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The Journal of Thoracic and Cardiovascular Surgery, Vol 90, 291-296, Copyright © 1985 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
FM Lupinetti, TH Wareing, CB Huddleston, JC Collins, RJ Boucek Jr, HW Bender Jr and JW Hammon Jr
To investigate the pathophysiology of chronic cyanosis, we subjected 14
adult mongrel dogs to diversion of the inferior vena cava to the right
inferior pulmonary vein. This produced a mean oxygen tension of 42 +/- 2 mm
Hg and a calculated right-to-left shunt of 52.0% +/- 3.9%. These animals
(Group C) and 15 normal dogs (Group N) were subjected to cardiopulmonary
bypass with 20 minutes of normothermic global ischemia. Functional indices
studied were rate of rise of left ventricular pressure and the end-systolic
pressure/volume ratio. Metabolic status was assessed by obtaining
transmural myocardial biopsy specimens for measurement of adenosine
triphosphate content. Myocardial blood flow was measured with radiolabeled
microspheres. There were no significant differences between Group C and
Group N in either functional index or blood flow measurement prior to
global ischemia. At 45 minutes after ischemia, Group N animals had a
significantly greater rate of rise of left ventricular pressure (at a left
ventricular end-diastolic pressure of 0, 5, 10, and 15 mm Hg, p less than
0.025 to 0.05) and subendocarial perfusion (endocardial/epicardial flow
ratio 0.961 +/- 0.037 versus 0.815 +/- 0.021, p less than 0.01). At 90
minutes after ischemia, Group N animals exhibited a significantly higher
end-systolic pressure/volume ratio (4.9 +/- 0.7 versus 3.0 +/- 0.4 mm
Hg/ml, p less than 0.05), rate of rise of left ventricular pressure (at an
end-diastolic pressure of 0 to 20 mm Hg, p less than 0.005 to 0.05), and
endocardial/epicardial flow ratio (1.065 +/- 0.046 versus 0.829 +/- 0.059,
p less than 0.01). No differences in adenosine triphosphate content were
found at any sampling period. The Group C left ventricles exhibited no
hypertrophy but were significantly dilated compared to Group N (38.8 +/-
0.3 versus 30.1 +/- 0.2 mm, p less than 0.05). Inferior vena cava to
pulmonary vein diversion produces cyanosis with left ventricular dilatation
but without hypertrophy. It is proposed that abnormal loading
characteristics of the left ventricle are responsible for the functional
derangements that result from global ischemia.
ARTICLES
Pathophysiology of chronic cyanosis in a canine model. Functional and metabolic response to global ischemia
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