Bethencourt D M, Laks H
J Thorac Cardiovasc Surg. 1981 Mar;81(3):440-9.
The development of myocardial edema and the changes in compliance during long-term preservation and reperfusion of 10 dog hearts were studied. Krebs solution, modified by the addition of potassium chloride (20 mEq/L), was used for 24 hours of low-pressure perfusion (15 mm Hg), at 4 degrees C. The hearts then were reperfused with the use of a support dog. Gravimetric heart water of myocardial biopsy tissue increased from control values of 78.0 +/- 0.8 to 82.8 +/- 0.6 ml/100 gm at 1 hour (p less than 0.01) and to 84.2 +/- 0.3 ml/100 gm after 24 hours of preservation (p less than 0.05 compared to 1 hour). After reperfusion, heart water decreased to 82.8 +/- 0.3 ml/100 gm (p less than 0.05). Passive compliance during preservation, obtained using an inflatable intraventricular balloon, decreased from 1.49 +/- 0.03 ml/mm Hg at 1 hour to 0.65 +/- 0.14 ml/mm Hg at 24 hours (p less than 0.05). High-energy phosphate levels were unchanged at 1 and 24 hours of preservation. Light and electron microscopy at 24 hours of preservation showed marked pericapillary edema and excellent preservation of intracellular structures. During reperfusion, ventricular function curves and dp/dt (2,841 +/- 581 mm Hg/sec) were comparable to previously reported control values. Passive compliance at 24 hours correlated with the diastolic compliance during reperfusion (p less than 0.01). The change in passive compliance during preservation also correlated with the change in coronary vascular resistance, a previously reported index of myocardial viability (p less than 0.05). This study has shown that the change in passive compliance of the heart during perfusion correlates with the adequacy of myocardial preservation and provides an additional index of preserved heart viability.
研究了10只犬心脏在长期保存和再灌注过程中心肌水肿的发展及顺应性的变化。用添加了氯化钾（20 mEq/L）的Krebs溶液在4℃下进行24小时的低压灌注（15 mmHg）。然后用一只辅助犬进行心脏再灌注。心肌活检组织的重量法测定的心含水量从对照值78.0±0.8增加到保存1小时时的82.8±0.6 ml/100 g（p＜0.01），保存24小时后增加到84.2±0.3 ml/100 g（与1小时相比，p＜0.05）。再灌注后，心含水量降至82.8±0.3 ml/100 g（p＜0.05）。使用可充气的心室内球囊获得的保存期间的被动顺应性从1小时时的1.49±0.03 ml/mm Hg降至24小时时的0.65±0.14 ml/mm Hg（p＜0.05）。保存1小时和24小时时高能磷酸水平无变化。保存24小时时的光镜和电镜检查显示有明显的毛细血管周围水肿，细胞内结构保存良好。再灌注期间，心室功能曲线和dp/dt（2,841±581 mmHg/秒）与先前报道的对照值相当。24小时时的被动顺应性与再灌注期间的舒张顺应性相关（p＜0.01）。保存期间被动顺应性的变化也与冠状动脉血管阻力的变化相关，冠状动脉血管阻力是先前报道的心肌活力指标（p＜0.05）。本研究表明，灌注期间心脏被动顺应性的变化与心肌保存的充分性相关，并提供了一个额外的保存心脏活力指标。
