Effects of cardioplegia on vascular function and the “no-reflow" phenomenon after ischemia and reperfusion: Studies in the isolated blood-perfused rat.

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Presentation transcript:

Effects of cardioplegia on vascular function and the “no-reflow" phenomenon after ischemia and reperfusion: Studies in the isolated blood-perfused rat heart Vincenzo Argano, MD, FRCSb (by invitation), Manuel Galiñanes, MD, PhDa (by invitation), Stephen Edmondson, FRCSb (by invitation), David J. Hearse, DSca (by invitation) The Journal of Thoracic and Cardiovascular Surgery Volume 111, Issue 2, Pages 432-442 (February 1996) DOI: 10.1016/S0022-5223(96)70454-3 Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 1 Diagrammatic representation of the isolated blood-perfused rat heart preparation. LV, left ventricular. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 432-442DOI: (10.1016/S0022-5223(96)70454-3) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 2 A, Correlation between the amount of fluorescein in the tissue and the intensity of light emitted (measured as GSD). Dotted lines represent 95% confidence limits. B, Distribution of pixels in control aerobic hearts and hearts that had been subjected to ischemia (40 minutes) and reperfusion (40 minutes). GSD has been divided into three bands: good flow (<149), low flow (150 to 170), and no reflow (>256). SD, standard deviation. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 432-442DOI: (10.1016/S0022-5223(96)70454-3) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 2 A, Correlation between the amount of fluorescein in the tissue and the intensity of light emitted (measured as GSD). Dotted lines represent 95% confidence limits. B, Distribution of pixels in control aerobic hearts and hearts that had been subjected to ischemia (40 minutes) and reperfusion (40 minutes). GSD has been divided into three bands: good flow (<149), low flow (150 to 170), and no reflow (>256). SD, standard deviation. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 432-442DOI: (10.1016/S0022-5223(96)70454-3) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 3 Recovery of LVDP (A) and coronary flow (B), expressed as percentages of preischemic control values in the ischemia-only group (black bars) and cardioplegia group (cross-hatched bars) at different times of ischemia. Asterisk indicates p < 0.05 between ischemia-alone group and corresponding cardioplegia group. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 432-442DOI: (10.1016/S0022-5223(96)70454-3) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 3 Recovery of LVDP (A) and coronary flow (B), expressed as percentages of preischemic control values in the ischemia-only group (black bars) and cardioplegia group (cross-hatched bars) at different times of ischemia. Asterisk indicates p < 0.05 between ischemia-alone group and corresponding cardioplegia group. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 432-442DOI: (10.1016/S0022-5223(96)70454-3) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 4 Vascular responses to SNP (A) and l-NAME (B), expressed as percentage changes from baseline coronary flow (flow immediately before drug infusion) in time-matched aerobic control group (open bars), ischemia-only group (black bars), and cardioplegia group (cross-hatched bars) after different durations of ischemia. Asterisk indicates p < 0.05 between ischemia-alone group and corresponding cardioplegia group. Dagger indicates p < 0.05 versus nonischemic control group. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 432-442DOI: (10.1016/S0022-5223(96)70454-3) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 4 Vascular responses to SNP (A) and l-NAME (B), expressed as percentage changes from baseline coronary flow (flow immediately before drug infusion) in time-matched aerobic control group (open bars), ischemia-only group (black bars), and cardioplegia group (cross-hatched bars) after different durations of ischemia. Asterisk indicates p < 0.05 between ischemia-alone group and corresponding cardioplegia group. Dagger indicates p < 0.05 versus nonischemic control group. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 432-442DOI: (10.1016/S0022-5223(96)70454-3) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 5 Areas of good flow (A), low flow (B), and no reflow (C) expressed as percentages of the left ventricle analyzed in the ischemia-only group (black bars) and cardioplegia group (cross-hatched bars) at different times of ischemia. Asterisk indicates p < 0.05 between ischemia-alone group and corresponding cardioplegia group. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 432-442DOI: (10.1016/S0022-5223(96)70454-3) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 5 Areas of good flow (A), low flow (B), and no reflow (C) expressed as percentages of the left ventricle analyzed in the ischemia-only group (black bars) and cardioplegia group (cross-hatched bars) at different times of ischemia. Asterisk indicates p < 0.05 between ischemia-alone group and corresponding cardioplegia group. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 432-442DOI: (10.1016/S0022-5223(96)70454-3) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 5 Areas of good flow (A), low flow (B), and no reflow (C) expressed as percentages of the left ventricle analyzed in the ischemia-only group (black bars) and cardioplegia group (cross-hatched bars) at different times of ischemia. Asterisk indicates p < 0.05 between ischemia-alone group and corresponding cardioplegia group. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 432-442DOI: (10.1016/S0022-5223(96)70454-3) Copyright © 1996 Mosby, Inc. Terms and Conditions

Fig. 6 Representative digitized images of the left ventricle. The two images are a control heart (A) and a heart subjected to 40 minutes of ischemia and 40 minutes of reperfusion (B). Similar areas taken from the control heart and from the ischemic and reperfused heart are enlarged and displayed separately as a graphic distribution of GSDs of the image pixels. The displayed GSD was divided into three bands. The Journal of Thoracic and Cardiovascular Surgery 1996 111, 432-442DOI: (10.1016/S0022-5223(96)70454-3) Copyright © 1996 Mosby, Inc. Terms and Conditions