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J Thorac Cardiovasc Surg 1996;112:1054-1063
© 1996 Mosby, Inc.

CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES

CORONARY VASCULAR REGULATION DURING POSTCARDIOPLEGIA REPERFUSION

Supported by U.S. Public Health Service grant HL 43213 and a grant from CNPq Conselho Nacional de Desenvolvimento Cientifico e Tecnologico, Brazil. This work was performed during Dr. Holman's tenure as an Established Investigator for the American Heart Association.

Received for publication Jan. 9, 1996 Revisions requested Feb. 21, 1996; revisions received March 14, 1996 Accepted for publication April 23, 1996. Address for reprints: William L. Holman, MD, Department of Surgery, University of Alabama at Birmingham, University Station, Birmingham, AL 35294-0007.

Abstract

Background:This study extends previous investigations of global and regional myocardial blood flow during early postcardioplegia reperfusion. The hypothesis tested is that coronary vascular regulation becomes abnormal within 3 minutes after the start of postcardioplegia reperfusion. Methods:Pigs (n= 40) were supported by cardiopulmonary bypass and 38º C blood cardioplegic solution was infused. A control preischemic microsphere injection (No. 1) was given in asystolic hearts. Groups 1 to 3 had 1 hour of hypothermic cardioplegic arrest. Group 4 (control group) had 1 hour of perfusion without cardioplegia. A blood cardioplegic solution at 38º C and 70 mm Hg pressure was infused to maintain asystole during the initial 7 to 10 minutes of reperfusion in all groups. Left ventricular intracavitary pressures were set at 0, 10, 20, or 0 mm Hg in groups 1, 2, 3, and 4 (n= 10 pigs per group), respectively, during the initial 7 minutes of reperfusion. The ventricle was then decompressed. At 30 seconds, 3 minutes, and 6 minutes after reperfusion, microsphere injections 2, 3, and 4 were given in asystolic hearts. Microsphere injection No. 5 was given 10 minutes after reperfusion in beating vented hearts. Results:(1) Left ventricular distention during the initial 7 minutes of reperfusion after hypothermic cardioplegic arrest attenuates postischemic hyperemia. (2) Left ventricular intracavitary pressure of 20 mm Hg during reperfusion causes a decrease in endocardial blood flow relative to epicardial blood flow at 6 minutes after reperfusion. (3) Global myocardial blood flow during postcardioplegia reperfusion falls significantly below preischemic control values despite the return of electromechanical activity. Inference:Coronary vascular regulation (i.e., coronary resistance and metabolic flow recruitment) becomes abnormal within 3 minutes after the start of reperfusion after hypothermic blood cardioplegic arrest. (J THORACCARDIOVASCSURG1996;112:1054-63)

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