Cardioplegia containing specific adenosine-triphosphate
|
|
- Polly Alexia Atkinson
- 5 years ago
- Views:
Transcription
1 The Adenosine-Triphosphate Sensitive Potassium- Channel Opener Pinacidil Is Effective in Blood Cardioplegia Jennifer S. Lawton, MD, Peng-Wie Hsia, PhD, and Ralph J. Damiano, Jr, MD Department of Surgery, Medical College of Virginia, Richmond, Virginia Background. This study was designed to evaluate the adenosine-triphosphate sensitive potassium channel opener pinacidil as a blood cardioplegic agent. Methods. Using a blood-perfused, parabiotic, Langendorff rabbit model, hearts underwent 30 minutes of normothermic ischemia protected with blood cardioplegia (St. Thomas solution [n 8] or Krebs-Henseleit solution with pinacidil [50 mol/l, n 8]) and 30 minutes of reperfusion. Percent recovery of developed pressure, mechanical arrest, electrical arrest, reperfusion ventricular fibrillation, percent tissue water, and myocardial oxygen consumption were compared. Results. The percent recovery of developed pressure was not different between the groups ( and for hyperkalemic and pinacidil cardioplegia, respectively). Pinacidil cardioplegia was associated with prolonged electrical and mechanical activity ( and minutes), compared with hyperkalemic cardioplegia ( and minutes, respectively; p < 0.05). Pinacidil cardioplegia was associated with a higher reperfusion myocardial oxygen consumption ( versus ml/100 g myocardium/ beat; p < 0.05) and a higher percent of tissue water (79.6% 0.7% versus 78.6% 1.2%; p < 0.05). Conclusions. Systolic recovery was not different between groups, demonstrating comparable effectiveness of pinacidil and hyperkalemic warm blood cardioplegia. (Ann Thorac Surg 1998;66:768 73) 1998 by The Society of Thoracic Surgeons Cardioplegia containing specific adenosine-triphosphate (ATP) potassium channel openers has been documented to provide an effective form of myocardial protection in various animal models [1 4]. The pharmacologic opening of the ATP potassium channel results in potassium efflux from the myocyte and a shortening of the action potential duration. Reduction in the duration of the action potential decreases the plateau phase, and thus decreases calcium influx. This leads to contractile failure and therefore energy conservation during ischemia [4, 5]. Adenosine-triphosphate potassium channels are inhibited by intracellular ATP. They open during myocardial ischemia and are part of the cell s natural response to a limited supply of energy substrate [4, 6]. Crystalloid cardioplegia containing ATP potassium channel openers (PCOs) has been demonstrated to provide superior or equivalent myocardial protection when compared with hyperkalemic arrest [2, 3]. The PCO pinacidil has been demonstrated to be an effective cardioplegic agent in an acutely injured isolated rabbit heart model and hypothermic arrest [7]. However, there is little information on the efficacy of PCOs in warm blood cardioplegia. The benefits of blood cardioplegia have been clearly demonstrated in the literature and include rapid cardiac Accepted for publication March 31, Address reprint requests to Dr Damiano, The Milton S. Hershey Medical Center, PO Box 850, Hershey, PA ( damiano@surg.hmc. psu.edu). arrest in an oxygenated environment, oncotic constituents to prevent or minimize myocardial edema, improved oxygen-carrying and buffering capacity, improved capillary flow distribution, limitation of systemic hemodilution, and endogenous free radical scavenging [8 10]. Because of these advantages, most cardiac surgeons incorporate blood cardioplegia into their myocardial protection regimen. This study was performed to evaluate the effectiveness of the PCO pinacidil in blood cardioplegia during normothermic arrest in an isolated rabbit heart model. Material and Methods Experimental Preparation Adult New Zealand white rabbits of either sex weighing 3.0 to 5.0 kg were anesthetized intramuscularly with acepromazine (1 mg/kg) and xylazine (17.5 mg/kg), followed by ketamine (62.5 mg/kg). Each study involved a support animal and a study animal. The support animal was prepared, continuously monitored, and ventilated while on an extracorporeal circuit for parabiotic support of the isolated heart, as previously described [2]. After support animal preparation, the donor animal was heparinized and ventilated through a tracheostomy. The animal then underwent rapid sternotomy. A 2-0 silk suture was placed into the transverse sinus and tied to secure closure of both cavas and the pulmonary veins. A rapid cardiectomy was performed. The heart was im by The Society of Thoracic Surgeons /98/$19.00 Published by Elsevier Science Inc PII S (98)
2 Ann Thorac Surg LAWTON ET AL 1998;66: PINACIDIL IS EFFECTIVE IN BLOOD CARDIOPLEGIA 769 mersed in iced Plasmalyte (Baxter Healthcare Corp, Deerfield, IL) while the pulmonary artery was opened and a vent (polyethylene tubing, internal diameter 0.86 mm; Clay Adams, Parsippany, NJ) was placed into the left ventricle through a left atriotomy. The aorta was cannulated and coronary perfusion instituted through the Langendorff column. A fluid-filled latex balloon was placed into the left ventricle and secured with a pursestring suture in the mitral annulus for continuous pressure monitoring, as previously described [2]. An oximetric catheter (Fiberoptic Oximetric catheter; Abbott Laboratories, Chicago, IL) was inserted into the coronary sinus by a right atriotomy and secured. This catheter was connected to an oximeter (model 1270; Shaw Oximetrix, Mountain View, CA) and calibrated daily using a co-oximeter (model IL-482; Instrument Laboratories, Lexington, MA). Two right atrial electrodes were positioned for continuous pacing, and two left ventricular epicardial bipolar electrodes were positioned for continuous electrogram monitoring, as described previously [2]. The pressure and electrogram waveforms were digitized online using an AT-CODAS system (DATAQ Instruments, Akron, OH) at a sampling rate of 1,000 Hz. The heart was enclosed in an air bath surrounded by a glass-jacketed water beaker. Myocardial temperature was monitored throughout the experiment using a temperature probe (model 0112; Shiley Inc, Irvine, CA) placed in the right ventricle. Myocardial temperature was maintained at 37 C by adjusting the water bath (Model 71, Polyscience, Niles, IL) temperature. Coronary flow was monitored using an inline flow probe located directly above the aortic inflow (model 2N; Transonic Systems, Ithaca, NY) and an ultrasonic blood flow meter (model 101; Transonic Systems). Experimental Protocol Hearts were excluded from the study if they did not obtain a developed pressure of 80 mm Hg at an enddiastolic pressure of 10 mm Hg, or if the baseline developed pressure did not remain stable during the 30 minutes after instrumentation. After the 30-minute equilibration period, baseline electrolytes, hematocrit, hemoglobin, arterial blood oxygen saturation, and arterial blood gases were recorded for the support animal and any abnormalities were corrected. Left ventricular pressure-volume relationships were measured. A wide range of volumes were infused into the intraventricular latex balloon to generate enddiastolic pressures (EDP) of 0, 2.5, 5, 10, 15, and 20 mm Hg. After baseline data acquisition, fluid was adjusted in the latex balloon to obtain an EDP of 5 mm Hg before the ischemic period. Sixteen hearts were randomly assigned to receive either hyperpolarizing blood cardioplegia with pinacidil or depolarizing blood hyperkalemic cardioplegia for myocardial protection during a 30-minute period of global normothermic ischemia. Hyperpolarizing blood cardioplegia consisted of Krebs-Henseleit solution (in mmol/l distilled water: NaCl, 118.5; NaHCO 3, 25.0; KCl, 3.2; Table 1. Cardioplegic Solutions a Variable Pinacidil Hyperkalemic ph po pco b Hct Osmolarity a Values are represented as mean standard error of the mean. b p versus pinacidil. Hct hematocrit; PCO 2 carbon dioxide tension; PO 2 oxygen tension. MgSO 4, 1.2; KH 2 PO 4, 1.2; glucose, 5.5; and CaCl 2, 2.5) with pinacidil (50 mol/l, n 8) in a 1:2 mixture with rabbit blood. Depolarizing blood cardioplegia consisted of St. Thomas solution (n 8) in a 1:2 concentration with rabbit blood, with a final concentration of 20 mmol/l KCl. Rabbit blood was obtained at the time of cardiectomy from the donor rabbit. The ph, oxygen tension, carbon dioxide tension, and hematocrit of the cardioplegia solutions were similar and ranged between 7.45 and 7.66, 98 and 230, 18 and 34, and 18 and 25, respectively (Table 1). Pinacidil was provided by Leo Pharmaceuticals, Ballerup, Denmark. St. Thomas solution (in mmol/l: NaCl, 110.0; CaCl 2, 1.6; MgCl 2, 16.0; and KCl, 16.0) was provided by Abbott Laboratories (North Chicago, IL). Sodium bicarbonate (8.4%) was added to the St. Thomas solution (0.5 ml/50 ml) to correct the ph to 7.8. Heparin (12.5 U/mL) was added to each of the cardioplegia solutions. At the start of the ischemic period, the Langendorff perfusion column was clamped and 50 ml of normothermic (37 C) blood cardioplegia was infused from a height of 80 cm H 2 O through a separate column. The cardioplegic effluent was collected and discarded. Both the time until cessation of mechanical activity and the time until electrical quiescence were recorded. Cessation of mechanical activity was defined as the absence of a developed pressure. After 30 minutes of normothermic global ischemia, the Langendorff column was unclamped and the heart reperfused for 30 minutes. If ventricular fibrillation persisted after reperfusion, the heart was defibrillated (Model K84, Electrodyne Co., Inc., Westwood, MA). Electrolytes, hematocrit, hemoglobin, arterial blood oxygen saturation, and arterial blood gas measurements of the support animal were repeated to ensure stability. After 30 minutes of reperfusion, data were collected at the identical balloon volumes used during baseline preischemic data acquisition. At the conclusion of the experiment, the left ventricle, together with the septum and the right ventricular free wall, were separated, blotted, and weighed to obtain wet weight. The samples were dried until a constant dry weight was achieved. Percent tissue water (%TW) was determined using the following equation: %TW (wet weight dry weight)/wet weight. Myocardial Oxygen Consumption The coronary sinus venous saturation was recorded and myocardial oxygen consumption was calculated at each
3 770 LAWTON ET AL Ann Thorac Surg PINACIDIL IS EFFECTIVE IN BLOOD CARDIOPLEGIA 1998;66: EDP during baseline data acquisition, reperfusion, and postischemic data acquisition. Total myocardial oxygen consumption (ml/100 g myocardium/beat) was calculated as the product of coronary blood flow and the arteriovenous oxygen content difference and normalized for heart weight and heart rate [11]. Left ventricular thebesian flow was excluded because it was negligible in this model [12]. Because the right ventricle remained vented and unloaded throughout the experiment, the oxygen consumption of the right ventricle was considered to be minimal and constant [12]. All animals received humane care in Association for Assessment and Accreditation of Laboratory Animal Care-accredited (#00036), United States Department of Agriculture-registered (#52-R-007) facilities in compliance with the Principles of Laboratory Animal Care formulated by the National Society for Medical Research and the Guide for the Care and Use of Laboratory Animals prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH publication 85-23, revised 1985). Data Analysis Left ventricular systolic and diastolic pressures were determined from the digitized data files using software developed in our laboratory. END-SYSTOLIC PRESSURE. The end-systolic pressure (ESP) of a beat was defined as the maximum point of the digitized pressure waveform. The average ESP was calculated by averaging the ESPs of 10 beats. Average ESPs were obtained for each balloon volume at baseline and postreperfusion. The ESP versus balloon volume data for baseline and postreperfusion data were fitted to the linear ESP-volume relationship below using a leastsquares linear regression algorithm: ESP E max (BV) k, where E max is the slope, k is the y-intercept, and BV is the balloon volume. END-DIASTOLIC PRESSURE. The EDP of a beat was defined as the point at which the increase in slope of the pressure waveform exceeded a threshold of 0.5 mm Hg/ms. This was confirmed visually for each beat. The average EDP was calculated by averaging the EDPs of 10 beats, and was obtained for each balloon volume at baseline and postreperfusion. The EDP versus balloon volume data were fitted to the linear EDP-volume relationship below using a leastsquares linear regression algorithm: EDP m (BV BV 0, where m is the slope and BV 0 is the balloon volume corresponding to an EDP of zero, or the x-intercept [13]. The mean linear regression coefficient for the diastolic pressurevolume curves was and for the hyperkalemic and the pinacidil groups, respectively. Thus, a linear representation of the diastolic pressure-volume relationships was appropriate over the limited range of end-diastolic volumes examined in this model [14]. DEVELOPED PRESSURE. The left ventricular developed pressure was obtained by subtracting the EDP from the ESP for each data point. An average of 10 data points was used for each balloon volume. The developed pressure versus balloon volume data for baseline and postreperfusion were fitted to a linear pressure-volume relationship using the following linear regression algorithm: DP ESP EDP (E max BV k) m (BV BV 0 ), where DP is the developed pressure. PERCENT RECOVERY OF DEVELOPED PRESSURE. The percent recovery of developed pressure was calculated as the percentage of the post-reperfusion average developed pressure to the baseline average developed pressure at the same balloon volume. This was calculated for each of the postreperfusion matched balloon volumes. The average percent recovery of developed pressure was the integral of change in developed pressure over the change in balloon volume and was obtained using the trapezoidal rule [15] and the following equation: Bvmin Average % Rec DP DP 100 BV max DP postreperfusion d BV/(Bv DP baseline max BV min, where % Rec DP is the percent recovery of developed pressure, BV max is the maximum postreperfusion matched balloon volume, and BV min is the minimum postreperfusion matched balloon volume [3]. Statistical Analysis Values are represented as the mean standard error of the mean. Analysis of variance (or Kruskall-Wallis when appropriate) was used for multiple comparisons of means with a Dunnett s test for individual comparisons. A Fisher s exact test was used to compare mutually exclusive data where appropriate. A Student s t test (or Mann-Whitney test when appropriate) was used to compare two means. A paired Student s t test was used to compare means before and after an intervention. Differences were considered statistically significant when p was less than Statistical analysis was performed using Sigma Stat (version 1.01; Jandel Corp, San Rafael, CA). Results Cardioplegia Delivery and the Development of Electromechanical Arrest The mean time to infuse the blood cardioplegia solution was minutes for the hyperkalemic group and minutes for the pinacidil group (not significant). Electrical and mechanical arrest occurred most rapidly in the hyperkalemic group ( and minutes). This was significantly shorter than the time until electrical and mechanical arrest in the pinacidil group ( and minutes; p 0.05). Reperfusion Arrhythmias Upon release of the Langendorff column clamp, no hearts protected with hyperkalemic blood cardioplegia underwent ventricular fibrillation. However, 50% of the hearts in the pinacidil group fibrillated upon reperfusion. This
4 Ann Thorac Surg LAWTON ET AL 1998;66: PINACIDIL IS EFFECTIVE IN BLOOD CARDIOPLEGIA 771 Table 2. Postischemic Recovery of Systolic and Diastolic Function a Cardioplegia % Recovery of Developed Pressure Baseline Slope b (mm Hg/mL) Reperfusion Slope (mm Hg/mL) Hyperkalemic c 50 mol/l pinacidil a Data are represented as mean standard error the mean. b Slope (m) is the slope of y m (BV BV 0 ), where BV balloon volume and BV 0 the balloon volume corresponding to an end-diastolic pressure of zero. c p versus baseline value. difference was not statistically significant (p 0.077). After initial cardioversion, all hearts in the pinacidil group remained in normal sinus rhythm for the remainder of the reperfusion period. Postischemic Recovery of Systolic and Diastolic Function After 30 minutes of reperfusion, the hearts protected with hyperkalemic blood cardioplegia recovered a mean 52.3% 5.9% of their preischemic developed pressure. The hearts protected with pinacidil blood cardioplegia developed a mean 52.8% 6.9% of their preischemic developed pressure (not significant) (Table 2). The mean baseline slopes of the linear diastolic pressure-volume relationships were not different between groups (Table 2). After ischemia and reperfusion, the hearts in the hyperkalemic group had a significant increase in the mean slope of the linear diastolic pressurevolume relationships (p 0.001). In contrast, the mean slope of the linear diastolic pressure-volume relationships for the pinacidil group did not significantly increase above its baseline value (p 0.068). Reperfusion Coronary Blood Flow The mean baseline preischemic coronary blood flow before ischemia at an EDP of 5 mm Hg was not significantly different between groups (Fig 1). Upon reperfusion, the coronary blood flow in the hyperkalemic group increased significantly above baseline level for 1 minute and then the coronary blood flow declined until it reached a level significantly below baseline level after 6 minutes of reperfusion. The coronary blood flow remained significantly below baseline level until 25 minutes of reperfusion, when it returned to baseline levels. The coronary blood flow in the pinacidil group also increased above baseline level upon reperfusion. However, this increase continued until 11 minutes of reperfusion, when the coronary blood flow returned to near baseline levels. Between 1 and 25 minutes of reperfusion, the coronary blood flow in the pinacidil group remained significantly higher than that in the hyperkalemic group. Fig 1. Reperfusion coronary blood flow is represented versus time. Time 5 is baseline, time 0 is reperfusion, time 5 is 5 minutes after reperfusion, and so on. Values are represented as mean standard error of the mean (*p 0.05 versus St. Thomas by analysis of variance.) Reperfusion Myocardial Oxygen Consumption The baseline preischemic myocardial oxygen consumption was not different between groups (Fig 2). The reperfusion myocardial oxygen consumption in the hyperkalemic group remained near baseline level for the entire reperfusion period. The reperfusion myocardial oxygen consumption in the pinacidil group increased significantly above that in the hyperkalemic group after 2 minutes of reperfusion, and this persisted until 20 minutes of reperfusion. Myocardial Tissue Water The mean percent tissue water after reperfusion in the hyperkalemic group was significantly lower ( ) than that in the pinacidil group ( ; p 0.05). Comment Traditional hyperkalemic cardioplegia arrests the myocyte at depolarized membrane potentials. At these potentials, energy-consuming ion transport pumps are activated and these harmful transmembrane ion fluxes can exacerbate ischemic injury. To overcome the shortcomings of hyperkalemic cardioplegia, numerous adjuncts Fig 2. Myocardial oxygen consumption (MVO2) is represented versus time. Time 0 is baseline, time 1 is 1 minute after reperfusion, and so on. Values are represented as mean standard error of the mean (*p 0.05 versus St. Thomas by analysis of variance.)
5 772 LAWTON ET AL Ann Thorac Surg PINACIDIL IS EFFECTIVE IN BLOOD CARDIOPLEGIA 1998;66: have been developed to improve myocardial protection, including hypothermia, blood-enriched solutions, and substrate enhancement. The pharmacologic opening of ATP potassium channels arrests the cell close to its resting membrane potential (hyperpolarized arrest), which approximates the natural resting state of the myocyte. At this membrane potential, transmembrane ion gradients are largely balanced and net ion flux is minimal. Theoretically, this provides a more physiologic environment in which to provide ischemic protection. This may make potassium channel openers more ideal cardioplegic agents than traditional hyperkalemic solutions. Potassium channel openers in crystalloid solutions have provided superior myocardial protection, compared with hyperkalemic cardioplegia [3]. However, several investigators have documented the benefits of blood cardioplegia in both experimental models and clinical trials [10, 16, 17]. This study investigated the effectiveness and the characteristics of the PCO pinacidil as a cardioplegic agent in warm blood cardioplegia in an isolated blood-perfused rabbit heart model. Development of Electromechanical Arrest Hyperkalemic blood cardioplegia provided a more rapid electrical and mechanical arrest than pinacidil blood cardioplegia. This is similar to our previous results with crystalloid PCO cardioplegia [2, 3]. The equivalent recovery of systolic function between the two groups indicates that pinacidil was able to provide comparable protection despite prolonged mechanical and electrical activity. Reperfusion Arrhythmias There was an increased, although not statistically significant, incidence of ventricular fibrillation with pinacidil in this study. Our previous experiments using crystalloid cardioplegia demonstrated a statistically significant increased incidence of ventricular fibrillation with PCOs [2]. Further studies are needed to characterize this proarrhythmic trend with PCOs in blood cardioplegia. Recovery of Systolic Function There was no statistically significant difference between the percent recovery of developed pressure between the two groups, indicating equivalent myocardial protection. This is in contrast to the results of other investigators using cold blood pinacidil cardioplegia [1]. These investigators noted superior myocardial protection with cold blood pinacidil (200 mol/l) cardioplegia when compared with hyperkalemic cardioplegia in an intact porcine model [1]. This difference may be related to a species difference in the response to myocardial ischemia, or perhaps to the protective effect of hypothermia in overcoming the increased oxygen consumption after ischemia with pinacidil. Recovery of Diastolic Function The hearts in the hyperkalemic cardioplegia group had evidence of a decrease in ventricular compliance, as the slopes of the diastolic pressure-volume relationships significantly increased after ischemia. The hearts in the pinacidil group also sustained a diastolic injury; however, this was not statistically significant. This suggests superior diastolic protection by the pinacidil group. Reperfusion Coronary Blood Flow and Myocardial Oxygen Consumption Upon reperfusion, hearts in both cardioplegia groups demonstrated an increase in coronary blood flow compared with baseline, consistent with a postischemic hyperemic response. After reperfusion, however, the coronary blood flow in the pinacidil group remained significantly higher than that in the hyperkalemic group for 25 minutes of reperfusion. This is similar to our previous findings with crystalloid cardioplegia, and to the findings of other investigators using PCOs [2, 18 20]. Pinacidil is a known vasodilator, and the increased coronary blood flow may represent a prolonged vasodilatory effect as the drug washes out of the coronary circulation during reperfusion. It is unlikely, however, that the drug remained in the coronary vasculature for 25 minutes at a flow rate of to ml/min. The increased coronary blood flow in the pinacidil group may be reflective of an increased sensitivity of the coronary resistance vessels to metabolic vasodilators or an increased production of vasodilator messengers, such as adenosine during ischemia [11]. This would, however, suggest less effective myocardial protection during ischemia. This would be supported by the elevated myocardial oxygen consumption during reperfusion in this group. An increased energy demand upon reperfusion would result in an increased supply (coronary blood flow). This, however, is not consistent with the equivalent recovery of developed pressure in the pinacidil group. The elevated reperfusion myocardial oxygen consumption in the pinacidil group, compared with the hyperkalemic group, is similar to our previous finding in crystalloid cardioplegia in this model [21]. This elevated myocardial oxygen demand suggests that a higher oxygen debt was incurred during ischemia in the pinacidil group that had to be repaid during reperfusion, to result in equivalent recovery of function [22]. The elevated myocardial oxygen consumption in the pinacidil group could also be explained by the Gregg phenomenon, in which the increased coronary blood flow resulted in a change in the myocardial fibers, thus affecting (increasing) their contractility and oxygen consumption [23]. In addition, it has been suggested that a decrease in extravascular compressive forces (such as edema) is associated with improved coronary blood flow rate [11]. However, this is not consistent with our findings, as both postischemic tissue water (myocardial edema) and coronary blood flow were elevated in the pinacidil group. It is more likely, however, that the increased coronary blood flow during reperfusion in the pinacidil group resulted in an elevated level of myocardial edema by increasing hydrostatic pressure, as has been proposed by other investigators [24]. Determining which came first (the increase in reperfusion coronary blood flow or the increase in percent tissue water) in this study was impos-
6 Ann Thorac Surg LAWTON ET AL 1998;66: PINACIDIL IS EFFECTIVE IN BLOOD CARDIOPLEGIA 773 sible to determine because the myocardial sample was obtained at the end of reperfusion. Further research is needed to delineate the etiology of the increased coronary blood flow and myocardial oxygen consumption during reperfusion associated with PCOs. Myocardial Tissue Water The elevated percent of tissue water in the pinacidil group suggests an increased level of myocardial edema after ischemia and reperfusion. This is consistent with previous work using the PCO aprikalim as a crystalloid cardioplegic agent in this model [3]. The possible reasons for this were discussed previously. Despite the increased percent of tissue water, pinacidil blood cardioplegia was able to provide systolic protection and diastolic protection comparable to hyperkalemic blood cardioplegia in this model. The difference in percent tissue water between the groups was small and did not appear to be functionally significant. Shortcomings of the Model The advantages and disadvantages of this model have been described previously [2]. An isolated heart model lacks the neurohumoral, structural, and vascular effects seen in intact preparations. The blood-perfused isolated rabbit heart Langendorff model has advantages over crystalloid perfusion, including a higher oncotic pressure, improved oxygen carrying and buffering capacity, free radical scavengers, and improved capillary flow distribution [8]. However, although this model offers a closer approximation of the clinical scenario than a crystalloid-perfused preparation, care should be taken in extrapolating these results to the clinical setting. In vivo studies are clearly needed to establish the feasibility of PCO cardioplegia. Summary Hyperpolarizing blood cardioplegia containing pinacidil (50 mol/l) provides equivalent systolic and diastolic myocardial protection to hyperkalemic blood cardioplegia during normothermic arrest in the isolated, bloodperfused rabbit heart model. However, the associated elevated tissue water, the prolonged mechanical and electrical activity, and the elevated myocardial oxygen demand upon reperfusion are worrisome and warrant further investigation. We gratefully acknowledge the help of Luke Wolfe for statistical analysis and Cynthia T. Allen and Nancy N. Lee for technical assistance, and the generous donation of pinacidil by Leo Pharmaceuticals, Denmark. This work has been supported by a National Institutes of Health National Research Service Award grant HL (J.S.L., R.J.D.) and National Institutes of Health R01 HL51032 (R.J.D.). References 1. Kirvaitis RJ, Krukenkamp IB, Bukhari EA, Gaudette GR, Miyatake T, Levitsky S. Pinacidil-induced hyperpolarized cold blood cardioplegia: a novel myoprotective strategy. Surg Forum 1995;46: Lawton JS, Harrington GC, Allen CT, Hsia P, Damiano RJ. Myocardial protection with pinacidil cardioplegia in the blood-perfused heart. Ann Thorac Surg 1996;61: Maskal SL, Cohen NM, Hsia PW, Wechsler AS, Damiano RJ. Hyperpolarized cardiac arrest with a potassium-channel opener, aprikalim. J Thorac Cardiovasc Surg 1995;110: Noma A. ATP-regulated K channels in cardiac muscle. Nature 1983;305: Cohen NM, Lederer WJ, Nichols CG. Activation of ATPsensitive potassium channels underlies contractile failure in single human cardiac myocytes during complete metabolic blockade. J Cardiovasc Electrophys 1992;3: Nichols CG, Lederer WJ. Adenosine triphosphate-sensitive potassium channels in the cardiovascular system. Am J Physiol 1991;261:H Lawton JS, Hsia P, Damiano RJ. Myocardial protection in the acutely injured heart: hyperpolarizing versus depolarizing hypothermic cardioplegia. J Thorac Cardiovasc Surg 1997; 113: Barner HB. Blood cardioplegia: a review and comparison with crystalloid cardioplegia. Ann Thorac Surg 1991;52: Buckberg GD. Update on current techniques of myocardial protection. Ann Thorac Surg 1995;60: Fremes SE, Christakis GT, Weisel RD, Mickle DA, Madonik MM, Ivanov J, et al. A clinical trial of blood and crystalloid cardioplegia. J Thorac Cardiovasc Surg 1984;88: Laxson DD, Homans DC, Dai X, Sublett E, Bache RJ. Oxygen consumption and coronary reactivity in postischemic myocardium. Circ Res 1989;64: Goto Y, Slinker BK, LeWinter MM. Decreased contractile efficiency and increased nonmechanical energy cost in hyperthyroid rabbit heart. Circ Res 1990;66: Moon MR, DeAnda A, Daughters GT, Ingels NB, Miller DC. Experimental evaluation of different chordal preservation methods during mitral valve replacement. Ann Thorac Surg 1994;58: Fremes SE, Zhang J, Furukawa RD, Mickle DA, Weisel RD. Adenosine pretreatment for prolonged cardiac storage. J Thorac Cardiovasc Surg 1995;110: Stark PA. Introduction to numerical methods. New York: Macmillan Publishing, 1970: Barner HB, Laks H, Codd JE, Standeven JW, Jellinek M, Kaiser GC, et al. Cold blood as the vehicle for potassium cardioplegia. Ann Thorac Surg 1979;28: Feindel CM, Tait GA, Wilson GJ, Klement P, MacGregor DC. Multidose blood versus crystalloid cardioplegia. Comparison by quantitative assessment of irreversible myocardial injury. J Thorac Cardiovasc Surg 1984;87: Galinanes M, Shattock MJ, Hearse DJ. Effects of potassium channel modulation during global ischemia in isolated rat heart with and without cardioplegia. Cardiovasc Res 1992;26: Yao Z, Gross GJ. Effects of the K ATP channel opener bimakalim on coronary blood flow, monophasic action potential duration, and infarct size in dogs. Circulation 1994;89: Wang SY, Friedman M, Johnson RG, Zeind AJ, Sellke FW. Adenosine triphosphate-sensitive K channels mediate postcardioplegia coronary hyperemia. J Thorac Cardiovasc Surg 1995;110: Lawton JS, McClain LC, Maier GW, Hsia P, Damiano RJ. Myocardial oxygen consumption in the rabbit heart after ischemia. Hyperpolarized arrest with pinacidil versus depolarized hyperkalemic arrest. Circulation 1997;96(Suppl 2): Olsson RA, Gregg DE. Metabolic responses during myocardial reactive hyperemia in the unanesthetized dog. Am J Physiol 1965;208: Gregg DE. Effect of coronary perfusion pressure or coronary flow on oxygen usage of the myocardium. Circ Res 1963;13: Rubboli A, Sobotka PA, Euler DE. Effect of acute edema on left ventricular function and coronary vascular resistance in the isolated rat heart. Am J Physiol 1994;267:H
CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES
CARDIOPULMONARY BYPASS, MYOCARDIAL MANAGEMENT, AND SUPPORT TECHNIQUES MYOCARDIAL PROTECTION IN THE ACUTELY INJURED HEART: HYPERPOLARIZING VERSUS DEPOLARIZING HYPOTHERMIC CARDIOPLEGIA Jennifer S. Lawton,
More informationMyocardial Protection With Potassium-Channel Openers Is as Effective as St. Thomas' Solution in the Rabbit Heart
Myocardial Protection With Potassium-Channel Openers Is as Effective as St. Thomas' Solution in the Rabbit Heart Jennifer S. Lawton, MD, Jerry D. Sepic, BA, Cynthia T. Allen, Peng-Wie Hsia, PhD, and Ralph
More informationPrevious attempts to prevent myocardial edema
PREVENTION OF CELL SWELLING WITH LOW CHLORIDE ST. THOMAS HOSPITAL SOLUTION IMPROVES POSTISCHEMIC MYOCARDIAL RECOVERY A. Mark Jayawant, MD a Edward R. Stephenson, Jr., a MD Clive M. Baumgarten, PhD b Ralph
More informationHyperkalemic cardioplegia, although clinically efficacious,
2,3-Butanedione Monoxime Cardioplegia: Advantages Over Hyperkalemia in Blood-Perfused Isolated Hearts A. Mark Jayawant, MD, Edward R. Stephenson, Jr, MD, and Ralph J. Damiano, Jr, MD Milton S. Hershey
More informationHeart transplantation is the gold standard treatment for
Organ Care System for Heart Procurement and Strategies to Reduce Primary Graft Failure After Heart Transplant Masaki Tsukashita, MD, PhD, and Yoshifumi Naka, MD, PhD Primary graft failure is a rare, but
More information2. Langendorff Heart
2. Langendorff Heart 2.1. Principle Langendorff heart is one type of isolated perfused heart which is widely used for biochemical, physiological, morphological and pharmacological researches. It provides
More informationFeasibility of Leadless Cardiac Pacing Using Injectable. Magnetic Microparticles
Supplementary Information for Feasibility of Leadless Cardiac Pacing Using Injectable Magnetic Microparticles Menahem Y. Rotenberg, Hovav Gabay, Yoram Etzion and Smadar Cohen. Correspondence to: scohen@bgu.ac.il,
More informationSolution for cardiac perfusion in viaflex plastic container
CARDIOPLEGIA SOLUTION A Solution for cardiac perfusion in viaflex plastic container DESCRIPTION Cardioplegia Solution A is a sterile, non-pyrogenic solution in a Viaflex bag. It is used to induce cardiac
More informationThinking outside of the box Perfusion management and myocardial protection strategy for a patient with sickle cell disease
Thinking outside of the box Perfusion management and myocardial protection strategy for a patient with sickle cell disease Shane Buel MS, RRT 1 Nicole Michaud MS CCP PBMT 1 Rashid Ahmad MD 2 1 Vanderbilt
More informationTemporal Relation of ATP-Sensitive Potassium- Channel Activation and Contractility Before Cardioplegia
Temporal Relation of ATP-Sensitive Potassium- Channel Activation and Contractility Before Cardioplegia Latha Hebbar, MD, Ward V. Houck, MD, James L. Zellner, MD, B. Hugh Dorman, MD, PhD, and Francis G.
More informationSteph ani eph ani Mi M ck i MD Cleveland Clinic
Stephanie Mick MD Stephanie Mick MD Cleveland Clinic Upper hemisternotomy AVR Ascending Aorta MVr Thoracotomy Based Anterior AVR Lateral Thoracotomy Mitral/Tricuspid surgery Robotically assisted surgery
More informationPotassium Efflux from Myocardial Cells Induced by Defibrillator Shock
Purdue University Purdue e-pubs Weldon School of Biomedical Engineering Faculty Publications Weldon School of Biomedical Engineering 1986 Potassium Efflux from Myocardial Cells Induced by Defibrillator
More informationOriginal Article. Introduction
Original Article The Effects of Na Movement on Surgical Myocardial Protection: The Role of the Na + -H + Exchange System and Na-Channel in the Development of Ischemia and Reperfusion Injury Ke-Xiang Liu,
More informationCardiovascular system
BIO 301 Human Physiology Cardiovascular system The Cardiovascular System: consists of the heart plus all the blood vessels transports blood to all parts of the body in two 'circulations': pulmonary (lungs)
More informationCalcium Content of St. Thomas I1 Cardioplegic Solution Damages Ischemic Immature Myocardium
Calcium Content of St. Thomas I1 Cardioplegic Solution Damages Ischemic Immature Myocardium E. Jack Baker IV, MD, Gordon N. Olinger, MD, and John E. Baker, PhD Department of Cardiothoracic Surgery, Medical
More informationEffect of Four Crystalloid Cardioplegias on Immature Rabbit Hearts During Global Ischaemia
Original Article Effect of Four Crystalloid Cardioplegias on Immature Rabbit Hearts During Global Ischaemia Yunqing Mei, Hua Liu, Cun Long, Bangchang Cheng, Shangzhi Gao and Dayi Hu, Department of Thoracic
More informationRelaxation responses of aortic rings from salt-loaded high calcium fed rats to potassium chloride, calcium chloride and magnesium sulphate
Pathophysiology 4 (1998) 275 280 Relaxation responses of aortic rings from salt-loaded high calcium fed rats to potassium chloride, calcium chloride and magnesium sulphate B.J. Adegunloye, O.A. Sofola
More informationEarly reperfusion with warm, polarizing adenosine lidocaine cardioplegia improves functional recovery after 6 hours of cold static storage
Evolving Technology/Basic Science Rudd and Dobson Early reperfusion with warm, polarizing adenosine lidocaine cardioplegia improves functional recovery after 6 hours of cold static storage Donna M. Rudd,
More information4. The two inferior chambers of the heart are known as the atria. the superior and inferior vena cava, which empty into the left atrium.
Answer each statement true or false. If the statement is false, change the underlined word to make it true. 1. The heart is located approximately between the second and fifth ribs and posterior to the
More informationCardiovascular Nursing Practice: A Comprehensive Resource Manual and Study Guide for Clinical Nurses 2 nd Edition
Cardiovascular Nursing Practice: A Comprehensive Resource Manual and Study Guide for Clinical Nurses 2 nd Edition Table of Contents Volume 1 Chapter 1: Cardiovascular Anatomy and Physiology Basic Cardiac
More informationdelnido for Myocardial Protection
delnido for Myocardial Protection Linda B. Mongero, CCP Director of Education and Clinical Performance IV.PERFUSION SYMPOSIUM 3-5 NOVEMBER 2017 TİTANİC HOTEL LARA, ANTALYA IV.PERFUSION SYMPOSIUM 2017 No
More informationPreconditioning is defined as the cardioprotective effects
Preconditioning Prevents Myocardial Stunning After Cardiac Transplantation Roderick W. Landymore, MD, Alexander J. Bayes, MD, J. Thomas Murphy, MD, and John H. Fris, RT King Fahad National Guard Hospital,
More informationPHYSIOLOGY MeQ'S (Morgan) All the following statements related to blood volume are correct except for: 5 A. Blood volume is about 5 litres. B.
PHYSIOLOGY MeQ'S (Morgan) Chapter 5 All the following statements related to capillary Starling's forces are correct except for: 1 A. Hydrostatic pressure at arterial end is greater than at venous end.
More informationSpecial circulations, Coronary, Pulmonary. Faisal I. Mohammed, MD,PhD
Special circulations, Coronary, Pulmonary Faisal I. Mohammed, MD,PhD 1 Objectives Describe the control of blood flow to different circulations (Skeletal muscles, pulmonary and coronary) Point out special
More informationPROTECTIVE EFFECT OF NICORANDIL AS AN ADDITIVE TO THE SOLUTION FOR CONTINUOUS WARM CARDIOPLEGIA
PROTECTVE EFFECT OF NCORANDL AS AN ADDTVE TO THE SOLUTON FOR CONTNUOUS WARM CARDOPLEGA Experiments were designed to assess whether (1) nicorandil given before global low-flow ischemia or (2) included in
More informationHemolysis is a well known complication caused by
Free Hemoglobin Impairs Cardiac Function in Neonatal Rabbit Hearts Shintaro Nemoto, MD, Mitsuru Aoki, MD, Chang Dehua, MD, and Yasuharu Imai, MD Department of Pediatric Cardiovascular Surgery, The Heart
More information2. MATERIALS AND METHODS
2. MATERIALS AND METHODS 2.1 Materials [ 3 H]-Digoxin (37Ci/mmol) was purchased from Perkin-Elmer Life Sciences Inc. (Boston, USA) and [U- 14 C]-Sucrose (660mCi/mmol) was purchased from Amersham Bioscience
More informationIt has been shown that the inhibition of Na /H exchange
The Contribution of Na /H Exchange to Ischemia-Reperfusion Injury After Hypothermic Cardioplegic Arrest Takashi Yamauchi, MD, Hajime Ichikawa, MD, Yoshiki Sawa, MD, Norihide Fukushima, MD, Koji Kagisaki,
More informationRadnoti Langendorff Constant Pressure Non-Recirculating Pump Driven Isolated Heart System For Mouse EZ
Radnoti Langendorff Constant Pressure Non-Recirculating Pump Driven Isolated Heart System For Mouse Radnoti 2006 Description Qty Part # Base only, for 4-bar stand 1 159950-B4 Stabilizer Bar only, for 4-Bar
More informationChapter 9, Part 2. Cardiocirculatory Adjustments to Exercise
Chapter 9, Part 2 Cardiocirculatory Adjustments to Exercise Electrical Activity of the Heart Contraction of the heart depends on electrical stimulation of the myocardium Impulse is initiated in the right
More informationThe Effect of Acute Coronary Artery Occlusion during Cardioplegic Arrest
The Effect of Acute Coronary Artery Occlusion during Cardioplegic Arrest and Reperfusion on Myocardial Preservation John H. Rousou, M.D., Richard M. Engelman, M.D., William A. Dobbs, Ph.D., and Mooideen
More informationThe Circulatory System. The Heart, Blood Vessels, Blood Types
The Circulatory System The Heart, Blood Vessels, Blood Types The Closed Circulatory System Humans have a closed circulatory system, typical of all vertebrates, in which blood is confined to vessels and
More informationMirsad Kacila*, Katrin Schäfer, Esad Subašić, Nermir Granov, Edin Omerbašić, Faida Kučukalić, Ermina Selimović-Mujčić
& Influence of Two Different Types of Cardioplegia on Hemodilution During and After Cardiopulmonary Bypass, Postoperative Chest-Drainage Bleeding and Consumption of Donor Blood Products Mirsad Kacila*,
More informationCardiothoracic Fellow Expectations Division of Cardiac Anesthesia, Beth Israel Deaconess Medical Center
The fellowship in Cardiothoracic Anesthesia at the Beth Israel Deaconess Medical Center is intended to provide the foundation for a career as either an academic cardiothoracic anesthesiologist or clinical
More informationIntraoperative Myocardial Protection: Current Trends and Future Perspectives
Intraoperative Myocardial Protection: Current Trends and Future Perspectives Gideon Cohen, MD, Michael A. Borger, MD, Richard D. Weisel, MD, and Vivek Rao, MD, PhD Division of Cardiovascular Surgery, The
More informationCardiac anaesthesia. Simon May
Cardiac anaesthesia Simon May Contents Cardiac: Principles of peri-operative management for cardiac surgery Cardiopulmonary bypass, cardioplegia and off pump cardiac surgery Cardiac disease and its implications
More informationAprikalim Reduces the Na -Ca 2 Exchange Outward Current Enhanced by Hyperkalemia in Rat Ventricular Myocytes
Aprikalim Reduces the Na -Ca 2 Exchange Outward Current Enhanced by Hyperkalemia in Rat Ventricular Myocytes Hong-Yu Li, PhD, Song Wu, PhD, Guo-Wei He, MD, PhD, and Tak-Ming Wong, PhD Department of Physiology,
More informationThe radial procedure was developed as an outgrowth
The Radial Procedure for Atrial Fibrillation Takashi Nitta, MD The radial procedure was developed as an outgrowth of an alternative to the maze procedure. The atrial incisions are designed to radiate from
More informationLactate Release During Reperfusion Predicts Low Cardiac Output Syndrome After Coronary Bypass Surgery
Lactate Release During Reperfusion Predicts Low Cardiac Output Syndrome After Coronary Bypass Surgery Vivek Rao, MD, PhD, Joan Ivanov, RN, MSc, Richard D. Weisel, MD, Gideon Cohen, MD, Michael A. Borger,
More informationTechniques of preservation and storage of the donor
Continuous Perfusion Improves Preservation of Donor Rat Hearts: Importance of the Implantation Phase David K. Nickless, MB, BS, Marc Rabinov, MB, BS, PhD, Stephen M. Richards, PhD, Robert A. J. Conyers,
More informationCardiovascular Physiology. Heart Physiology. Introduction. The heart. Electrophysiology of the heart
Cardiovascular Physiology Heart Physiology Introduction The cardiovascular system consists of the heart and two vascular systems, the systemic and pulmonary circulations. The heart pumps blood through
More informationDifficult Scenarios for Myocardial Protection SAHA Gil Bolotin M.D., Ph.D. Rambam Medical Center, Haifa, Israel
Difficult Scenarios for Myocardial Protection SAHA 2017 Gil Bolotin M.D., Ph.D. Rambam Medical Center, Haifa, Israel Difficult Scenarios for Myocardial Protection Stone Heart Nightmare Nightmare of the
More informationIntra-operative Effects of Cardiac Surgery Influence on Post-operative care. Richard A Perryman
Intra-operative Effects of Cardiac Surgery Influence on Post-operative care Richard A Perryman Intra-operative Effects of Cardiac Surgery Cardiopulmonary Bypass Hypothermia Cannulation events Myocardial
More informationControl of blood tissue blood flow. Faisal I. Mohammed, MD,PhD
Control of blood tissue blood flow Faisal I. Mohammed, MD,PhD 1 Objectives List factors that affect tissue blood flow. Describe the vasodilator and oxygen demand theories. Point out the mechanisms of autoregulation.
More informationCollin County Community College
Collin County Community College BIOL. 2402 Anatomy & Physiology WEEK 5 The Heart 1 The Heart Beat and the EKG 2 1 The Heart Beat and the EKG P-wave = Atrial depolarization QRS-wave = Ventricular depolarization
More informationComparison of Flow Differences amoiig Venous Cannulas
Comparison of Flow Differences amoiig Venous Cannulas Edward V. Bennett, Jr., MD., John G. Fewel, M.S., Jose Ybarra, B.S., Frederick L. Grover, M.D., and J. Kent Trinkle, M.D. ABSTRACT The efficiency of
More informationPolarized arrest with warm or cold adenosine/lidocaine blood cardioplegia is equivalent to hypothermic potassium blood cardioplegia
Polarized arrest with warm or cold adenosine/lidocaine blood cardioplegia is equivalent to hypothermic potassium blood cardioplegia Joel S. Corvera, MD a Hajime Kin, MD, PhD a Geoffrey P. Dobson, PhD b
More informationMyocardial Protection Principles. David J Chambers
David J Chambers Cardiac Surgical Research/Cardiothoracic Surgery The Rayne Institute (King s College London) Guy s & St Thomas NHS Foundation Trust St Thomas Hospital London UK ScanSect, Aarhus, Denmark.
More informationA Change in Myocardial Preservation Strategies using the Quest Medical MPS 2 System
A Change in Myocardial Preservation Strategies using the Quest Medical MPS 2 System Jim MacDonald, CPC,CCP Clinical Perfusion Services, London Health Sciences Centre London, Ontario, Canada Why the Change
More informationCardiovascular System: The Heart
Cardiovascular System: The Heart I. Anatomy of the Heart (See lab handout for terms list) A. Describe the size, shape and location of the heart B. Describe the structure and function of the pericardium
More informationCardiovascular System
Cardiovascular System The Heart Cardiovascular System The Heart Overview What does the heart do? By timed muscular contractions creates pressure gradients blood moves then from high pressure to low pressure
More informationLecture 10. Circulatory systems; flow dynamics, flow regulation in response to environmental and internal conditions.
Lecture 10 Circulatory systems; flow dynamics, flow regulation in response to environmental and internal conditions Professor Simchon Influence of P O2 on Hemoglobin Saturation Hemoglobin saturation plotted
More information11/10/2014. Muscular pump Two atria Two ventricles. In mediastinum of thoracic cavity 2/3 of heart's mass lies left of midline of sternum
It beats over 100,000 times a day to pump over 1,800 gallons of blood per day through over 60,000 miles of blood vessels. During the average lifetime, the heart pumps nearly 3 billion times, delivering
More informationClinical Results of Different Myocardial Protection Techniques in Aortic Stenosis
Korean J Thorac Cardiovasc Surg 2015;48:164-173 ISSN: 2233-601X (Print) ISSN: 2093-6516 (Online) Clinical Research http://dx.doi.org/10.5090/kjtcs.2015.48.3.164 Clinical Results of Different Myocardial
More informationThe Heart. Happy Friday! #takeoutyournotes #testnotgradedyet
The Heart Happy Friday! #takeoutyournotes #testnotgradedyet Introduction Cardiovascular system distributes blood Pump (heart) Distribution areas (capillaries) Heart has 4 compartments 2 receive blood (atria)
More informationEffect of an Increase in Coronary Perfusion on Transmural Ventricular Repolarization
Physiol. Res. 56: 285-290, 2007 Effect of an Increase in Coronary Perfusion on Transmural Ventricular Repolarization Y.-Z. ZHANG 1, B. HE 1, L.-X. WANG 2 1 Department of Cardiology, Renji Hospital, Medical
More informationRyuzo Bessho, MD * David J. Chambers, PhD
EXPERIMENTAL STUDY OF INTERMITTENT CROSSCLAMPING WITH FIBRILLATION AND MYOCARDIAL PROTECTION: REDUCED INJURY FROM SHORTER CUMULATIVE ISCHEMIA OR INTRINSIC PROTECTIVE EFFECT? Ryuzo Bessho, MD * David J.
More informationCardiovascular System Notes: Heart Disease & Disorders
Cardiovascular System Notes: Heart Disease & Disorders Interesting Heart Facts The Electrocardiograph (ECG) was invented in 1902 by Willem Einthoven Dutch Physiologist. This test is still used to evaluate
More informationHeart. Structure Physiology of blood pressure and heartbeat
Heart Structure Physiology of blood pressure and heartbeat Location and Anatomy Location and Anatomy Pericardial cavity: surrounds, isolates, and anchors heart Parietal pericardium lined with serous membrane
More informationWHILE it is generally agreed that elevation
The Derivation of Coronary Sinus Flow During Elevation of Right Ventricular Pressure By HERMAN M. GELLER, B.S., M.D., MARTIN BRANDFONBRENEU, M.D., AND CARL J. WIGGERS, M.D., The derivation of coronary
More informationEFFECTS OF SIGMA RECEPTOR LIGAND BD737 IN RAT ISOLATED HEARTS
SCRIPTA MEDICA (BRNO) 80 (6): 255 262, December 2007 EFFECTS OF SIGMA RECEPTOR LIGAND BD737 IN RAT ISOLATED HEARTS Nováková M. Department of Physiology, Faculty of Medicine, Masaryk University, Brno, Czech
More informationIn the name of GOD. Animal models of cardiovascular diseases: myocardial infarction & hypertension
In the name of GOD Animal models of cardiovascular diseases: myocardial infarction & hypertension 44 Presentation outline: Cardiovascular diseases Acute myocardial infarction Animal models for myocardial
More informationAirway Management in a Patient with Klippel-Feil Syndrome Using Extracorporeal Membrane Oxygenator
Airway Management in a Patient with Klippel-Feil Syndrome Using Extracorporeal Membrane Oxygenator Beckerman Z*, Cohen O, Adler Z, Segal D, Mishali D and Bolotin G Department of Cardiac Surgery, Rambam
More informationUnit 1: Human Systems. The Circulatory System
Unit 1: Human Systems The Circulatory System nourish all cells with oxygen, glucose, amino acids and other nutrients and carry away carbon dioxide, urea and other wastes Purposes Transport chemical messengers
More informationCollin County Community College. ! BIOL Anatomy & Physiology! WEEK 5. The Heart
Collin County Community College! BIOL. 2402 Anatomy & Physiology! WEEK 5 The Heart 1 (1578-1657) A groundbreaking work in the history of medicine, English physician William Harvey s Anatomical Essay on
More informationC preservation was described 5 years ago by Lichtenstein
Effect of Intermittent Deliverv of Warm Blood J Cardioplegia on Myocardial Recovery Roderick W. Landymore, MD, Alan E. Marble, PhD(Eng), and John Fris, RRT Department of Surgery, Dalhousie University,
More informationEffect of an increase in coronary perfusion on transmural. ventricular repolarization
Effect of an increase in coronary perfusion on transmural ventricular repolarization Yan-Zhou Zhang 1, MD, PhD, Ben He 1, MD, Le-Xin Wang 2, MD, PhD. From: 1 Department of Cardiology, Renji Hospital, Medical
More informationThe Groningen hypothermic liver perfusion system for improved preservation in organ transplantation Plaats, Arjan van der
University of Groningen The Groningen hypothermic liver perfusion system for improved preservation in organ transplantation Plaats, Arjan van der IMPORTANT NOTE: You are advised to consult the publisher's
More informationTopics to be Covered. Cardiac Measurements. Distribution of Blood Volume. Distribution of Pulmonary Ventilation & Blood Flow
Topics to be Covered MODULE F HEMODYNAMIC MONITORING Cardiac Output Determinants of Stroke Volume Hemodynamic Measurements Pulmonary Artery Catheterization Control of Blood Pressure Heart Failure Cardiac
More informationReplacing Potassium with Nicorandil in Cold St. Thomas Hospital Cardioplegia Improves Preservation of Energetics and Function in Pig Hearts
Replacing Potassium with Nicorandil in Cold St. Thomas Hospital Cardioplegia Improves Preservation of Energetics and Function in Pig Hearts Tor Steensrud, MD, Dag Nordhaug, MD, Kjell V. Husnes, MD, Ebrahim
More informationProviding the cardiac surgeon with a relaxed and still
Mechanisms and Alternative Methods of Achieving Cardiac Arrest David J. Chambers, PhD Cardiac Surgical Research/Cardiothoracic Surgery, The Rayne Institute, Guy s and St Thomas NHS Hospital Trust, St Thomas
More informationReperfusion Effects After Cardiac Ischemia
Reperfusion Effects After Cardiac Ischemia Dave Milzman, MD, FACEP Professor and Assistant Dean for Clinical Research Georgetown University School of Medicine Research Director, Depts of Trauma and Emerg
More informationAcid-base management during hypothermic CPB alpha-stat and ph-stat models of blood gas interpretation
Acid-base management during hypothermic CPB alpha-stat and ph-stat models of blood gas interpretation Michael Kremke Department of Anaesthesiology and Intensive Care Aarhus University Hospital, Denmark
More informationAtrial fibrillation (AF) is associated with increased morbidity
Ablation of Atrial Fibrillation with Concomitant Surgery Edward G. Soltesz, MD, MPH, and A. Marc Gillinov, MD Atrial fibrillation (AF) is associated with increased morbidity and mortality in coronary artery
More informationCirculation. Circulation = is a process used for the transport of oxygen, carbon! dioxide, nutrients and wastes through-out the body
Circulation Circulation = is a process used for the transport of oxygen, carbon! dioxide, nutrients and wastes through-out the body Heart = muscular organ about the size of your fist which pumps blood.
More informationCh.15 Cardiovascular System Pgs {15-12} {15-13}
Ch.15 Cardiovascular System Pgs {15-12} {15-13} E. Skeleton of the Heart 1. The skeleton of the heart is composed of rings of dense connective tissue and other masses of connective tissue in the interventricular
More informationSAMPLE CHAPTER CHAPTER
2.1 Introduction CHAPTER 2 Cardiovascular Structure and Function One may question why it is important for a biomedical engineer to study physiology. To answer this question, we can begin by recognizing
More informationThe cardiovascular system is composed of a pump the heart and blood
5 E X E R C I S E Cardiovascular Dynamics O B J E C T I V E S 1. To understand the relationships among blood flow, pressure gradient, and resistance 2. To define resistance and describe the main factors
More informationPrinciples of Anatomy and Physiology
Principles of Anatomy and Physiology 14 th Edition CHAPTER 20 The Cardiovascular System: The Heart Introduction The purpose of the chapter is to: 1. Learn about the components of the cardiovascular system
More information2.02 Understand the functions and disorders of the circulatory system
2.02 Understand the functions and disorders of the circulatory system 2.02 Understand the functions and disorders of the circulatory system Essential questions: What are the functions of blood? What are
More informationM myocardial preservation [l], and may act by antagonizing
Myocardial Preservation Related to Magnesium Content of Hyperkalemic Cardioplegic Solutions at 8 C Tommy R. Reynolds, MD, Gillian A. Geffin, MB, BS, James S. Titus, Dennis D. O Keefe, MD, and Willard M.
More informationImpedance Cardiography (ICG) Method, Technology and Validity
Method, Technology and Validity Hemodynamic Basics Cardiovascular System Cardiac Output (CO) Mean arterial pressure (MAP) Variable resistance (SVR) Aortic valve Left ventricle Elastic arteries / Aorta
More informationPharmacology & Therapeutics
Pharmacology & Therapeutics 127 (2010) 41 52 Contents lists available at ScienceDirect Pharmacology & Therapeutics journal homepage: www.elsevier.com/locate/pharmthera Associate editor: M. Madhani Cardioplegia
More informationProtection of the Chronic Hypoxic Immature Rat Heart During Global Ischemia
Protection of the Chronic Hypoxic Immature Rat Heart During Global Ischemia Matthias Karck, MD, Gerhard Ziemer, MD, Max Zoeller, MD, Steffen Schulte, MD, Klaus-D. Juergens, MD, Herwig Weisser, MD, and
More informationCONTINUOUS PERFUSION OF DONOR HEARTS IN THE BEATING STATE EXTENDS PRESERVATION TIME AND IMPROVES RECOVERY OF FUNCTION
CONTINUOUS PERFUSION OF DONOR HEARTS IN THE BEATING STATE EXTENDS PRESERVATION TIME AND IMPROVES RECOVERY OF FUNCTION Waleed H. Hassanein, MD Lambros Zellos, MD Tracey A. Tyrrell, BA Nancy A. Healey, BS
More informationControl of blood tissue blood flow. Faisal I. Mohammed, MD,PhD
Control of blood tissue blood flow Faisal I. Mohammed, MD,PhD 1 Objectives List factors that affect tissue blood flow. Describe the vasodilator and oxygen demand theories. Point out the mechanisms of autoregulation.
More informationDemonstration of Uneven. the infusion on myocardial temperature was insufficient
Demonstration of Uneven in Patients with Coronary Lesions Rolf Ekroth, M.D., HAkan erggren, M.D., Goran Sudow, M.D., Josef Wojciechowski, M.D., o F. Zackrisson, M.D., and Goran William-Olsson, M.D. ASTRACT
More informationPearson's Comprehensive Medical Assisting Administrative and Clinical Competencies
Pearson's Comprehensive Medical Assisting Administrative and Clinical Competencies THIRD EDITION CHAPTER 27 The Cardiovascular System Lesson 1: Overview of the Cardiovascular System Lesson Objectives Upon
More informationBME 5742 Bio-Systems Modeling and Control. Lecture 41 Heart & Blood Circulation Heart Function Basics
BME 5742 Bio-Systems Modeling and Control Lecture 41 Heart & Blood Circulation Heart Function Basics Dr. Zvi Roth (FAU) 1 Pumps A pump is a device that accepts fluid at a low pressure P 1 and outputs the
More informationAugust, 2015 STATE MEDICAL FACULTY OF WEST BENGAL. Preliminary Examinations for Diploma in Perfusion Technology : DPfT. Paper I ANATOMY & PHYSIOLOGY
August, 2015 STATE MEDICAL FACULTY OF WEST BENGAL Paper I ANATOMY & PHYSIOLOGY Time 3 hours Full Marks 80 Group A Q-1) Write the correct Answer: 10x1 = 10 i) The posterior descending artery is branch of
More informationObstructed total anomalous pulmonary venous connection
Total Anomalous Pulmonary Venous Connection Richard A. Jonas, MD Children s National Medical Center, Department of Cardiovascular Surgery, Washington, DC. Address reprint requests to Richard A. Jonas,
More informationPressure-Flow Relationships in the Coronary Circulation
Pressure-Flow Relationships in the Coronary Circulation By Wadie M. Fam, M.D., Ph.D., and Maurice McGregor, M.D. ABSTRACT This study was designed to define more accurately the respective influences of
More information10/23/2017. Muscular pump Two atria Two ventricles. In mediastinum of thoracic cavity 2/3 of heart's mass lies left of midline of sternum
It beats over 100,000 times a day to pump over 1,800 gallons of blood per day through over 60,000 miles of blood vessels. During the average lifetime, the heart pumps nearly 3 billion times, delivering
More informationEFFECTS OF RETROGRADE CARDIOPLEGIA ON MYOCARDIAL PERFUSION AND ENERGY METABOLISM IN IMMATURE PORCINE MYOCARDIUM
EFFECTS OF RETROGRADE CARDIOPLEGIA ON MYOCARDIAL PERFUSION AND ENERGY METABOLISM IN IMMATURE PORCINE MYOCARDIUM Godwin Oriaku, MSc a Bo Xiang, DDS a Guangping Dai, PhD a Jie Shen, PhD b Jiankang Sun, MSc
More informationMechanical Bleeding Complications During Heart Surgery
Mechanical Bleeding Complications During Heart Surgery Arthur C. Beall, Jr., M.D., Kenneth L. Mattox, M.D., Mary Martin, R.N., C.C.P., Bonnie Cromack, C.C.P., and Gary Cornelius, C.C.P. * Potential for
More informationEfficacy and safety of the reciprocal pulse defibrillator current waveform
Purdue University Purdue e-pubs Weldon School of Biomedical Engineering Faculty Publications Weldon School of Biomedical Engineering 1984 Efficacy and safety of the reciprocal pulse defibrillator current
More informationCARDIOVASCULAR SYSTEM
CARDIOVASCULAR SYSTEM Overview Heart and Vessels 2 Major Divisions Pulmonary Circuit Systemic Circuit Closed and Continuous Loop Location Aorta Superior vena cava Right lung Pulmonary trunk Base of heart
More informationTHE CARDIOVASCULAR SYSTEM. Heart 2
THE CARDIOVASCULAR SYSTEM Heart 2 PROPERTIES OF CARDIAC MUSCLE Cardiac muscle Striated Short Wide Branched Interconnected Skeletal muscle Striated Long Narrow Cylindrical PROPERTIES OF CARDIAC MUSCLE Intercalated
More informationMR Advance Techniques. Cardiac Imaging. Class IV
MR Advance Techniques Cardiac Imaging Class IV Heart The heart is a muscular organ responsible for pumping blood through the blood vessels by repeated, rhythmic contractions. Layers of the heart Endocardium
More informationEffect of Outflow Pressure upon Lymph Flow from Dog Lungs
Effect of Outflow Pressure upon Lymph Flow from Dog Lungs R.E. Drake, D.K. Adcock, R.L. Scott, and J.C. Gabel From the Department of Anesthesiology, University of Texas Medical School, Houston, Texas SUMMARY.
More information