Effects of Simulated Clinical Cardiopulmonary Bypass and Cardioplegia on Mass of the Canine Left Ventricle

Rosenblum, Harry M.; Haasler, George B.; Spotnitz, William D.; Lazar, Harold L.; Spotnitz, Henry M.

doi:10.1016/s0003-4975(10)62553-2

Cited by 10 publications

(5 citation statements)

References 18 publications

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“…On CPB in the research laboratory, 2‐DE revealed 15–30% increases in LVM [1, 2, 40–48]. The magnitude of these changes was surprising but predictable, as described above.…”

Section: Myocardial Water Content and LV Massmentioning

confidence: 82%

“…Calculations improved with image quality as well as better algorithms for LV end‐diastolic volume (EDV), LVM, and geometry in dogs. Multiple observers blinded to the conditions under which 2‐DE was done validated our calculations [1, 2, 40–48]. LVM measurements proved more accurate and reproducible than measurements of LVEDV despite the fact that LVM is defined by the mathematic difference of calculations of the epicardial and endocardial shells.…”

Section: Myocardial Water Content and LV Massmentioning

confidence: 88%

“…Infants and children with congenital heart disease are of particular interest for studies of edema on CPB because the volume and surface area of the CPB circuit is large in relation to the patient’s blood volume, similar to conditions in our earlier studies of edema in dogs [2, 40–48]. Despite efforts to miniaturize CPB circuits [62], inflammation is recognized to be problematic in children [62], and ultrafiltration to remove free water has been advocated after CPB [63].…”

Section: Myocardial Water Content and LV Massmentioning

confidence: 99%

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Ventricular Function in Surgery for Congenital Heart Disease

Spotnitz

2009

World j. surg.

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BACKGROUND The history of measuring myocardial edema by two-dimensional echocardiography and the pathophysiology of myocardial edema are reviewed. METHODS The relevance of this subject to management of children undergoing corrective surgery for single ventricle physiology and tetralogy of Fallot is reviewed. RESULTS Evidence is presented that myocardial edema is an ongoing clinical problem with relevance to management and outcomes. Methods for measuring mass increases noninvasively in the range of 10-25% with increases in myocardial water content on the order of 2-4% are now well established. CONCLUSIONS These methods and advanced animal models replicating conditions of surgery for cyanotic congenital heart disease set the stage for clinical advances in this important area.

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“…On CPB in the research laboratory, 2‐DE revealed 15–30% increases in LVM [1, 2, 40–48]. The magnitude of these changes was surprising but predictable, as described above.…”

Section: Myocardial Water Content and LV Massmentioning

confidence: 82%

Section: Myocardial Water Content and LV Massmentioning

confidence: 88%

Section: Myocardial Water Content and LV Massmentioning

confidence: 99%

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Ventricular Function in Surgery for Congenital Heart Disease

Spotnitz

2009

World j. surg.

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“…[7][8][9] It was reported that hypothermic cardioplegic arrest is associated with a blunting of inotropic responsiveness and the important factors in this impairment are abnormalities in myocardial water content, extracellular pH, and calcium metabolism. 2,9,10 Isolated heart studies have demonstrated that cardioplegic arrest is associated with decreased left ventricular compliance. The extent of shortening and the velocity of lengthening is impaired after hypothermic cardioplegic arrest followed by rewarming.…”

Section: Discussionmentioning

confidence: 99%

“…Activation of the betaadrenergic system through binding of beta agonists to receptors stimulates cyclic adenosine monophosphate (cAMP) production with a subsequent increase in intracellular calcium concentration during myocyte depolarization. [10][11][12][13] In the light of these findings, it could be expected that treatment of left ventricular dysfunction after elective cardiac arrest with beta-adrenergic agonists in the acute postoperative period, may not be effective. We speculated that after cardioplegic arrest, cAMPdependent enzymes may not function very effectively and there may be a reduction of cAMP below the level required to activate the enzymes responsible for intracellular calcium transport.…”

Section: Discussionmentioning

confidence: 99%

Beneficial Effects of Aminophylline on Ischemia-Reperfusion in Isolated Rabbit Heart

Ulus¹,

Gökçe

Özgencil

et al. 1999

Asian Cardiovasc Thorac Ann

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Eighteen rabbit hearts were arrested for 3 hours with cardioplegic solution at 4°C, followed by reperfusion with oxygenated perfusion solution at 37°C for 2 hours. Six control hearts received no drug during arrest or reperfusion (group 1). Six hearts received 3 mg•L -1 aminophylline during the arrest period (group 2). Six hearts received 3 mg•L -1 aminophylline during the reperfusion period (group 3). Effects of aminophylline were evaluated in terms of the pressure-volume relationship, coronary flow, myocardial oxygen extraction, and lactate release before cardioplegic arrest and after 1 and 2 hours of reperfusion. End-diastolic pressure at constant volume after 2 hours of reperfusion was 19 ± 2.63 mm Hg in group 1, 14 ± 1.7 mm Hg in group 2, and 19 ± 2.55 mm Hg in group 3 (p < 0.05 for group 2 versus groups 1 and 3). End-systolic pressure at constant volume after 2 hours of reperfusion was 81 ± 3.55 mm Hg in group 1, 90 ± 2.95 mm Hg in group 2, and 84 ± 3.47 mm Hg in group 3 (p < 0.05 for group 2 versus groups 1 and 3). Oxygen extraction was significantly higher and release of lactate was significantly lower in group 2 compared to groups 1 and 3. The results indicate that aminophylline administration during cardioplegic arrest improved systolic and diastolic function and had a beneficial effect on metabolic recovery.

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New Technique for Myocardial Contrast Echocardiography in the Experimental Canine Model Using a Special Cannula for Selective Left Main Coronary Artery Cannulation

Spotnitz

Oliner

Gascho

et al. 1986

J of Clinical Ultrasound

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Echocardiography has been used successfully as a tool for the evaluation of myocardial mass and function in open-chested animals and humans.'-'' However, myocardial contrast echocardiography is a new and experimental technique for assessing myocardial perfusion zones and blood flow in the open-chested animal mode1.12-20 Some investigators have injected contrast agents into the coronary circulation via a Gregg cannula positioned in the left main coronaryThe unique features of such an approach are that the cannula allows adequate mixing of the contrast agent and blood, thus preventing streaming, and allows for the evaluation of myocardial contrast washout characteristics at variable, controlled rates of coronary blood f l~w . '~-'~ Cannulation of the left main coronary artery in the dog using the Gregg cannula is, however, beset with major difficulties. A tie has to be placed around the left main coronary artery to secure the cannula in place. This artery is very short in the dog, and attempts at isolation of the artery frequently result in damage to the aorta, pulmonary artery, or coronary artery, causing significant bleeding. In addition, the cannula may obstruct the first septal perforator artery, resulting in ischemia of the interventricular septum. This artery is susceptible to injury because it arises from the left main coronary artery before its bifurcation into the left anterior descending and left circumflex coronary arteries. These technical prob!ems can result in significant animal attrition during preparation of the model. In this paper we describe a new cannula for injecting contrast agents during echocardiography that does not require isolation of the left main coronary artery and, when entering the left main coronary artery, does not occlude the first septal perforator arising proximal to the bifurcation of the coronary artery. DESCRIPTION OF THE CANNULAThis cannula is a modification of the standard Gregg cannula2' and is very similar to it (Fig. 1). Like the Gregg cannula, it must be introduced via the left brachiocephalic artery, with its tip guided into the left main coronary artery by palpation. The significant difference between this catheter and the Gregg cannula lies in the distal end, where a flange has been soldered. A 0.75-in.4ong tip is attached to the cannula distal to the flange and separated from it by a groove 0.64 cm wide. This tip has four side holes 0.055 in. in diameter spaced evenly around its circumference.These modifications of the Gregg cannula serve three important purposes. The flange prevents selective migration of the cannula into either the left anterior descending or the left circumflex coronary artery. As long as the aortic pressure is higher than the coronary perfusion pressure, the flange prevents the cannula from slipping out of the left main coronary artery. In addition, the distal tip allows easy manipulation of the cannula into the left main coronary artery. Finally, the holes in the tip prevent occlusion of the first septal perforator artery: a very proximal first...

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Effects of Simulated Clinical Cardiopulmonary Bypass and Cardioplegia on Mass of the Canine Left Ventricle

Cited by 10 publications

References 18 publications

Ventricular Function in Surgery for Congenital Heart Disease

Ventricular Function in Surgery for Congenital Heart Disease

Beneficial Effects of Aminophylline on Ischemia-Reperfusion in Isolated Rabbit Heart

New Technique for Myocardial Contrast Echocardiography in the Experimental Canine Model Using a Special Cannula for Selective Left Main Coronary Artery Cannulation

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