Microcirculatory dysfunction following perfusion with hyperkalemic, hypothermic, cardioplegic solutions and blood reperfusion

Effects of adenosine

Mark W. Keller, Lisa Geddes, William Spotnitz, Sanjiv Kaul, Brian R. Duling

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

Background. Cardioplegic solutions have been used to enhance myocardial preservation during cardiac surgery. The benefits derived from preventing myocardial ischemia with cardioplegic solutions may, however, be countered by tissue damage that occurs when the myocardium is reperfused with oxygenated blood. Furthermore, cardioplegia-induced endothelial dysfunction may contribute to depressed myocardial function postoperatively. The endothelium of coronary arteries and vein grafts is damaged by crystalloid cardioplegic solutions. There is less known about the effects of cardioplegic solutions on the microvasculature. Methods and Results. The hypothesis that microvascular damage occurs following perfusion with hyperkalemic, crystalloid, cardioplegic solutions and blood reperfusion, leading to decreased blood flow and increased neutrophil accumulation, was tested in a model system. Intravital microscopic observations were performed during a 20-minute perfusion of the hamster cremaster muscle with cardioplegic solutions (10°C) via the femoral artery with the iliac occluded and during a subsequent 2-hour blood reperfusion period (iliac open). Arteriolar vasoconstriction (27% decrease in diameter, p+) compared to control hamsters (no cardioplegic solution given). Neutrophils accumulated on venular endothelium in treated animals (250% increase, p-4 M) and albumin (2 g%) to the cardioplegic perfusate, accompanied by the administration of adenosine (10-4 M) during reperfusion, produced arteriolar vasodilation (34% diameter increase, p0.05 versus control). Capillary perfusion, however, was still significantly diminished (28% decrease, p

Original languageEnglish (US)
Pages (from-to)2485-2494
Number of pages10
JournalCirculation
Volume84
Issue number6
StatePublished - Dec 1991
Externally publishedYes

Fingerprint

Cardioplegic Solutions
Adenosine
Reperfusion
Perfusion
Cricetinae
Endothelium
Coronary Vessels
Neutrophils
Abdominal Muscles
Induced Heart Arrest
Femoral Artery
Microvessels
Vasoconstriction
Vasodilation
Thoracic Surgery
Myocardial Ischemia
Albumins
Myocardium
Transplants

Keywords

  • Arterioles
  • Capillaries
  • Cardioplegia
  • Endothelium
  • Leukocytes
  • Microbubbles
  • Reperfusion injury

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Microcirculatory dysfunction following perfusion with hyperkalemic, hypothermic, cardioplegic solutions and blood reperfusion : Effects of adenosine. / Keller, Mark W.; Geddes, Lisa; Spotnitz, William; Kaul, Sanjiv; Duling, Brian R.

In: Circulation, Vol. 84, No. 6, 12.1991, p. 2485-2494.

Research output: Contribution to journalArticle

Keller, Mark W. ; Geddes, Lisa ; Spotnitz, William ; Kaul, Sanjiv ; Duling, Brian R. / Microcirculatory dysfunction following perfusion with hyperkalemic, hypothermic, cardioplegic solutions and blood reperfusion : Effects of adenosine. In: Circulation. 1991 ; Vol. 84, No. 6. pp. 2485-2494.
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