The effect of blood oxygen content and the no-reflow phenomenon on the subendocardial ultrastructural reversibility following anoxic arrest using hemodilution variables in the experimental model.

Hemodilution is an accepted modality for the conduct of cardiopulmonary bypass. The degree of hemodilution clinically employed has been in the range of 20 per cent of the initial hematocrit levels. This study was designed to evaluate the effects of hemoglobin levels and oxygen content on the reversibility of the damaged or altered ultrastructure of the endocardial layer of the ventricle and the possible role of the no-reflow phenomenon. Two series of mongrel dogs were subjected to cardiopulmonary bypass at normothermic levels and a standard period of ischemic arrest. One series was with hemoglobin levels between 5 and 10 grams (mean 7.25 grams) designated as moderate hemodilution (MH). The second series was of hemodilution with less than 5 grams of hemoglobin (mean 4.8 grams) designated as severe hemodilution (SH). The ultrastructural alteration gradient (UAG) between the epicardium and endocardium was studied with its relationship to reversibility of myocardial function and animal survival. The study demonstrated a definitive relationship between oxygen content and the reversibility of myocardial damage under normothermic conditions and anoxic arrest. The poor survival results in the SH group; two of 12 are attributed to the low oxygen availability possibly triggering the no-reflow phenomenon which prevents reversibility of the myocardial ultrastructural damage and ultimately the functional integrity of the ventricle.