Carteaux J P, Mertes P M, Pinelli G, Escanye J M, Walker P, Brunotte F, Jaboin Y, Robert J, Villemot J P
Laboratory of Experimental Surgery, University of Nancy, France.
J Heart Lung Transplant. 1994 Jul-Aug;13(4):661-8.
Early graft failure accounts for a substantial portion of the mortality after heart transplantation. This factor underscores the need for the development of reliable methods for predicting graft performance and thus ensuring optimal clinical outcome. The aim of this study was to describe the link between myocardial metabolism evaluated throughout preservation with the use of phosphorus 31-nuclear magnetic resonance spectroscopy and ventricular contractility after reperfusion. Thirteen pig hearts were excised and preserved from 3 to 12 hours with clinical techniques. During preservation the hearts underwent phosphorus 31-nuclear magnetic resonance spectroscopy. After reperfusion, left ventricular contractility was evaluated with an isolated heart model undergoing isovolumetric contraction. Throughout storage, beta-adenosine triphosphate remained stable and intracellular pH and phosphocreatine decreased exponentially, whereas inorganic phosphate increased exponentially. Intracellular pH, phosphocreatine, inorganic phosphates measured at the onset of preservation, and intracellular pH and phosphocreatine measured at the end of preservation correlated significantly with the left ventricular contractility after reperfusion. We conclude that the metabolic state of myocardium at excision is especially important and that phosphorus 31-nuclear magnetic resonance evaluation of the heart during preservation appears to provide reliable indexes for predicting subsequent ventricular contractility after reperfusion.
早期移植物功能衰竭在心脏移植后的死亡率中占相当大的比例。这一因素凸显了开发可靠方法以预测移植物功能从而确保最佳临床结果的必要性。本研究的目的是描述在整个保存过程中使用磷31核磁共振波谱法评估的心肌代谢与再灌注后心室收缩性之间的联系。13只猪心脏被切除并用临床技术保存3至12小时。在保存过程中，心脏接受磷31核磁共振波谱分析。再灌注后，使用进行等容收缩的离体心脏模型评估左心室收缩性。在整个保存过程中，三磷酸腺苷（ATP）保持稳定，细胞内pH值和磷酸肌酸呈指数下降，而无机磷酸盐呈指数增加。保存开始时测量的细胞内pH值、磷酸肌酸、无机磷酸盐以及保存结束时测量的细胞内pH值和磷酸肌酸与再灌注后左心室收缩性显著相关。我们得出结论，切除时心肌的代谢状态尤为重要，并且在保存过程中对心脏进行磷31核磁共振评估似乎为预测再灌注后随后的心室收缩性提供了可靠指标。
