Quantitative effects of myocardial edema on the left ventricular pressure- volume relation

Influence of cardioplegia osmolarity over two hours of ischemic arrest

Daphne T. Hsu, Z. C. Weng, A. C. Nicolosi, P. W. Detwiler, R. Sciacca, H. M. Spotnitz

Research output: Contribution to journalArticle

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Abstract

We previously studied edema and left ventricular pressure-volume relations in a porcine heart model in which edema occurred even with hyperosmolar crystalloid cardioplegia. This susceptibility to edema was attributed to venous occlusion and an initial 20-minute period of ischemia. Results did not demonstrate reversal of edema by hyperosmolar perfusates. Accordingly, in the present study, heart weight, myocardial water content, and left ventricular pressure-volume curves were measured before and after perfusion-induced edema in eight isolated, arrested, hypothermic porcine hearts. Cardioplegic solution was infused 2.1 ± 0.8 minutes after the onset of ischemia, and the atrioventricular ring was not clamped during the administration of cardioplegic solution. Cardioplegic solution (1 L) was infused at intervals of 33 ± 6 minutes at 4° C. Solution osmolarity was 380 (Stanford solution) or 294 mOsm/L (Plegisol solution). The perfusion sequence was 380-1, 380-2, 294-1, 380-3. Pressure-volume relations were assessed with the use of left ventricular volume at a pressure of 10 mm Hg and the ventricular chamber stiffness constant, β, derived from P = αe(βV). Perfusion 380-1 and 380-2 did not affect the pressure-volume curve. Perfusion 294-1 increased heart weight and water content (p < 0.05) and decreased left ventricular volume at 10 mm Hg compared with perfusions 380-1, 380-2, and 380-3. In addition, β increased (0.023 ± 0.005 versus 0.029 ± 0.006, p < 0.05) after perfusion 294-1, compared with 380-1. Correlation coefficients for linear regressions between left ventricular volume at 10 mm Hg and heart weight and water content were r = 0.84 and r = 0.70, respectively. We conclude that under conditions similar to those used clinically, the left ventricle of the pig does not develop edema with Stanford solution (380 mOsm/L). Edema does follow Plegisol solution (294 mOsm/L) cardioplegia. Edema and reduced compliance are incompletely reversed by hypertonic cardioplegia. The porcine left ventricle can usefully replicate the clinical model.

Original languageEnglish (US)
Pages (from-to)651-657
Number of pages7
JournalJournal of Thoracic and Cardiovascular Surgery
Volume106
Issue number4
StatePublished - 1993
Externally publishedYes

Fingerprint

Induced Heart Arrest
Ventricular Pressure
Osmolar Concentration
Edema
Perfusion
Cardioplegic Solutions
Swine
Pressure
Weights and Measures
Heart Ventricles
Water
Ischemia
Compliance
Linear Models

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Quantitative effects of myocardial edema on the left ventricular pressure- volume relation : Influence of cardioplegia osmolarity over two hours of ischemic arrest. / Hsu, Daphne T.; Weng, Z. C.; Nicolosi, A. C.; Detwiler, P. W.; Sciacca, R.; Spotnitz, H. M.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 106, No. 4, 1993, p. 651-657.

Research output: Contribution to journalArticle

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AU - Sciacca, R.

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