• Journal of Chest Surgery
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• v.22 no.6
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• pp.927-935
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• 1989

Using an isolated Rat heart preparation of the Sprague Dawley strain, the YUMC cardioplegic solution k the St. Thomas Hospital Cardioplegic Solution were compared in the non waking K working heart perfusion systems by evaluating the hemodynamics, [bio] chemical, and light microscopic finding The heart rate k coronary flow of the two groups in the 20 minutes post ischemic recovery time were 288.6*6.5 vs 283.7*12 and 21.3*1.0 vs 19.0*1.7 respectively with no statistical significance existing. However the aortic systolic pressure, aortic overflow, cardiac output which were 81.7[4.2 vs 78.4*1.8, 18.3*1.1 vs 13.0*2.5 and 36.9*0.9 vs 32.0*3.2 respectively with P < 0.01 indicate that the comparison of these three parameters is statistically meaningful. The amount of CPK extracted in the 20 minutes post 120 minutes of ischemia was compared for the two cardioplegic solution, the results of which turned out to be similar, light microscopic findings were also found to be similar. It is thought that the YUMC cardioplegic solution provided better results than the St. Thomas hospital solution because of the differing composition of the two solution such as glucose, mannitol, albumin were put only in the former solution enhancing osmolarity of the cardioplegic solution providing better hemodynamic results.

• Journal of Chest Surgery
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• v.18 no.4
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• pp.732-739
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• 1985

This study was experimentally undertaken to evaluate the effect of the coronary vasodilator-mixed cardioplegic solution on myocardial protection during prolonged aortic cross-clamping. The dogs were divided into two groups: control group A[received hypothermic cardioplegic solution without any additive coronary vasodilator], and comparing group 8[received hypothermic cardioplegic solution, mixed with various coronary vasodilators and Inderal]. Group A further was divided into two subgroups: subgroup A-1[ischemic time, 90 minutes], and subgroup A-2 [ischemic time, 240 minutes]. Group B further was divided into five subgroups: subgroup B-1 [received papaverine mixed hypothermic cardioplegic solution], subgroup B-2[received nitroglycerin mixed hypothermic cardioplegic solution], subgroup B-3 [received nitroprusside mixed hypothermic cardioplegic solution, subgroup B-4[received hydralazine mixed hypothermic cardioplegic solution], and subgroup B-5 [received inderal mixed hypothermic cardioplegic solution]. The specimens from all of the subgroups were studied by electron microscopic examination. The specimens of subgroups [B-l, B-2 8-3, and B-4], received coronary vasodilators mixed hypothermic cardioplegic solutions, were also compared by methylene blue induced staining of the myocardium and coronary vessels. The results obtained were as followings: l. On electron microscopic examination, all of the specimens, including subgroup A-2, showed no irreversible change of the myocardium. But the best result was obtained from the subgroup B-l, treated by papaverine mixed hypothermic cardioplegic solution. The subgroup B-2, treated by nitroglycerin, was next. And the subgroup B-5, treated by Inderal, was agreeable, comparing the electron microscopic finding with control group in the effect of myocardial protection. 2. The distribution in the myocardium of cardioplegic solution was demonstrated with the aid of methylene blue staining in the subgroups of B-l, B-2, B-3, and B-4, and they were the groups treated by papaverine, nitroglycerin, nitroprusside, and hydralazine in their grouping order. The best result was obtained from the subgroup B-1 [papaverine]. The subgroup B-2 [nitroglycerin] was next. The subgroup B-3 [nitroprusside] was moderate in finding of the colorization. The subgroup B-4 [hydralazine] was the poorest in the distribution of the cardioplegic solution in the myocardium. From these results, it appeared that myocardial protection during ischemic arrest for open heart surgery could be enhanced considerably when coronary dilatation was assured.

• Journal of Chest Surgery
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• v.27 no.10
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• pp.815-823
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• 1994

This study was undertaken to hemodynamically determine the differences of myocardial protective effect between crystalloid and blood cardioplegic solution. Twenty nine children undergoing cardiac operations due to cyanotic congenital heart diseases were randomized into two groups receiving crystalloid or blood cardioplegia. Cardiac indices and other hemodynamic datum were examined postoperatively. Although there was no statistical differences between groups, postoperative stroke volume indices and left ventricular stroke work indices were slightly better with blood cardioplegia. We also found that postoperative left atrial pressures[p=0.0003], central venous pressures[p=0.004], and heart rates[p=0.014] were significantly lower with blood cardioplegia. The fact that relatively lower ventricular preloads [left atrial pressure and central venous pressure] were required to provide adequate cardiac output in blood cardioplegia group suggested superior myocardial protective effect of blood cardioplegic solution.

• Journal of Chest Surgery
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• v.18 no.4
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• pp.759-770
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• 1985

This study was experimentally undertaken to evaluate the effect of hypothermic oxygenated cardioplegic solution on myocardial protection during prolonged aortic cross clamping under cardiopulmonary bypass. Dogs were divided into two groups control group [received hypothermic unoxygenated cardioplegic solution] and experimental group [received hypothermic oxygenated cardioplegic solution]. Coronary sinus effluent was obtained at once and 30, 60, 90 minutes after cross-clamping for the determination of pH, PCO2,PO2 and lactate level during the infusion of cardioplegic solution and myocardial biopsies were obtained after cessation of 90 minutes of aortic cross-clamping. The results obtained were as follows: 1. There was no significant differences in the pH and PCO2 between the oxygenated and unoxygenated cardioplegic solution but the PO2 of the oxygenated solution was 4 times greater than unoxygenated solution, and also the oxygenated solution had a significantly greater oxygen content [2.020.05 ml 02/min] and had much more oxygen delivery than unoxygenated solution. 2. The myocardial oxygen consumption and the myocardial oxygen extraction in oxygenated group were 1.63 ml 02/100 ml and 67.32% respectively, which was greater than those in unoxygenated group. 3. Regarding to pH and PCO2 of coronary sinus effluent, there was no significant differences between two groups in early period of infusion of cardioplegic solution, but the pH shifted to acidosis from 60 minutes, PCO2 increased from 90 minutes of aortic cross-clamping, and PO2 markedly decreased from 90 minutes of aortic cross-clamping in unoxygenated group. 4. The lactate concentration of coronary sinus effluent revealed relatively normal in both groups, but showed slight increase up to 27.54.56 mg/100 ml at 90 minutes of aortic cross-clamping in unoxygenated group. 5. On electron microscopic study, the ultrastructural integrity of myocardial cells in oxygenated group was well preserved within 90 minutes. Slight swelling and deformity of mitochondria, interfibrillar widening, and disarrangement of myofibrils were observed at 90 minutes after aortic cross-clamping in unoxygenated group. From these results, the use of hypothermic oxygenated cardioplegic solution seemed to be effective and better method for the preservation of ischemic myocardium during the prolonged aortic cross-clamping.

• Journal of Chest Surgery
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• v.25 no.12
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• pp.1391-1398
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• 1992

The hypothesis tested is that shifts in pH, induced when a cardioplegic solution is oxygenated, can be detrimental. The object of this study is to evaluate the effect of the pH of the oxygenating cardioplegic solution on postischemic recovery in the isolated rat heart. Either 100% oxygen or 95% oxygen: 5% carbon dioxide was added to the cardioplegic solution[St. Thomas` Hospital No. 2] and determined postischemic recovery of isolated rat hearts after 2 hours and 3 hours of 20oC cardioplegic protected ischemia. Heart were arrested and reinfused every 30 minutes throughout the ischemic period with cardioplegic solution. When 100% oxygen was added, the pH of the cardioplegic solution increased from 7.8[no oxygen] to 8.5[100% oxygen] without any change in postischemic functional recovery. But when 95% oxygen ; 5% carbon dioxide was added, the pH of the cardioplegic solution reversely decreased to 6.84 in the 2-hour ischemic group and 6.73 in the 3-hour ischemic group, associated with improved postischemic functional recovery. After 2-hour ischemia, systolic pressure improved from 88.2$\pm$3.7%[no oxygen] and 88.7$\pm$3.8%[100% oxygen] to 96.6$\pm$1.8%[95% oxygen : 5% carbon dioxide], p<0.05, aortic flow from 43.3$\pm$3.1% and 38.4$\pm$10.6% to 74.5$\pm$5.0%, p<0.001, cardiac output from 55.5$\pm$4.6% and 47.4%$\pm$10.6% to 73.1$\pm$4.6%, p<0.05, stroke volume from 62.7$\pm$4.6% and 52.0$\pm$10.1% to 77.2$\pm$4.6%, p<0.05, and dP/dT from 59.3$\pm$7.2% and 56.7$\pm$7.6% to 78.9$\pm$4.6%, p<0.05. The infused amount of the cardioplegic solution during 2-hour ischemic period was similar in three groups. After 3-hour ischemia, cardiac output improved from 17.0$\pm$3.8%[no oxygen] to 45.9$\pm$7.5%[95% oxygen: 5% carbon dioxide], p<0.05, and stroke volume from 21.0$\pm$3.9%[no oxygen] to 50.1$\pm$6.6%[95% oxygen: 5% carbon dioxide], p<0.01. In conclusion, the St. Thomas` Hospital No. 2 cardioplegic solution should be oxygenated but with 95% oxygen: 5% carbon dioxide and not 100% oxygen because of the additive effect of a relatively "Acidotic" pH.t; pH.

• Journal of Chest Surgery
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• v.15 no.1
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• pp.35-39
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• 1982

Cold blood potassium cardioplegia, by two types of the infusion systems, was used in 45 patients who were undergone the open cardiac operation. Method A [in 25 patients] was the syringe infusion system and method B [in 20 patients] was the pump infusion system. Cold blood potassium cardioplegic solution was used less amount on method B than method A. Serum potassium was often increased significantly on method A as a result of excessive infusion of cold blood potassium cardioplegic solution. But method B, excessive infusion of cold blood potassium cardioplegic solution was prevented by reperfusion of the previous infused cold blood potassium cardioplegic solution through the recirculation system. Alteration of infused rate and concentration of potassium in cold blood potassium cardioplegic solution during infusion [which might be suggested on the method A] could be controlled on method B.

• Journal of Chest Surgery
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• v.17 no.4
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• pp.565-573
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• 1984

The increasing use of cardioplegic solution for the reduction of ischemic tissue injury requires that all cardioplegic solution be carefully assessed for any protective or damaging properties. This study describes functional assessment of the efficiency of steroid in cardioplegic solution by using a Langendorffs perfusion model. Isolated rat heart were subject to a 2 minute period of coronary infusion with the steroid mixed cold cardioplegic solution immediately before and also at the midpoint of a 60 minutes period of hypothermic [10\ulcorner\ulcorner] ischemic arrest. The result of this study were as follows: 1.Spontaneous heart beat after ischemic arrest occurred 14 second later Langendorffs reperfusion in the steroid mixed Young & GIK group and 16 second later in the control group. [Young & GIK without steroid] A good recovery state of spontaneous heart beat was shown in both groups. 2.The percentage of recoveries of heart rate during the 30 minute after postischemic Langendorffs reperfusion was; at first 5 minute 106.3\ulcorner.7% [P<0.05] in the steroid mixed Young & GIK group. This percentage of recovery of steroid mixed Young & GIK group was significantly greater than the control group during the first 5 minute course. 3.The percentage of recovery of coronary flow during the 30 minute after postischemic Langendorffs reperfusion was; at first 5 minute 101\ulcorner.2% in the steroid mixed Young & GI K group. This percentage of recovery of the steroid mixed Young & GIK group was not significantly than the control group during the first 5 minute.

• Journal of Chest Surgery
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• v.25 no.2
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• pp.125-130
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• 1992

To evaluate the effect of oxygenation[95% O2+5% CO2] of St. Thomas Hospital No.2 cardioplegic solution[Plegisol], 20 isolated perfused rat hearts were studied under hyp-othermic[20oC] ischemic arrest for 2 hours with infusion of cardioplegic solution every 30 minutes throughout the ischemic period. Ten isolated hearts were studied with the oxygenated cardioplegic solution and 10 another isolated hearts with the nonoxygenated one. Mean oxygen tensions of the nonoxygenated and oxygenated cardioplegic solutions were 150mmHg and 470mmHg, respectively. Two in 10 hearts infused with the nonaxygenated cardioplegic solution were not recovered from nonworking heart due to persistent ventricular fibrillation. In comparing hem-odynamic parameters between both groups, the mean postischemic recovery[expressed as a percentage of its preischemic control value] was significantly greater with the oxygenated solution[in 10 recovered hearts] than the nonoxygenated solution[in 8 recovered hearts] [95.9$\pm$1.8% compared with 88.5$\pm$2.9% in peak aortic pressure, p<0.05, 75.7$\pm$5.2% compared with 43.5$\pm$6.5% in aortic flow, p<0.01, 75.5$\pm$4.6% compared with 54.1$\pm$5.6% in cardiac output, p<0.01, 78.3$\pm$4.6% compared with 60.3$\pm$4.6% compared with 60.3$\pm$6.2% in stroke volume, p<0.05, and 80.4$\pm$5.3% compared with 58.6$\pm$7.0% in dP/dT, p<0.05]. It is concluded that oxygenation of St. Thomas Hospital No.2 cardioplegic solution improves cardiac electrical stability and postischemic hemodynamic recovery after ischemic arrest in the isolated perfused rat heart.

• Journal of Chest Surgery
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• v.24 no.11
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• pp.1058-1067
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• 1991

High potassium cardioplegia is a widely accepted procedure to enhance myocardial protection from ischemic injuries associated with open heart surgery. Maintaining optimum osmolarity of the cardioplegic solution is one of the required conditions for an ideal cardioplegic solution Albumin is an frequently added component for maintaining optimum osmolarity of clinically used cardioplegic solutions. But the source of albumin is human blood so that the supply is limited and the cost of manufacturing is relatively high. Recently there are moves to minimized the use of blood product for fear of blood-associated infections or immunological disorders. In this experiment, we substituted mannitol or glucose for albumin added to the cardioplegic solution which has been used at the Wonju Medical College, To determine whether addition of mannitol or glucose instead of albumin in the cardioplegic solution can produce satisfactory myocardial protection during ischemia, three different groups of isolated rat heart perfused by modified Langendorff technique were studied. Wonju Cardioplegic Solution was selected as a standard high potassium[18mEq/L of K+] cardioplegic solution. Three kinds of cardioplegic solution were made by modifying the composition maintaining the same osmolarity[339$\pm$1mOsm/Kg] Isolated rat heart were perfused initially with retrograde nonworking mode and then changed to working mode. After measuring the heart rate, systolic aortic pressure, aortic flow, coronary flow, ischemic arrest by aorta cross clamp and cardioplegia was made maintaining the temperature of water jacket at 10oC. The heart was rewarmed and reperfused after 60min of ischemic arrest with intermittent cardioplegia at the 30min interval. The time to return of heart beat and the time required to get. Regular heart beat were observed after reperfusion. The recovery rate of the functional variables-heart rate, systolic aortic pressure, aortic flow, coronary flow and cardiac output were calculated and compared among the three groups of different cardioplegia-albumin, mannitol, and glucose. The wet weight and dry weight was measured and the water content of the heart as figured out for comparison. The time to return of heart beat was fastest in the albumin group, The functional recovery rates were best in the albumin group also. In the above conditions, albumin was the best additive to the cardioplegic solution compared to the mannitol or glucose.

• The Korean Journal of Physiology
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• v.22 no.1
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• pp.1-12
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• 1988

The changes in membrane potential and intracellular $Ca^{2+}$ activities along with adenosine triphosphate (ATP) and creatine phosphate (CP) contents of guinea pig hearts were studied during the cardioplegia and recovery phase. The results obtained were summarized as follows: 1) A low concentration of $Ca^{2+}$ in the cardioplegic solution caused significant changes in membrane potential during the cardioplegia and action potential configurations of the first beat after cardioplegia. 2) Intracellular $Ca^{2+}$ activities were decreased significantly during cardioplegia and increased when the cardiac tissue was reperfused with the normal Tyrode solution. The magnitude of increase in intracellular $Ca^{2+}$ activities was larger in the 0.1 mM $Ca^{2+}-cardioplegic$ solution than the 1.8 mM $Ca^{2+}-solution$. 3) ATP and CP contents of cardiac ventricular tissue were decreased during the cardioplegia, regardless of $Ca^{2+}$ concentration in the cardioplegic solutions, and CP contents were recovered with the reperfusion of normal Tyrode solution faster than those of ATP. And, there were no significant differences in the recovery of CP contents with different concentrations of $Ca^{2+}$ in the cardioplegic solutions tested, while the recovery of ATP contents was faster with $15mM\;K^{+},\;0.1mM\;Ca^{2+}$ cardioplegic solution. These results suggest that the $Ca^{2+}$ concentration in the cardioplegic solution is one of major factors influencing the recovery of cardiac tissue from the cardioplegia.