MYOCARDIAL PROTECTION OF PERFLUOROCHEMICALS (FC-43) IMMERSION DURING ISCHEMIA
Topical cooling of the heart is an effective method of protection for the myocardium during ischemia, but it has some disadvantages. The disadvantages include phrenic nerve injury, uneven supply of the cardioplegic solution due to coronary spasm and damage to the epicardium. In order to avoid these...
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| Published in | Journal of The Showa Medical Association Vol. 55; no. 5; pp. 473 - 478 |
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| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | English Japanese |
| Published |
The Showa University Society
1995
昭和大学学士会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0037-4342 2185-0976 |
| DOI | 10.14930/jsma1939.55.473 |
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| Abstract | Topical cooling of the heart is an effective method of protection for the myocardium during ischemia, but it has some disadvantages. The disadvantages include phrenic nerve injury, uneven supply of the cardioplegic solution due to coronary spasm and damage to the epicardium. In order to avoid these cooling-related disorders, mild topical cooling was applied and the heart was immersed in FC 43 emulsion of perfluorochemicals (PFC) which has an excellent oxygen transport activity, in attempt to supply oxygen to meet the increasing demand for oxygen of the myocardium. The hemodynamic recovery was studied in 4 groups of isolated rat hearts, during ischemia for 60 minutes (group A) and 90 minutes (group B) at 30°C after cardioplegic arrest, two groups (A1 and B1) were not immersed in FC 43; the other two groups (A2 and B2) were immersed in FC 43. As a result, there are no significant differences in the hemodynamic recovery between group A2 and group A1. The 5 hearts in group B1 were unable to resume the beat after reperfusion. In contrast, all hearts of group B2 resumed the beat; the cardiac function was restored by more than 70%, and the results were significantly better (p<0.001) than in group B1. These results suggest the possibility that oxygen was supplied to the myocardium by immersion of the hearts in perfluorochemicals there by meeting the demand for oxygen of the myocardium in the state of ischemia and hypoxia with the aid of mild topical hypothermia. |
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| AbstractList | Topical cooling of the heart is an effective method of protection for the myocardium during ischemia, but it has some disadvantages. The disadvantages include phrenic nerve injury, uneven supply of the cardioplegic solution due to coronary spasm and damage to the epicardium. In order to avoid these cooling-related disorders, mild topical cooling was applied and the heart was immersed in FC 43 emulsion of perfluorochemicals (PFC) which has an excellent oxygen transport activity, in attempt to supply oxygen to meet the increasing demand for oxygen of the myocardium. The hemodynamic recovery was studied in 4 groups of isolated rat hearts, during ischemia for 60 minutes (group A) and 90 minutes (group B) at 30°C after cardioplegic arrest, two groups (A1 and B1) were not immersed in FC 43; the other two groups (A2 and B2) were immersed in FC 43. As a result, there are no significant differences in the hemodynamic recovery between group A2 and group A1. The 5 hearts in group B1 were unable to resume the beat after reperfusion. In contrast, all hearts of group B2 resumed the beat; the cardiac function was restored by more than 70%, and the results were significantly better (p<0.001) than in group B1. These results suggest the possibility that oxygen was supplied to the myocardium by immersion of the hearts in perfluorochemicals there by meeting the demand for oxygen of the myocardium in the state of ischemia and hypoxia with the aid of mild topical hypothermia.
心臓手術における心筋局所冷却法は有効な心筋保護法とされているが, 冷却による様々な問題が存在する.心膜腔に氷水を満たすことによる横隔神経障害, 冠動脈スパズムによる心筋保護液の不均等供給, 心筋細胞蛋白の変性などである.これらの冷却障害を回避するため心筋冷却を軽度とし, 増大する心筋酸素需要に対する酸素供給の目的で, 優れた酸素運搬能を持つPerfluorochemicals (PFC) のFC43に心臓を浸漬し, その有効性について検討した.ラット摘出灌流心でcardioplegiaによる急速心停止後, 心筋温30℃で60分間 (A群) および90分間 (B群) の冠灌流遮断中に心臓をFC 43に浸漬したA2群, B2群とFC 43に浸漬しなかった対照A1群, B1群の再灌流後の心機能 (心拍数, 左室最大収縮期圧, LV dp/dt) および冠灌流量の回復を検討した.その結果60分遮断実験ではA2群の回復率平均値がA1群より高値であったが有意差は認められなかった.遮断時間を90分にしてみるとB1群は再灌流後心拍動を再開できなかった心臓が10例中5例あった.これに対しFC43に浸漬したB2群は全例が心拍を再開し, 心機能は70%以上に回復し, B1群より有意 (p<0.001) に良好であった.心筋冷却軽度 (30℃) で虚血, 低酸素下の心筋の酸素需要に対し, Perfluorochemicalsに心臓を浸漬することで心筋に酸素を供給した可能性が示唆され, 心筋保護に有用と考えられた. Topical cooling of the heart is an effective method of protection for the myocardium during ischemia, but it has some disadvantages. The disadvantages include phrenic nerve injury, uneven supply of the cardioplegic solution due to coronary spasm and damage to the epicardium. In order to avoid these cooling-related disorders, mild topical cooling was applied and the heart was immersed in FC 43 emulsion of perfluorochemicals (PFC) which has an excellent oxygen transport activity, in attempt to supply oxygen to meet the increasing demand for oxygen of the myocardium. The hemodynamic recovery was studied in 4 groups of isolated rat hearts, during ischemia for 60 minutes (group A) and 90 minutes (group B) at 30°C after cardioplegic arrest, two groups (A1 and B1) were not immersed in FC 43; the other two groups (A2 and B2) were immersed in FC 43. As a result, there are no significant differences in the hemodynamic recovery between group A2 and group A1. The 5 hearts in group B1 were unable to resume the beat after reperfusion. In contrast, all hearts of group B2 resumed the beat; the cardiac function was restored by more than 70%, and the results were significantly better (p<0.001) than in group B1. These results suggest the possibility that oxygen was supplied to the myocardium by immersion of the hearts in perfluorochemicals there by meeting the demand for oxygen of the myocardium in the state of ischemia and hypoxia with the aid of mild topical hypothermia. |
| Author | NOMOTO, Seiro TAKABA, Toshihiro KADOKURA, Mitsutaka INOUE, Koichi HANAFUSA, Yuji ANDO, Susumu SEKIGUCHI, Shigeaki OZAWA, Atsusi YAMADA, Makoto HONDA, Osamu |
| Author_FL | 花房 雄治 関口 茂明 山田 眞 門倉 光隆 小沢 敦 井上 恒一 野元 成郎 本田 完 安藤 進 高場 利博 |
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| References | 8) 野元成郎, 井上恒一, 渡辺俊明, 他: 人工血液 (FDA-20%) と心筋保護. 人工臓器15 : 410-413, 1986. 6) 遠藤希彦, 長谷川隆光, 塩野元美, 他: Perfluorochemicalを用いた心筋保存の実験的研究. 臨床胸部外科10 Suppl. : 51-55, 1990. 3) Allen, B. S., Buckberg, G. D., Rosenkranz, E. R., et al.: Topical cardiac hypothermia in patients with coronary disease. J. Thorac. Cardiovasc. Surg. 104 : 626-631, 1992. 5) 横山和正, 山内紘一, 大柳治正: ペルフルオロケミカルを利用した酸素輸液. 材料技術 2: 632-638, 1984. 10) 井上恒一, 横川秀男, 山田眞, 他: フルオゾール浸漬法の心筋保護効果. 日心臓血管外科会誌21 : 239, 1992. 2) Esposito, R. A, and Spencer, F. C.: The effect of pericardial insulation on hypothermic phrenic nerve injury during open-heart surgery. Ann. Thorac. Surg. 43: 303-308, 1987. 1) Marco, J. D., Hahn, J. W, and Barner, H. B.: Topical cardiac hypothermia and phrenic nerve injury. Ann. Thorac. Surg. 23: 235-237, 1977. 4) 光野孝雄: 人工血液について. Med. Postgrad. 13: 373-388, 1975. 9) 野元成郎: ラット摘出心による酸素加心筋保護液の検討. 日胸外会誌34 : 1627-1635, 1986. 7) 野元成郎, 井上恒一, 堀内誠, 他: 心筋保護液としての人工血液 (FDA-20%, フルオゾール) の利用. 呼と循33 : 1355-1360, 1985. |
| References_xml | – reference: 4) 光野孝雄: 人工血液について. Med. Postgrad. 13: 373-388, 1975. – reference: 3) Allen, B. S., Buckberg, G. D., Rosenkranz, E. R., et al.: Topical cardiac hypothermia in patients with coronary disease. J. Thorac. Cardiovasc. Surg. 104 : 626-631, 1992. – reference: 6) 遠藤希彦, 長谷川隆光, 塩野元美, 他: Perfluorochemicalを用いた心筋保存の実験的研究. 臨床胸部外科10 Suppl. : 51-55, 1990. – reference: 2) Esposito, R. A, and Spencer, F. C.: The effect of pericardial insulation on hypothermic phrenic nerve injury during open-heart surgery. Ann. Thorac. Surg. 43: 303-308, 1987. – reference: 7) 野元成郎, 井上恒一, 堀内誠, 他: 心筋保護液としての人工血液 (FDA-20%, フルオゾール) の利用. 呼と循33 : 1355-1360, 1985. – reference: 1) Marco, J. D., Hahn, J. W, and Barner, H. B.: Topical cardiac hypothermia and phrenic nerve injury. Ann. Thorac. Surg. 23: 235-237, 1977. – reference: 9) 野元成郎: ラット摘出心による酸素加心筋保護液の検討. 日胸外会誌34 : 1627-1635, 1986. – reference: 5) 横山和正, 山内紘一, 大柳治正: ペルフルオロケミカルを利用した酸素輸液. 材料技術 2: 632-638, 1984. – reference: 10) 井上恒一, 横川秀男, 山田眞, 他: フルオゾール浸漬法の心筋保護効果. 日心臓血管外科会誌21 : 239, 1992. – reference: 8) 野元成郎, 井上恒一, 渡辺俊明, 他: 人工血液 (FDA-20%) と心筋保護. 人工臓器15 : 410-413, 1986. |
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| SubjectTerms | isolated rat heart myocardial protection Perfluorochemicals (FC 43) ラット摘出心 心筋保護 |
| Title | MYOCARDIAL PROTECTION OF PERFLUOROCHEMICALS (FC-43) IMMERSION DURING ISCHEMIA |
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