Efflux of enzymes in right duct lymph and serum after coronary perfusion and ischaemic arrest.

Right lymphatic duct was cannulated in 40 patients operated upon with cardiopulmonary bypass and moderate hypothermia, 30-32 degrees C. The diagnoses were aortic valve disease in 20 cases and mitral valve disease in 20 cases. The operative procedure was valve replacement with a Björk-Shiley prosthesis in 36 cases, fascia lata prosthesis in 1 case and plastic procedure in 3 cases. Coronary perfusion was used in 19 cases, ischaemic arrest in 10 cases and ischaemic arrest continued by coronary perfusion on the fibrillating heart in 11 cases. Frequent enzyme analyses were performed in lymph and serum for GOT, GPT, CPK and LDH before, during and after bypass. A statistically significant higher efflux of enzymes after bypass was found in the group of patients with ischaemic arrest continued by coronary perfusion as compared with coronary perfusion or ischaemic arrest. No difference was found between patients operated upon with coronary perfusion and those with ischaemic arrest. It is concluded that ischaemic arrest should not be followed by extended coronary perfusion on a fibrillating heart. Ischaemic arrest seems to have certain advantages over continuous coronary perfusion in selected cases.