DOES SIMULTANEOUS ANTEGRADE RETROGRADE CARDIOPLEGIA IMPROVE MYOCARDIAL PERFUSION IN THE AREAS AT RISK - A MAGNETIC-RESONANCE PERFUSION IMAGING STUDY IN ISOLATED PIG HEARTS/

Citation
Gh. Tian et al., DOES SIMULTANEOUS ANTEGRADE RETROGRADE CARDIOPLEGIA IMPROVE MYOCARDIAL PERFUSION IN THE AREAS AT RISK - A MAGNETIC-RESONANCE PERFUSION IMAGING STUDY IN ISOLATED PIG HEARTS/, Journal of thoracic and cardiovascular surgery, 115(4), 1998, pp. 913-924
Citations number
25
Categorie Soggetti
Cardiac & Cardiovascular System",Surgery
ISSN journal
00225223
Volume
115
Issue
4
Year of publication
1998
Pages
913 - 924
Database
ISI
SICI code
0022-5223(1998)115:4<913:DSARCI>2.0.ZU;2-4
Abstract
Objective: This study was designed to determine whether simultaneous a ntegrade/retrograde cardioplegia improves myocardial perfusion in area s supplied by occluded vessels. Methods: Isolated pig hearts placed in a Langendorff preparation were divided into two groups. The left ante rior descending coronary artery was occluded at its origin. In group 1 (n = 7), simultaneous antegrade/retrograde cardioplegia was conducted with use of a single perfusion unit with tubing in a Y-shaped configu ration at the end, joined to the aorta and the coronary sinus. In grou p 2 (n = 8) simultaneous antegrade/retrograde cardioplegia was perform ed with two separate units, one for antegrade delivery of cardioplegic solution and the other for retrograde cardioplegic solution delivery. Myocardial perfusion in the region supplied by the left anterior desc ending artery and the region not supplied by this artery was assessed by magnetic resonance imaging, with use of a magnetic resonance contra st agent. The contrast agent was introduced into the common perfusion line in group 1 and into the aortic line only in group 2, Results: Mag netic resonance images showed that the myocardium in the region suppor ted by the left anterior descending artery could not be perfused with antegrade cardioplegic solution because of occlusion of the artery. Du ring simultaneous antegrade/retrograde cardioplegia, however, the myoc ardium in the left anterior descending region was perfused by approxim ately 40% to 50% (group 1) or 20% to 30% (group 2) of the degree of pe rfusion in the region not perfused by the left anterior descending art ery (100%), Almost no cardioplegic solution was delivered to the heart through the coronary sinus route during simultaneous antegrade/retrog rade cardioplegia in both groups of hearts, Myocardial perfusion in th e region supported by the left anterior descending artery was heteroge neous during simultaneous antegrade/retrograde cardioplegia. Conclusio ns: Simultaneous antegrade/retrograde cardioplegia significantly impro ved myocardial perfusion in jeopardized areas of the myocardium, The j eopardized myocardium was mainly perfused by the solution drained from the adjacent normal tissue. Elevated pressure at the coronary sinus d uring simultaneous antegrade/retrograde cardioplegia is responsible fo r the redistribution of antegradely delivered cardioplegic solution.