Stone heart syndrome after prolonged cardioplegia induced cardiac arrest in open-heart surgery – a pilot study on pigs

Krasniqi, Lytfi; Ipsen, Marie Hvid; Hejbøl, Eva Kildall; Rojek, Aleksandra; Kjeldsen, Bo Juel; Riber, Lars Peter

doi:10.1016/j.carpath.2022.107427

Cited by 3 publications

(3 citation statements)

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“…Исходя из результатов работы, перфузию сердца при искусственно вызванной ФЖ можно предложить использовать при длительных кардиохирургических операциях, что может повысить устойчивость сердца к ишемии и предотвратить реперфузионные осложнения, что благоприятно повлияет на течение операции и послеоперационное восстановление сердца. Для «поддержания» оперируемого сердца используют кардиоплегию, но при кардиоплегии сердце страдает от ишемии и реперфузии [22,23], причем защите миокарда от ишемии и реперфузии при кардиоплегии посвящен ряд работ [24,25].…”

Section: Discussionunclassified

Destabilization of the Organized Structure of Ventricular Fibrillation During Reperfusion

Gurianov,

Yablonsky

2023

Obŝaâ reanimatologiâ

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Aim: to study the effect of reperfusion on the organized frequency-amplitude structure of ventricular fibrillation (VF) in the dog heart.Materials and methods. We conducted 4 experiments on 8 dogs. In each experiment, the isolated heart of one dog was perfused with the blood of the second (supporting) dog. In 4 experiments on an isolated artificially perfused heart, 6 episodes of 3-minute ischemia and 10-minute reperfusion of the heart were performed in VF (1-2 episodes of ischemia-reperfusion in one experiment). Each episode of 3-minute ischemia in VF was preceded by a 10-minute perfusion of the heart in VF. Ventricular electrogram was recorded during VF episodes. A frequency-amplitude (spectral) analysis of one-second segments of the electrogram was performed, and the proportion (in %) of 0.5-15 Hz frequency oscillations in 10-second segments of the electrogram was determined in 6 episodes of perfusion, ischemia and reperfusion in VF (M±m, n=60). The VF frequency-amplitude structures during ischemia and reperfusion were compared with the stable VF frequency-amplitude structure during perfusion taken as the control. The nonparametric Welch criterion in the “The R Project for Statistical Computing” software environment was used to compare the VF parameters during perfusion, ischemia and reperfusion.Results. 9-10 Hz frequency oscillations dominated in the VF frequency-amplitude structure during heart perfusion, taken as the control. In the first 30 seconds of ischemia, the frequency and amplitude of the dominant oscillations did not significantly change vs VF control obtained during cardiac perfusion. A decrease of dominant oscillations frequency up to 6.5-7.5 Hz, and of the proportion of oscillations - up to 26% was documented at the 3rd minute of ischemia. At the 1st minute of reperfusion, the frequency of dominant oscillations increased to 13.5-14.5 Hz, but the proportion of oscillations remained reduced to 26%, as at the 3rd minute of ischemia. At the 2nd minute of reperfusion, the frequency of dominant oscillations decreased to 9.5-10.5 Hz, and the proportion of dominant oscillations increased to 33%. The frequency and amplitude of the dominant oscillations stabilized at 3-10 minutes of reperfusion: oscillations at 9-10 Hz frequency accounted for 32-33% of the spectral power.Conclusion. Reperfusion in VF is characterized by transient destabilization of VF organized structure at the 1st minute of the procedure. VF organized structure regains stabilization within 2-10 minutes of reperfusion. Cardiac perfusion in intentionally induced VF can be used instead of cardioplegia during major cardiac surgery to boost cardiac resistance to ischemia and prevent or reduce reperfusion complications.

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Section: Discussionunclassified

Destabilization of the Organized Structure of Ventricular Fibrillation During Reperfusion

Gurianov,

Yablonsky

2023

Obŝaâ reanimatologiâ

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“…У літературі багато робіт, присвячених впливу кардіоплегії на морфологічну характеристику міокарда. Причому ультраструктурні зміни вивчали здебільшого на експериментальних тваринах [2,3]. Але результати цих досліджень не можна повною мірою екстраполювати на пацієнтів кардіохірургічних клінік, тому що хворі, на відміну від тварин, поступають на операційний стіл вже із скомпрометованим міокардом.…”

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“…КМЦ у басейні неперфузованих капілярів насамперед страждали від гіпоксії, а самі капіляри до 180-ї хвилини перфузії зазнавали незворотних змін. Слід відзначити, що в експериментах на здорових свинях показано, що до 120-ї хвилини перфузії ультраструктура КМЦ і мікросудин зовсім не відрізнялася від вихідних показників і перші значні зміни з'явились лише на 180-й хвилині [3].…”

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The Reaction of Myocardial Capillaries to Crystalloid Cardioplegia of Different Durations in Patients with Valvular Pathology and Coronary Heart Disease

Zakharova

Krykunov

Semeniv

et al. 2022

ujcvs

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The aim. To study the morphological manifestations of the response of the myocardial capillaries to cardioplegia in patients with valvular defects and coronary heart disease. Materials and methods. Morphological research of operative and sectional material was carried out. Myocardium fragments for microscopical study were obtained from patients at different stages of an open-heart surgery and patients who died at the stage of conservative treatment without surgical intervention. Similar samples of the myocardium of a healthy young man who died from injuries incompatible with life were studied as a control. For electron microscopy study, samples of myocardium were taken from patients at the 185th minute of perfusion. Results. Histological preparations of the myocardium showed pronounced diffuse hypertrophy of cardiomyocytes (CMCs), sometimes at the stage of decompensation (perinuclear edema, loss of myofibrils, apoptosis). This transformation of CMCs was obviously related to their functional overload caused by combined defects of the mitral and aortic valves. Changes in muscle fibers were accompanied by interstitial and perinuclear fibrosis. In the pool of coronary arteries affected by atherosclerosis, signs of small focal coronary fibrosis were visible, as well as rough post-infarction scars in 3 patients. All the patients had signs of acute hypoxic damage to the myocardium in the form of CMCs shortening and interstitial edema. Conclusions. In patients with combined defects of the aortic and mitral valves of the heart with coronary artery disease, the phenomena of myocardial fibrosis prevail. Heart valve disease combined with coronary heart disease lead to the development of both alterative and compensatory-adaptiveprocesses in the vessels of the microcirculatory bed. The greatest loss of vital organelles in small vessels is observed at 185 min after administration of cardioplegic solution, irreversible changes develop 3 h after perfusion.

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Síndrome De Stone Heart: Relato De Caso

De Faria Neto,

Lordello

2023

Rev. Contemp.

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Objetivo: Relatar caso de uma paciente diagnosticada com stone heart e revisão bibliográfica sobre o tema. Materiais e métodos: Trata-se de relato de caso e revisão da literatura. Os dados necessários para relatar o caso foram consultados do prontuário médico da paciente. A revisão da literatura foi realizada com auxílio das bases de dados da Biblioteca Virtual em Saúde (BVS), LILACS, PubMed, SciELO e Scopus. Como se trata de um tema com literatura limitada, todos os artigos no qual foram evidenciados a temática contratura miocárdica isquêmica ou síndrome de Stone Heart foram incluídos neste estudo, independentemente do ano de publicação, sendo incluídos 23 artigos referentes ao período de 1972 a 2022. Este estudo seguiu as diretrizes das resoluções que tratam do desenvolvimento de pesquisas com seres humanos no Brasil, em especial a resolução 466/12 do Conselho Nacional de Saúde. Conclusão: O desenvolvimento do presente estudo, com objetivo de relatar caso de uma paciente diagnosticada com stone heart e revisão bibliográfica sobre o tema, contribuiu para evidenciar que, mesmo após o relato dessa síndrome na década de setenta, ainda há grande dificuldade dos cirurgiões cardíacos em lidar com esta condição de saúde. Para amenizar essa situação, tendo sido evidenciado na literatura que o alongamento intermitente do miocárdio durante a parada isquêmica pode prevenir uma diminuição na complacência diastólica sem diminuir a recuperação da função contrátil, bem como o uso de propranolol para reduzir os riscos desta síndrome, contudo, em todos os casos observados na literatura, todos os pacientes forma à óbitos.

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Stone heart syndrome after prolonged cardioplegia induced cardiac arrest in open-heart surgery – a pilot study on pigs

Cited by 3 publications

References 20 publications

Destabilization of the Organized Structure of Ventricular Fibrillation During Reperfusion

Destabilization of the Organized Structure of Ventricular Fibrillation During Reperfusion

The Reaction of Myocardial Capillaries to Crystalloid Cardioplegia of Different Durations in Patients with Valvular Pathology and Coronary Heart Disease

Síndrome De Stone Heart: Relato De Caso

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