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Mechanism of ischemic contracture in ferret hearts: relative roles of [Ca2+]i elevation and ATP depletion.

When coronary perfusion is interrupted, the diastolic force generated by the myocardium first falls but eventually increases. The delayed rise in force, ischemic contracture, has been attributed either to ATP depletion or to elevation of the intracellular free calcium concentration ([Ca2+]i). To distinguish between these possibilities, we measured [Ca2+]i and ATP concentration [( ATP]) in ferret hearts using nuclear magnetic resonance (NMR) spectroscopy. Mean time-average [Ca2+]i and [ATP] equaled 0.25 microM and 2.7 mumol/g wet wt, respectively, under control perfusion conditions. [Ca2+]i increased and [ATP] fell during total global ischemia. Although [Ca2+]i exceeded the usual systolic levels of 1.7 microM within 20-25 min of ischemia and reached a steady level between 2 and 3 microM by 30-35 min, force only began to rise after 40 min. In contrast, the time required for [ATP] to fall to less than 10% of control levels coincided closely with the onset of contracture. Ischemia in the presence of iodoacetate, an inhibitor of glycolysis, led to a precipitous fall in [ATP] and a concomitant rise in force, both of which preceded any elevation of [Ca2+]i. Thus changes in [Ca2+]i are neither sufficient nor necessary for the initiation of ischemic contracture. We conclude that ATP depletion is primary and that the rise in resting force reflects the formation of rigor cross bridges.

Adenosine Triphosphate↗

Neonatal Volkmann's ischemic contracture of the forearm: a report of five cases.

We report five cases of children born with forearm wounds associated with motor and sensory losses to the hand and forearm. Their evolution toward muscle retraction is very similar to the classic description of Volkmann's ischemic contracture. These cases should not be confused with upper extremity gangrene of the newborn or aplasia cutis congenita. Two cases of neonatal Volkmann's ischemia have already been reported in the literature and identified as such. Another very similar case has been reported as upper extremity gangrene of the newborn, and three more cases of a forearm wound with neuromuscular involvement have been reported as aplasia cutis congenita. We believe that neonatal Volkmann's ischemic contracture of the forearm should be recognized as a separate entity. Its early diagnosis may improve treatment, especially for children with recent injury, in whom intracompartmental pressures may still be elevated. Early hand therapy and splinting are mandatory to minimize late sequelae.

Compartment Syndromes↗

[Dynamics of thermographic changes in patients with ischemic contracture of the foot].

In 28 patients with the foot ischemic contracture (FIC) the thermographic changes were studied up in reactive-restoration and residual periods. The patients' distribution in the reactive-restoration period according to the level of thermoasymmetry and radiation temperature has significance for the FIC of middle and severe stage prognostication.

Contracture↗

Scarred muscle excision for the treatment of established ischemic contracture of the lower extremity.

Nine patients with rigid equinocavovarus contractures of the foot and ankle after ischemic episodes of the leg were treated from 1986 to 1989. The ischemic contractures occurred after tibial and fibular fractures in six cases, and after a trimalleolar ankle fracture, an electrical burn, and cardiac bypass surgery in one case each. Previous tendon and nerve releases had failed. The scarred portion of the various involved muscles of the deep posterior compartment were widely excised along with the respective tendons. A variety of additional foot procedures were generally necessary to obtain a plantigrade foot. Night splinting to maintain a plantigrade foot was prescribed for all patients.

Adolescent↗

Clinical study of Volkmann's ischemic contracture of the upper limb.

A clinical study of Volkmann's ischemic contracture of the forearm has been presented. The total incidence was 0.105 percent of all orthopedic cases. Mostly it occurred in males (77.5 percent), mostly in the second or third decade of life. Most patients lived in rural areas, reflecting prevailing socioeconomic conditions.

Compartment Syndromes↗

Angiotensin II subtype 1 (AT1) receptors contribute to ischemic contracture and regulate chemomechanical energy transduction in isolated transgenic rat (alphaMHC-hAT1)594-17 hearts.

BACKGROUND: The role of AT1 receptors in myocardial ischemia/reperfusion injury is unclear. We, therefore, investigated the effects of the AT1 receptor antagonist irbesartan (Irb) in isolated hearts of selective myocardial AT1 overexpressing transgenic [transgenic(alphaMHC-hAT1)594-17] and Sprague-Dawley rats (SD) subjected to ischemia/reperfusion injury. METHODS AND RESULTS: Hearts of 4-week-old male SD or transgenic rats were isolated and perfused with Krebs-Henseleit buffer with or without 10 microM Irb in Langendorff mode. After 15 min of stabilization, pressure-volume curves were obtained and the hearts subjected to 20 min ischemia followed by 30 min reperfusion. A second set of pressure-volume curves was obtained thereafter. Left ventricular developed pressure (LVDP), end-diastolic pressure (LVEDP), total coronary flow (CF) and oxygen consumption (MVO2) were recorded continuously. Myocardial efficiency was derived from the slope of relations of MVO2 to pressure/volume area. After 20 min ischemia, LVEDP was significantly higher in transgenic than in SD (35.7+/-1.8 vs. 29.2+/-1.0 mmHg, P<0.05) or Irb treated transgenic hearts (24.3+/-1.6 mmHg, P<0.05). Myocardial efficiency was increased by Irb before ischemia. Ischemia increased efficiency in SD but not in transgenic rats, Irb increased efficiency in transgenic hearts post-ischemia. CONCLUSION: Transgenic hearts developed ischemic contracture more rapidly than SD hearts as indicated by higher LVEDP during ischemia. This response was antagonized by Irb, indicating a role of AT1 receptors in ischemic contracture, AT1-receptors also appear to be involved in the control of myocardial efficiency.

Animals↗

The relationship between ischemic contracture and no-reflow phenomenon in isolated rat heart.

The relationship between ischemic contracture and no-reflow phenomenon was studied in 59 isolated rat hearts during global ischemia. The contracture was measured by a water-filled balloon catheter placed in the left ventricular lumen. The time of onset of contracture was changed by preischemic infusion with buffer containing 0.5 mmoles/l iodoacetate (IAA) in order to get early contracture, and by hypothermia which delayed the development of contracture. The first signs of contracture were noticed in normothermia (37 degrees C) at 11 minutes, in hypothermia (26 degrees C) at 25 minutes, and in the IAA-infused group at 3 minutes. The completion of contracture occurred in these groups at 25, 90 and 11 minutes, respectively. The myocardial perfusability was tested at the pre- and postcontracture state by infusing 0.1% fluorescein in isotonic saline into the cannulated aortic root. The myocardial area perfused with fluorescein was quantified in colour photographs taken under ultraviolet light of frozen whole-heart sections. The myocardial perfusion - expressed ad percent of myocardial area - was 99% at the precontracture state in normothermia, 95% in hypothermia and 100% in the IAA-infused group. At the postcontracture state, the myocardial perfusion in these groups was 80, 56 and 18%, respectively. It was concluded that the no-reflow phenomenon in isolated rat heart is closely associated with the development of myocardial contracture during global ischemia.

Animals↗

Adhesions between muscle and bone after forearm fracture mimicking mild Volkmann's ischemic contracture.

Five cases of digital flexion contractures after healed forearm fractures were incorrectly diagnosed as mild Volkmann ischemic contractures. All failed to respond to conservative therapy and were considered significant enough to require surgical correction. At surgery, the involved muscle-tendon units were densely adherent to the bone and callus of the fracture site with no evidence of ischemic involvement of the muscle. Lysis of adhesions and lengthening of the contracted muscle corrected the deformities.

Adolescent↗

Ultrastructure of ischemic contracture of the left ventricle ("stone heart").

Myocardial biopsies from two patients who had developed "stone heart" (myocardial rigor mortis; ischemic contracture of the left ventricle) were studied by electron microscopy. The ultrastructure of tissue in stone heart, though ischemic in nature, differed from that of classic myocardial infarction in some respects. Apart from depletion of glycogen and distension of the sarcoplasmic reticulum and T-tubules, myofibrillar degeneration was much more widespread. Mitochondrial degeneration with active lysosomal autodigestion, disruption of the microcirculation, and lymphedema were prominent changes also observed. In the light of known clinical and experimental observations, our findings suggest that stone heart is an accelerated form of ischemic injury occurring in vulnerable (hypertrophied) hearts and is probably related to ischemia-triggered release of endogenous catecholamines.

Capillaries↗

[Application of ultrasonic investigation in estimation of morphofunctional state of muscles in patients with ischemic contracture of foot].

Results of ultrasonic investigation of the shin and foot muscles were analyzed in 14 patients with an ischemic contracture of foot (ICF). All the patients were operated on, clinical significance of ICF ultrasonic semiotics was estimated. Structural changes were demonstrated by diffuse strengthening of echogeneicity, striateness loss, ischemized muscles thickness reduction, origination of hypoechogenic (of hydrophilic nature) portions in places of necrosis of muscular tissues. Hyperechogeneicity is caused by fibrosis of an ischemized muscles, which during isometric contraction somewhat thickened, their echogeneicity did not change.

Contracture↗

Volkmann's ischemic contracture of the foot and ankle: evaluation and treatment of established deformity.

Fibrotic contracture of skeletal muscle can follow weeks or months after the severe ischemic insult of compartment syndrome. Commonly known as Volkmann's ischemic contracture, the affected limb often becomes dysfunctional and painful, and may lose sensibility. The pathogenesis of the muscle contracture includes prolonged ischemia, myonecrosis, fibroblastic proliferation, contraction of the cicatrix, and myotendinous adhesion formation. Resultant shortening or overpull of involved muscles leads to stiffness and deformity. Simultaneously, nerve injury from initial ischemia or subsequent soft tissue fibrotic compression leads to muscle paresis or paralysis of the involved compartment and of those muscles more distally innervated. The resultant deformity is thus a combination of varying degrees of contracture and weakness depending on which muscles and nerves are affected. Deformity and functional impairment in the foot and ankle secondary to ischemia are determined by many factors, including: (1) which leg compartment, if any, has been affected and to what degree extrinsic flexor or extensor overpull is exhibited, (2) degree of nerve injury sustained causing weakness or paralysis of extrinsic or intrinsic foot and ankle muscles (3) which foot compartment, if any, has been affected and to what degree intrinsic overpull is exhibited, and (4) degree of sensory nerve injury leading to anesthesia, hypoesthesia, or hyperesthesia of the foot. Therefore, a variety of clinical presentations can be encountered following compartment syndrome of the leg and foot. Treatment is based on an appreciation of the pathoanatomy of the deformity. Nonoperative therapy is aimed at obtaining or preserving joint mobility, increasing strength, and providing corrective bracing and accommodative footwear. Operative management is usually reserved for treatment of residual nerve compression or severe and problematic deformities. Established surgical protocols are performed in a stepwise fashion, to include: (1) release of residual or secondary nerve compression, (2) release of fixed contractures, using infarct excision, myotendinous lengthening, muscle recession, or tenotomy, (3) tendon transfers or arthrodesis to increase function, and (4) ostectomy or amputation for severe, refractory deformities.

Ankle Joint↗