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PubMedDate not supplied

Right ventricular end-diastolic volume index as a predictor of preload status in patients with low right ventricular ejection fraction during orthotopic liver transplantation.

OBJECTIVE: The objective of this study was to compare the accuracy of 2 variables: pulmonary artery occlusion pressure (PAOP) and right ventricular end diastolic volume index (RVEDVI) as predictors of the hemodynamic response to fluid challenge as well as definition of the overall correlation between RVEDVI and change in PAOP, right ventricular ejection fraction (RVEF), central venous pressure (CVP), and determination of the right ventricular function during orthotopic liver transplantation. MATERIALS AND METHODS: A modified pulmonary artery catheter equipped with a fast response thermistor was used to determine RVEF, allowing calculation of RVEF end-diastolic volume index (EDVI, as the ratio of stroke index [SI] to EF). The above-mentioned hemodynamic measures were taken in 4 phases: T0, after induction of anesthesia; T1, during anhepatic phase; T2, 30' after graft reperfusion; and T3, at the end of surgery. RESULTS: The variation of the REF value was 36 +/- 4% and 39 +/- 6%. Linear regression analysis showed a significant correlation between RVEDVI (range, 133 +/- 33-145 +/- 40 mL/m(2)) and stroke volume index (SVI) in each phase (r(2) = 0.49, P < .01; r(2) = 0.57, P < .01) at T0 and T1, respectively, and at T2 and T3 (r(2) = 0.51, P < .01; r(2) = 0.44, P < .01), respectively. No significant variations in the linear regression analysis between RVEDVI, PAOP, CVP, and RVEF were observed. No relationship was found between PAOP (range, 10 +/- 2-6 +/- 2 mm Hg) and SVI. CONCLUSION: RVEDVI may be the best clinical estimate of right ventricular preload. In fact, minor changes of RVEF have been recorded, confirming that RV function was not altered during uncomplicated orthotopic liver transplantation.

Adult↗
PubMed1991

Bilateral latissimus dorsi cardiomyoplasty.

This study was undertaken to test the hypothesis that a bilateral latissimus dorsi cardiomyoplasty provides greater hemodynamic augmentation than a unilateral procedure. Two types of bilateral procedure and a left posterior cardiomyoplasty were tested in each of 8 mongrel dogs. R-wave synchronous muscle pacing was achieved with a programmable burst stimulator. Hemodynamic variables of stimulated beats were compared with those of a nonstimulated baseline using paired t tests. The effects of a double anterior muscle wrap were equal to a right anterior/left posterior configuration. Therefore, the data on the two types of bilateral procedure were combined and compared with the left wrap. Stimulation of the bilateral cardiomyoplasty resulted in significant increases in right ventricular pressure (44 +/- 3.1 versus 26 +/- 1.8), first derivative of right ventricular pressure (595 +/- 117 versus 196 +/- 14), pulmonary artery pressure (34 +/- 1.9 versus 23 +/- 1.6), left ventricular pressure (90 +/- 5.9 versus 69 +/- 5.3), first derivative of left ventricular pressure (1454 +/- 141 versus 1072 +/- 107), aortic pressure (80 +/- 5.4 versus 67 +/- 4.9), and peak aortic flow (9.4 +/- 1.1 versus 7.7 +/- 0.8) (p less than 0.05). Significant increases in all of these variables also occurred with stimulation of the left cardiomyoplasty, but the increases in right ventricular pressure, first derivative of right ventricular pressure, pulmonary artery pressure, and aortic pressure were larger for the bilateral than the left cardiomyoplasty. The bilateral and the left procedure can each augment systolic ventricular function. The bilateral procedure appears to have greater effects, especially on right ventricular function.

Animals↗
PubMed1993

The effect of the pericardium on right and left ventricular diastolic functions during isoflurane anesthesia.

We examined the effects of the pericardium on diastolic function of the right and left ventricles during isoflurane anesthesia. The diastolic properties of the ventricles were assessed by indices of isovolumetric relaxation such as -dP/dt, -dP/dt25, and time constant for relaxation, and by end-diastolic pressure. In seven mongrel dogs, anesthesia was initially induced by the administration of pentobarbital and maintained with alpha-chloralose. Two 7F microtipped pressure transducers were inserted into the right and left ventricles, and a flow-directed pulmonary artery catheter was placed in the pulmonary artery. After a left thoracotomy, opening and closing the pericardium was performed at 0% isoflurane, 1.3% isoflurane, and 2.6% isoflurane. Isoflurane 1.3% and 2.6% produced a decrease in cardiac output in association with a decrease in -dP/dt and an increase in time constant for relaxation of both ventricles, suggesting that isoflurane may depress isovolumetric relaxation of both ventricles. Isoflurane also increased end-diastolic pressure of the left ventricle. With 0% isoflurane, pericardial opening did not significantly change the diastolic properties of either ventricle and other hemodynamics. Pericardial opening at 1.3% and 2.6% isoflurane increased cardiac output without any significant changes in -dP/dt and time constant of either ventricle, but with significant decreases in end-diastolic pressures of both ventricles. We conclude that the pericardium may have a constraining effect on the diastolic properties, especially end-diastolic pressure, but not on isovolumetric relaxation of both ventricles during isoflurane anesthesia.

Anesthesia, Inhalation↗
PubMed1978

Myocardial perfusion and function during acute right ventricular systolic hypertension.

Hemodynamics, myocardial function, and regional myocardial blood flow (MBF) were measured in 6 closed-chest ponies anesthetized with ketamine hydrochloride before (control) and after creation of acute right ventricular systolic hypertension (RVSH) during normoxia and isocapnic hypoxia. The right ventricular (RV) systolic pressure during each RVSH approached 90 mmHg. There were significant alterations in the pattern of total ventricular MBG distribution in favor of the RV. Because RV myocardium received proportionate increments to its endocardium as well as epicardium, it is concluded that autoregulation in the RV coronary vascular bed had not been abolished even during hypoxia + RVSH. Marked increase in MBF to the right side of the septum during each RVSH with little change in perfusion to other regions suggests that RV contraction is supported by the right side of the septum. Because these increments occurred with decreased RV coronary driving pressure they were the consequence of compensatory coronary vasodilatation. The slow heart rate of the pony in the presence of a large coronary vasodilatory reserve may have been the major factor in allowing large increments in MBF to the stressed regions despite decreased coronary driving pressure.

Acid-Base Equilibrium↗
PubMed1994

Right ventricular dysfunction after major pulmonary resection.

Right ventricular performance was assessed by thermodilution in 20 patients at rest and during exercise before and after lobectomy or pneumonectomy. The right ventricular ejection fraction was significantly decreased on the first postoperative day (0.36 +/- 0.34), the second postoperative day (0.34 +/- 0.04), and the third postoperative week (0.37 +/- 0.06) relative to the preoperative right ventricular ejection fraction value (0.43 +/- 0.07, p < 0.05). The right ventricular end-diastolic volume index was significantly increased by the second postoperative day (130 +/- 24 ml/m2) compared with the preoperative value (112 +/- 20 ml/m2). A significant decrease in the right ventricular stroke volume index was observed after operation, with a significant increase in heart rate considered necessary to maintain cardiac output. Pulmonary arterial pressure, the pulmonary vascular resistance index, and central venous pressure were unaltered over time. Indices of left ventricular function (that is, cardiac index, arterial pressure, and pulmonary arterial wedge pressure) were also preserved throughout the postoperative period. To explain the right ventricular dysfunction, ergometric exercise values were compared and the heart rate, pulmonary arterial pressure, central venous pressure, pulmonary vascular resistance index, and right ventricular end-diastolic volume index were all higher and the right ventricular ejection fraction lower during exercise after the operation. However, indices of left ventricular function remained unchanged. Significant elevations in pulmonary arterial pressure and the pulmonary vascular resistance index only during exercise occurred. These findings indicate that changes in right ventricular function at rest compensate for the increase in right ventricular volume, but adequate compensation does not occur during exercise, with a resultant increase in pulmonary arterial pressure and the pulmonary vascular resistance index. This suggests that a change in afterload may be the main determinant of the deterioration in right ventricular pump performance during exercise. We speculate that the main cause of right ventricular dysfunction after major pulmonary resection might be the changes in right ventricular afterload. The right ventricle may play an important role serving as a "reservoir" for afterload.

Aged↗
PubMed1987

Postoperative cardiac support with a pulsatile assist pump: techniques and results.

Since 1980 this group has employed a pulsatile assist pump(s) in 23 patients. Postoperative survival was 39% (9/23). In this group, 16 patients have required left ventricular support; 9 have been weaned from the pump, and 7 have survived (44%). Three patients required right ventricular support, and two have survived (66%). Four patients required biventricular assistance, but none survived. There have been four late deaths in this group. Of the five patients alive and well, all are New York Heart Association Class I or II. Important conclusions include the following: The pulsatile pump can adequately support the pulmonary or systemic circulation for a period of days; dramatic improvement in ventricular function is frequently observed in patients with univentricular failure; adequate right ventricular function is a major determinant of survival in a patient with pulsatile left ventricular support; preoperative cardiogenic shock and/or a prolonged time on cardiopulmonary bypass (CPB) predispose the patient to diffuse intravascular coagulation and a poor result; considerable information remains to be learned regarding the selection of assist pump candidates, optimal CPB techniques, and intraoperative identification of biventricular failure, which will further improve these results.

Adult↗
PubMed1995

Postinfarction ventricular septal rupture: repair by endocardial patch with infarct exclusion.

A novel operative technique for postinfarction ventricular septal defect has been used in 44 consecutive patients. The operation consists of excluding rather than excising the infarcted septum and ventricular walls. This is accomplished by performance of a left ventriculotomy through the infarcted muscle and securing a glutaraldehyde-fixed bovine pericardium patch to the endocardium of the left ventricle all around the infarcted myocardium. The ventriculotomy is simply closed over the pericardial patch. There were 21 men and 23 women whose mean age was 69 +/- 7 years. Twenty-nine patients were in cardiogenic shock at the time of operation. All patients had Doppler echocardiography and coronary angiography before operation. All but two patients were operated on during the acute phase of the myocardial infarction. There were six operative deaths. Postoperative complications included renal failure in 10 patients and respiratory failure in 18. Severe right ventricular dysfunction was the only independent predictor of operative mortality. Patients have been followed up for a mean of 40 +/- 34 months. There have been six late deaths and three of these were because of cardiac problems. The actuarial survival at 6 years was 66% +/- 7%. Only one patient had a small residual ventricular septal defect. Late postoperative assessment of ventricular function by echocardiography revealed that most patients had normal or mild impairment of right ventricular function and mild or moderate impairment of left ventricular function. Repair of acute postinfarction ventricular septal defect by endocardial patch with infarct exclusion of the left ventricule probably avoids additional damage to the right ventricle, remodels the acutely infarcted left ventricle, and enhances survival.

Aged↗
PubMed1992

Prognostic value of biventricular function in hypotensive patients after cardiac surgery as assessed by transesophageal echocardiography.

In patients after cardiac surgery, hypotension, defined as a mean arterial pressure less than 65 mmHg despite adequate filling pressures and positive inotropic medication, poses a problem. In addition, it is often difficult to determine whether these patients have suffered irreversible myocardial injury or if they are likely to recover. In this study, left and right ventricular function, as assessed by transesophageal echocardiography (TEE), was related to mortality both (1) quantitatively, using fractional area change (FAC), and (2) qualitatively, using a segmental wall motion analysis, which assigned a score to myocardial wall segments, in order to determine whether this technique can be used to predict survival. Mortality rate was very high in patients with biventricular and especially right ventricular failure (FAC less than 35%). Left and right ventricular wall motion abnormality indices were significantly better in survivors compared to nonsurvivors, but no distinct cut-off value could be determined. A wall motion index derived from only 6 segments at the mid-papillary muscle level was found to be as reliable as one based on 16 segments of the entire left ventricle. Thus, TEE provided information about the degree of left and right ventricular dysfunction by using a single cross-section at the papillary muscle level. It identified patients at high risk of death, ie, those with compromised right and biventricular function.

Adult↗
PubMed1998

Sex differences in ventricular function in patients with right bundle branch block.

BACKGROUND: Left ventricular function in patients with right bundle branch block is variable and depends on the population under study. This study assessed the implications of right bundle branch block for the estimation of resting left ventricular function in patients with right bundle branch and suspected coronary artery disease. METHODS AND RESULTS: Seventy-four patients with right bundle branch block, symptoms suggestive of coronary artery disease, and no electrocardiographic Q waves were compared with 649 patients with entirely normal electrocardiograms to assess the implications of right bundle branch block on resting left ventricular function. Resting ejection fraction was determined by radionuclide ventriculography. Patients with right bundle branch block were older (mean 65.0+/-10.2 years vs 53.8+/-11.1; P< .001) and had a lower mean ejection fraction (60%+/-11% vs 63%+/-9%; P< .005) compared with patients with normal electrocardiograms. There was a highly significant interaction between right bundle branch block and sex with respect to resting ejection fraction (P< .001). The mean ejection fraction for men with right bundle branch block was 57%+/-10% (17% with abnormal resting ejection fraction) compared with 62%+/-8% (7% with abnormal resting ejection fraction) for normal men. In contrast, the mean ejection fraction for women with right bundle branch block was 68%+/-9% (0% with abnormal resting ejection fraction) compared with 65%+/-9% (5% with abnormal resting ejection fraction) for normal women. CONCLUSIONS: Male patients with right bundle branch block and symptoms suggestive of coronary artery disease have a lower resting ejection fraction than mole patients with normal electrocardiograms. This difference is not seen in female patients.

Aged↗
PubMed2001

Usefulness of Doppler tissue imaging for the assessment of right and left ventricular myocardial function in patients with dual-chamber pacing.

The aim of the study was to evaluate by Doppler tissue imaging (DTI) the combined effects of atrio-ventricular (AV) delay and heart rate (HR) changes on global and segmental right (RV) and left (LV) ventricular diastolic function in 15 patients with dual-chamber pacemakers paced in the DDD mode. RV and LV inflow velocities and regional systolic and diastolic pulsed-wave (PW) DTI parameters were analyzed at four different pacing modes: (1) HR 70 beats/min, AV delay 125 ms; (2) HR 70 beats/min, AV delay 188 ms; (3) HR 89 beats/min, AV delay 125 ms; (4) HR 89 beats/min, AV delay 188 ms. For each pacing mode selected, RV diastolic filling velocities always prevailed over LV ones. As for RV and LV adaptation to the four different stimulation protocols, a higher paced rate and a prolonged AV delay caused across both the AV valves a decrease of E wave and of E/A ratios. The intersegmental comparison of PW-DTI parameters outlined that RV free wall exhibited significantly higher peak systolic (Sm) and early-diastolic (Em) wall velocities, and longer systolic ejection time. Considering separately RV and LV segmental physiology at the four programmed pacing modes, an increase in HR determined a progressive shortening of systolic ejection times in all the segments analyzed. Moreover, in each region the Em/Am ratio decreased with higher HR and longer AV delay. Conversely, Em encountered a progressive reduction in RV free wall, while remaining quite unchanged in all the LV regions. Both ventricles shared a similar pattern of global and regional adaptation to programmed HR and AV delay modifications, consisting in a progressive greater contribution of late diastole to ventricular filling at higher HR and more prolonged AV delay. However, at a regional level the right ventricle exhibited higher systolic and diastolic wall velocities than all left ventricular regions.

Aged↗
PubMed2003

Angiotensin-converting enzyme DD genotype in patients with primary pulmonary hypertension: increased frequency and association with preserved haemodynamics.

UNLABELLED: HYPOTHESIS/INTRODUCTION: A polymorphic marker within the angiotensin- converting enzyme (ACE) gene has been associated with circulating and tissue ACE activity and with a variety of forms of cardiovascular disease. Since angiotensin II (Ang II) causes pulmonary vasoconstriction and vascular and myocardial remodelling, we postulated a role for the renin-angiotensin system and the ACE DD genotype in the pathophysiology of primary pulmonary hypertension (PPH) and in the right ventricular response to pressure overload in these patients. METHODS AND RESULTS: The incidence of the ACE DD genotype was evaluated in 60 patients with severe PPH compared with two normal control populations, a group of healthy population-based controls (n=158) and subjects found suitable for cardiac organ donation (n=79). Genomic DNA extracted from peripheral leukocytes was amplified using the polymerase chain reaction to detect polymorphic markers. Haemodynamics were determined by right heart catheterisation in a subset of the PPH patients. The frequency of the ACE DD genotype was 45% in the patients with PPH, compared with 24% in the organ donors, and 28% in population-based healthy controls (p=0.01 for chi-square test). Of the 32 PPH patients with baseline haemodynamics, 12 exhibited the ACE DD genotype and 20 were non-DD. While the mean pulmonary artery pressure and the duration of symptoms attributable to pulmonary hypertension was not different between the DD and non-DD groups, cardiac output was significantly lower (3.29+0.27 vs. 5.07+0.37 L/minute, p=0.002) and the mean right atrial pressure tended to be higher (8.85+1.29 vs. 4.92+1.27 mmHg, p=0.08) in the non-DD group. The reduction in cardiac output seen in the non-DD group was not due to a difference in heart rate, but to a significant reduction in stroke volume, consistent with a decreased contractile state. In addition, non-DD patients exhibited a significantly worse functional capacity (NYHA Class 3.14+0.12 vs. 2.40+0.28, p=0.02). CONCLUSIONS: 1) The ACE DD genotype is significantly increased in patients with severe PPH compared with normal controls, suggesting that certain individuals may be genetically predisposed to developing pulmonary hypertension. 2) The ACE DD genotype is associated with preserved right ventricular function in PPH patients, supporting a compensatory myocardial or inotropic role for Ang II in the pressure overloaded right ventricle.

Adult↗
PubMed1981

Echocardiographic growth patterns of intracardiac dimensions and determination of function indices during the first year of life.

Cardiac dimensions and left and right ventricular function indices were studied consecutively in 53 healthy newborn babies throughout their first year of life. Cardiac dimensions, except right ventricular (RV) dimension, increase linearly with age, weight and body surface area, the relation being best described as a linear function of BSA. Left ventricular function indices do no change significantly during the first year of life. Right ventricular systolic time interval ratio (RVPEP/RVET) is high at birth, but declines rapidly during the first hours and days. This change is best described as a parabolic function and is an indicator of the physiological fall of pulmonary vascular resistances.

Anthropometry↗
PubMed1989

Long-term function of the morphologic right ventricle in adult patients with corrected transposition of the great arteries.

Because of the concern about the ability of the morphologic right ventricle (MRV) to function over a long term as a systemic ventricle, adult patients with congenitally corrected transposition of the great arteries (CCTGA) were evaluated to determine the long-term function of the MRV. Morphologic right ventricular function was assessed by functional clinical classification and angiographic ejection fraction in 18 adult patients with congenitally corrected transposition of the great arteries. These patients had a mean age of 30.2 +/- 14.5 years (range 10 to 67 years). All but one had hemodynamically significant lesions, the most common being left atrioventricular valve regurgitation (11 patients), ventricular septal defect (seven patients), atrial septal defect (four patients), and pulmonic stenosis (three patients). The mean MRV ejection fraction at presentation was 55% +/- 11.5% (range 24% to 74%). Twelve of the 18 patients (67%) were followed clinically, with a mean follow-up time of 9.9 +/- 7.1 years (range 1 to 22 years). Eight were reassessed angiographically, with a mean MRV ejection fraction of 51.3% +/- 10.7% (range 30% to 67%). The other four were followed up clinically and evaluated by two-dimensional echocardiography, with normal MRV function in two patients. Eight of 12 patients (67%) were in functional class I at follow-up, one was in functional class II, one was in functional class III, and two had died. Our data suggest that the morphologic right ventricle can function appropriately over a long term in adult patients with congenitally corrected transposition of the great arteries.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Assessment of right ventricular afterload in mitral valve diseases with radionuclide angiography].

Right ventricular function at rest and during exercise was studied in 33 patients with mitral valve disease by equilibrium gated radionuclide angiography using 99mTc in vivo labeled red blood cells. Radionuclide measurements of right ventricular ejection fraction (RVEF) were correlated with mean pulmonary arterial pressure (mPAP). RVEF decreased significantly with exercise. There was no significant correlation between RVEF at rest and mPAP. However, mPAP showed significant negative correlation with RVEF during exercise and with the changes of RVEF from rest to exercise. It is concluded that RVEF during exercise in mitral valve disease is affected by right ventricular afterload, and the measurements of RVEF at rest and during exercise by equilibrium gated radionuclide angiography is useful to assess right ventricular afterload.

Adult↗
PubMed1991

Patent foramen ovale associated with platypnea and orthodeoxia.

A case of positionally symptomatic right-to-left shunting across a patent foramen ovale with both platypnea and orthodeoxia despite normal pulmonary arterial pressures and normal right ventricular function is documented. When the patient was in a supine position, the calculated right-to-left shunt was 12.8 percent, and when seated 25 percent. Surgical closure of the patent foramen ovale relieved the symptoms and positionally induced shunting. The prevalence and associations of permanent and intermittent patency of the foramen ovale are discussed. It is recommended that those at risk of thromboembolism be screened for patency by contrast ultrasound or color flow techniques. If present, surgical closure needs to be considered to prevent paradoximal embolism and stroke.

Aged↗
PubMed2002

Haemodynamic evaluation of pulmonary hypertension.

Pulmonary hypertension is characterised by the chronic elevation of pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) leading to right ventricular enlargement and hypertrophy. Pulmonary hypertension may result from respiratory and cardiac diseases, the most severe forms occurring in thromboembolic and primary pulmonary hypertension. Pulmonary hypertension is most often defined as a mean PAP >25 mmHg at rest or >30 mmHg during exercise, the pressure being measured invasively with a pulmonary artery catheter. Doppler echocardiography allows serial, noninvasive follow-up of PAPs and right heart function. When the adaptive mechanisms of right ventricular dilatation and hypertrophy cannot compensate for the haemodynamic burden, right heart failure occurs and is associated with poor prognosis. The haemodynamic profile is the major determinant of prognosis. In both primary and secondary pulmonary hypertension, special attention must be paid to the assessment of pulmonary vascular resistance index (PVRI), right heart function and pulmonary vasodilatory reserve. Recent studies have stressed the prognostic values of exercise capacity (6-min walk test), right atrial pressure, stroke index and vasodilator challenge responses, as well as an interest in new imaging techniques and natriuretic peptide determinations. Overall, careful haemodynamic evaluation may optimise new diagnostic and therapeutic strategies in pulmonary hypertension.

Blood Pressure↗
PubMed2001

Magnetic resonance imaging of stentless xenografts for reconstruction of right ventricular outflow tract.

The objective was to overcome allograft shortage during the Ross operation; stentless xenografts were carefully evaluated for hemodynamic behavior and valve deterioration during medium term follow-up. Between January 10, 1994 and January 4, 1996 nine adult patients (age 31-51 years) underwent aortic valve replacement with an autologous pulmonary valve and right ventricular outflow tract reconstruction with the Edwards Prima or Medtronic Freestyle xenograft. One patient was dead early and one late, both from noncardiac reasons. Forty-eight to 66 months follow-up was available for 7 patients and was performed with physical examination in the outpatient clinic, transthoracic echocardiography (TTE), and magnetic resonance imaging (MRI). Two patients received 29-mm valves and the remaining 27-mm valves. No reoperation became necessary during follow-up. Preoperative left ventricular ejection fraction ranged from 20% to 84%, median 61%, mean 59% +/- 18%. At latest follow-up left ventricular ejection fraction was 49% to 70%, median 57%, mean 58% +/- 8%. TTE showed no calcification of the xenograft wall or cusps. MRI revealed good autograft function with no evidence of stenosis in any patient. Four patients showed no and three trivial regurgitation. Right ventricular outflow tract-stenosis could not be seen in any patient. Calculated gradients of the xenograft valves ranged from 2 to 6 mm Hg, median 3 mm Hg (mean 3.1 +/- 2.4 mm Hg) and calculated EOA ranged from 2.0 to 4.0 cm(2), median 2.8 cm(2). MRI supported these findings and showed pliable xenograft cusps in all patients. Right ventricular function was well preserved in all patients. In adult patients right ventricular outflow tract reconstruction with stentless xenografts can be performed safely and intermediate-term results are encouraging. During medium-term (5-7 years) follow-up no calcification or deterioration of valve function occurred with excellent hemodynamic behavior.

Adult↗
PubMed1992

Superior qualities of University of Wisconsin solution for ex vivo preservation of the pig heart.

The components of the University of Wisconsin solution have the potential to enhance and extend heart preservation. We have evaluated University of Wisconsin solution by comparing it with St. Thomas' Hospital cardioplegic solution in the isolated pig heart subjected to 8 hours of ischemia at 4 degrees C (n = 6 in each). The hearts were perfused ex vivo with enriched autologous blood for the control and the postpreservation assessments. Morphologic, metabolic, and functional evaluations were performed. Left and right ventricular function as assessed by the slope values of systolic and diastolic pressure-volume relationships of isovolumically contracting isolated heart was better preserved by University of Wisconsin solution (percent reduction: left ventricular systolic, 52.4% +/- 5.5% versus 17.7% +/- 6.7% [p less than 0.001]; right ventricular systolic, 125.6% +/- 46.4% versus 65.5% +/- 31.4% [p less than 0.05]; right ventricular diastolic, 112.3% +/- 48.7% versus 40.2% +/- 31.3% [p less than 0.02] after St. Thomas' Hospital and University of Wisconsin preservation, respectively). Postischemic recovery of left ventricular rate of rise of pressure and myocardial oxygen consumption were significantly improved after University of Wisconsin preservation (percent reduction, rate of rise of pressure: St. Thomas' Hospital 39.3% +/- 8.1%; University of Wisconsin 18.1% +/- 4.6%; percent reduction, myocardial oxygen consumption St. Thomas' Hospital 55.1% +/- 6.9%, University of Wisconsin 24.8% +/- 6.7%; p less than 0.001). Microvascular functional integrity as assessed by coronary vascular resistance was well maintained throughout the postischemic period and was similar to the preischemic control value in the University of Wisconsin group. By contrast, a significant increase was found at the beginning of postpreservation reperfusion, with a progressive rise thereafter in the St. Thomas' Hospital group (p less than 0.001). Preservation of myocardial adenosine triphosphate was improved and energy charge was unchanged after 8 hours of ischemia and reperfusion in the University of Wisconsin-preserved hearts compared with the St. Thomas' Hospital-preserved hearts (p less than 0.01). Electron microscopic examination revealed substantially better preservation of the contractile apparatus after preservation with University of Wisconsin solution. Myocytes from hearts receiving University of Wisconsin solution, unlike those given St. Thomas' Hospital solution, showed relaxed myofibrils with prominent I-bands. We conclude that University of Wisconsin solution has the potential to improve the preservation of the heart and possibly prolong the ischemic period in clinical cardiac transplantation.

Adenosine↗