Effect of retrograde coronary sinus perfusion during implantation of the preserved canine heart.
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Biomedical subjects
Publications and source records attributed to H Saigenji.
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The operation for the isolated secundum type of atrial septal defect (ASD) is usually conducted electively in the older age. Small number of cases, however, inevitably require surgical treatment for the reason of intractable heart failure. We have experienced such two infants with the isolated secundum type of ASD, whose conservative treatment was ineffective.
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Fatal hemolysis after mitral valve replacement with the St. Jude bileaflet tilting prosthesis is reported in two patients. Although one underwent re-replacement of the valve, both died from multiple organ failure and acute renal failure, respectively. Scanning electron microscopy revealed microthrombi adherent to a leaflet in one and irregular leaflet surfaces in the other. Such defects are rare but are possible causes of hemolysis in patients with the St. Jude mitral valve prosthesis.
Three cases with typical cooing murmurs in degenerated porcine valves at mitral positions were studied. An echophonocardiogram disclosed that the origin of cooing murmur was due to cusp vibration with fixed cycle in frequency. Three failed xenografts were replaced with mechanical valves and the removed prostheses were examined. The first valve had a torn cusp, the second had a perforated cusp and the third had both a torn and perforated cusps. The failed leaflets were all pliable and not thickened in properties. These common findings are suspected to relate closely to the occurrence of a musical cooing murmur. Since all cases with cooing murmurs suddenly developed severe or progressive heart failure, we recommend prompt evaluation and reoperation when a cooing murmur appears in the patients with xenografts.
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Of fifty-eight consecutive patients surgically treated for aneurysm of the abdominal aorta, twenty were emergency cases following the rupture. Associated diseases were found in 85 per cent of patients; hypertension being the most common. Fifty per cent of patients were in shock on admission. The duration between rupture and operation was three hrs to two weeks with the average of 115.5 hrs. In six patients, the diagnosis of abdominal aortic aneurysm was known for over six months. The operative mortality rate in case of ruptured abdominal aortic aneurysm was 45 per cent. The most important determinants of survival were the incidence of shock on admission, the incidence of associated disease, the known duration of the aneurysm, and the time interval from rupture to admission. The intraoperative factors most influencing survival were the type of rupture, intraoperative hypotension, and total blood loss. Comparison of the mortality rate in elective surgery of abdominal aortic aneurysms (5.3 per cent) with that in ruptured aneurysms (45.0 per cent) suggests the necessity for early elective operations whenever abdominal aortic aneurysms are diagnosed.
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The purpose of this study was to investigate the maximum limits of a simple topical cooling method with preservation of graft viability following orthotopic transplantation. Coronary vascular washout was performed with cold potassium-verapamil cardioplegia. The heart was then removed, suspended in the same solution, and stored at 4 degrees C. The experimental material was divided into three groups according to the preservation time: 24 h in group I (six animals), 36 h in group II (five animals), and 48 h in group III (three animals). All six animals in group I and four of five animals in group II maintained a stable recipient circulation after transplantation. No animals in group III could be taken off cardiopulmonary bypass. Contraction band injury after transplantation was more frequently observed in the group II grafts than in those of group I. In conclusion, the combination of coronary vascular washout with cold potassium-verapamil cardioplegia and storage at 4 degrees C in the same solution may preserve the canine heart for 24-36 h, as demonstrated by cardiac function immediately after orthotopic transplantation.
The viability of the heart was assessed following orthotopic transplantation. Following coronary vascular washout with cold potassium-verapamil cardioplegia, the heart was removed, immersed in the same solution, and stored at 4 degrees C for 24 hours in Group I (6 animals), 36 hours in Group II (5 animals), and 48 hours in Group III (3 animals). All six animals in Group I and four of five animals in Group II maintained a stable recipient circulation for the acute phase of 2 hours after transplantation, without cardiopulmonary bypass. For the dogs in Group III, cardiopulmonary bypass was vital. Contraction band injury after transplantation was more frequently observed in the Group II grafts than those of Group I. We conclude that the combination of coronary vascular washout with cold potassium-verapamil cardioplegia and storage at 4 degrees C in the same solution may preserve the canine heart for up to 24 to 36 hours, as demonstrated by post-orthotopic transplantation function.
Various kinds of models for canine heart preservation were evaluated through orthotopic transplantation. Following warm ischemic (WIT) and preservation times (PT), donor hearts were orthotopically transplanted to recipients and observed for 2 hours. The study was divided into four groups. A heart-lung preparation (Group A) was preserved by coronary perfusion with diluted blood for an hour following 15-minute WIT in A-1 (n = 33), and 2 hours following 30-minute WIT in A-2 (n = 19). Following 30-minute WIT, the heart (Group B) was preserved for an hour by coronary perfusion with diluted blood in B-1 (n = 20), a modified Krebs solution in B-2 (n = 14), and a EL-solution in B-2 (n = 14). Following 30-minute WIT, the heart (Group C) was preserved for 2 hours by a Langendorff's model with coronary perfusion using perfluorochemical in C-1 (n = 5) and Hydroxyethyl starch in C-2 (n = 1). In Group D, electromechanical arrest of the heart and coronary vascular washout were performed in D-1 (n = 8) with K+ cardioplegia, D-2 (n = 8) with K+-verapamil cardioplegia, and D-3 (n = 5) with Collins M-verapamil cardioplegia. The heart was then removed and suspended in the same solution. The graft was preserved at 4 degrees C for 6 hours in D-1 and D-2, and 24 hours in D-3. Fourty-eight % in A-1 and 26% in A-2 were successfully transplanted.(ABSTRACT TRUNCATED AT 250 WORDS)
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