1. Does Normothermic Normokalemic Simultaneous Antegrade/Retrograde Perfusion Improve Myocardial Oxygenation and Energy Metabolism for Hypertrophied Hearts? 
Jian Wang, MD, Hongyu Liu, MD, PhD, Tomas A. Salerno, MD, Bo Xiang, DDS, Gang Li, MD, PhD, Marco Gruwel, PhD, Michael Jackson, PhD, Darren Manley, PhD, Boguslaw Tomanek, PhD, Roxanne Deslauriers, PhD, Ganghong Tian, MD, PhD 
The Annals of Thoracic Surgery 
Volume 83, Issue 5, Pages (May 2007)
DOI: /j.athoracsur
Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

2. Fig 1
Schematic illustration of experimental protocols. (LAD = left anterior descending coronary artery; NNAP = normothermic normokalemic antegrade perfusion; NNSP = normothermic normokalemic simultaneous antegrade/retrograde perfusion.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

3. Fig 2
The left panel shows representative myocardial oxygenation (MO) images with differential left anterior descending artery (LAD) flows during normothermic normokalemic antegrade perfusion (NNAP) and normothermic normokalemic simultaneous antegrade/retrograde perfusion (NNSP). The right panel displays the orientation of hearts receiving myocardial oxygenation examination. The ratio of oxy-(hemoglobin + myoglobin) to total-(hemoglobin + myoglobin) was monitored and used as the myocardial oxygenation determinant. Green and blue areas represent regions of myocardium with high and low myocardial oxygenation, respectively. Note that the blue area was larger during NNSP than during NNAP, especially with 50% and 20% LAD blood flow.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

4. Fig 3
Myocardial oxygenation (MO) measured from the myocardium supported by the left anterior descending artery (LAD) during normothermic normokalemic simultaneous antegrade/retrograde perfusion (NNSP [gray bars]) and normothermic normokalemic antegrade perfusion (NNAP [black bars]). Myocardial oxygenation measurements were lower during NNSP than during NNAP with varying LAD flow. Reduction in LAD flow resulted in a significantly larger decline in myocardial oxygenation value during NNSP than during NNAP. (Hb = hemoglobin; Mb = myoglobin.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

5. Fig 4
Myocardial oxygenation (MO) measured from the right ventricle (RV) free wall. There was no significant difference in myocardial oxygenation of RV between normothermic normokalemic simultaneous antegrade/retrograde perfusion (NNSP [gray bars]) and normothermic normokalemic antegrade perfusion (NNAP [black bars]), suggesting that NNSP did not affect myocardial perfusion of the RV. (Hb = hemoglobin; LAD = left anterior descending artery; Mb = myoglobin.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

6. Fig 5
Representative 31P magnetic resonance spectra acquired from the myocardium served by the left anterior descending artery (LAD) during normothermic normokalemic antegrade perfusion (NNAP) and normothermic normokalemic simultaneous antegrade/retrograde perfusion (NNSP). The NNAP with 50% LAD blood flow maintained normal myocardial energy metabolism, whereas the NNSP with 50% LAD blood flow resulted in significant ischemic metabolic changes. With 20% LAD blood flow, NNSP caused a more severe metabolic disturbance than did NNAP. (ATP = adenosine triphosphate; PCr = phosphocreatine; Pi = inorganic phosphate; PPM = parts per million.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

7. Fig 6
Averaged levels of the myocardial high-energy phosphates (top) inorganic phosphate (Pi), (middle) phosphocreatine (PCr), and (bottom) adenosine triphosphate (ATP) and measured during normothermic normokalemic antegrade perfusion (NNAP [black bars]) and normothermic normokalemic simultaneous antegrade/retrograde perfusion (NNSP [gray bars]). Decrease in left anterior descending artery (LAD) blood flow resulted in a significantly greater extent of decline in PCr and ATP level with a larger increase in Pi level during NNSP than during NNAP.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions

8. Fig 7
Correlations of myocardial oxygenation (MO) with the levels of (top) myocardial inorganic phosphate (Pi), (middle) phosphocreatine (PCr), and (bottom) adenosine triphosphate (ATP). Note that both PCr and Pi levels displayed linear relationships with myocardial oxygenation level. (Hb = hemoglobin; LAD = left anterior descending artery; Mb = myoglobin.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2007 The Society of Thoracic Surgeons Terms and Conditions