemodynamics during deep hypothermic (DH) SCP in twenty patients (pts) (type A dissection; 10, arch aneurysm; 10). SCP was accomplished by perfusion to the brachiocephalic trunk (BCT) and the left common carotid artery (LCC) using separate pumps. Cardiopulmonary bypass and DHSCP time were 128-312 (222 +/- 43, mean +/- SD) minutes and 25-214 (122 +/- 49) minutes, respectively. The cerebral perfusion pressures (CPP) monitored at the bilateral temporal arteries were 20-60 (47 +/- 9) mmHg and cerebral perfusion flow (CPF) was 0.28-0.7 (0.43 +/- 0.10) L/min/m2. The cerebral perfusion score (CPS) defined as CPP X CPF was 7-39 (20 +/- 8). SvO2 ranged from 79 to 99 (94 +/- 7)%. Two operative deaths were encountered from unrelated causes to SCP in both cases. Cerebral infarction occurred in one patient possibly form prolonged low perfusion with low SvO2. When the safety range of SvO2 in DHSCP was defined as greater than 90%, essential criteria to keep this range was CPP greater than 40 mmHg. In 13 out of 15 pts with SvO2 greater than 90%, CPS were above 15. In conclusion, optimal perfusion criteria for DHSCP was defined as CPP greater than 40 mmHg and CPS(CPP X CPF) greater than 15 considering adequate cerebral oxygen consumption.

Adult↗

PubMed1978

Perfusate effects upon resistance to aqueous humor outflow in the rhesus monkey eye. A comparison of glutathione-bicarbonate Ringer's solution to pooled aqueous humor as perfusate.

In vivo perfusion of the anterior chamber of normal rhesus monkeys with pooled rhesus aqueous humor gives an initial total facility of 0.48 +/- 0.08 (+/-S.E.) microliter/min/mm Hg. With continued intermittent perfusion for 2 hr this value increased only slightly to 0.57 +/- 0.10 microliter/min/mm Hg. Perfusion of the paired eyes of the same monkeys with glutathionebicarbonate Ringer's solution gives an initial total facility of 0.55 +/- 0.08 microliter/min/mm Hg. This value increased to 1.21 +/- 0.15 microliter/min/mm Hg with continued intermittent perfusion. Thus aqueous is a satisfactory perfusate for experiments requiring prolonged stability of the eye, but glutathione-bicarbonate Ringer's solution is not a satisfactory substitute perfusate. Neither addition of physiologic amounts of ascorbic acid to the buffered salt solution nor careful modification of the pH of the solution to the physiologic level prevented the increase of total facility it produces when used as a perfusate. A reversible, fast-phased small-magnitude increase in total facility was noted in eyes perfused with either perfusate. It is speculated this is caused by neural mechanisms for intraocular pressure control.

Animals↗

PubMed1982

The role of amino acids in the regulation of protein synthesis in perfused rat liver. I. Reduction in rates of synthesis resulting from amino acid deprivation and recovery during flow-through perfusion.

The role of perfusate amino acid concentrations in regulating rates of protein synthesis was investigated using the perfused rat liver. Livers from fed rats were perfused with a nonrecirculating medium and the incorporation of [3H]leucine into albumin and total protein was determined under conditions where the leucyl-tRNALeu and perfusate leucine specific activities were equal and constant. During perfusions of less than 1 h, rates of total protein synthesis were sensitive to the concentrations of amino acids in the perfusate. When no exogenous amino acids were provided, rates of synthesis of albumin and total protein were 40% of the maximal rates which were achieved when the medium was supplemented with 5 times the normal plasma concentrations of amino acids. However, rates of synthesis in livers perfused with amino acid-deficient medium rose with extension of the duration of perfusion to 95 min. The defect induced by amino acid deficiency did not appear to result from reductions in the charging of tRNA since no change in the quantities of amino acids bound to tRNA occurred in the amino acid-deficient perfusion. The recovery of protein synthesis with time was prevented by inhibitors of proteolysis suggesting a role for protein degradation in this phenomenon.

Amino Acids↗

PubMed1997

Tc-99m DTPA perfusion scintigraphy and color coded duplex sonography in the evaluation of minimal renal allograft perfusion.

AIM: The clinical impact of perfusion scintigraphy versus color coded Duplex sonography was evaluated, with respect to their potential in assessing minimal allograft perfusion in vitally threatened kidney transplants, i.e. oligoanuric allografts suspected to have either severe rejection or thrombosis of the renal vein or artery. METHODS: From July 1990 to August 1994 the grafts of 15 out of a total of 315 patients were vitally threatened. Technetium-99m DTPA scintigraphy and color coded Duplex sonography were performed in all patients. For scintigraphic evaluation of transplant perfusion analog scans up to 60 min postinjection, and time-activity curves over the first 60 sec after injection of 370-440 MBq Tc-99m diethylenetriaminepentaacetate acid (DTPA) were used and classified by a perfusion score, the time between renal and iliac artery peaks (TDiff) and the washout of the renogram curve. Additionally, evaluation of excretion function and assessment of vascular or urinary leaks were performed. By color coded Duplex sonography the perfusion in all sections of the graft as well as the vascular anastomoses were examined and the maximal blood flow velocity (Vmax) and the resistive index (RI) in the renal artery were determined by means of the pulsed Doppler device. Pathologic-anatomical diagnosis was achieved by either biopsy or post-explant histology in all grafts. RESULTS: Scintigraphy and color coded Duplex sonography could reliably differentiate minimal (8/15) and not perfused (7/15) renal allografts. The results were confirmed either by angiography in digital subtraction technique (DSA) or the clinical follow up. CONCLUSION: In summary, perfusion scintigraphy and color coded Duplex sonography are comparable modalities to assess kidney graft perfusion. In clinical practice scintigraphy and color-coded Doppler sonography can replace digital subtraction angiography in the evaluation of minimal allograft perfusion.

Adult↗

PubMed1997