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Ann Thorac Surg 1993;56:410-417
© 1993 The Society of Thoracic Surgeons

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Articles

Gross and microvascular distribution of retrograde cardioplegia in explanted human hearts

Division of Cardiothoracic Surgery, Department of Surgery and Department of Pathology, University of California, Los Angeles, Medical Center, Los Angeles, California USA

^_* Address reprint requests to Dr Laks, Division of Cardiothoracic Surgery, UCLA Medical Center, CHS 62-182, 10833 LeConte Ave Los Angeles CA 90024.
The Thoracic Surgery Directors Association (TSDA) Resident Research Award, sponsored by Medtronic, Inc, was established in 1990 to encourage resident research in cardiothoracic surgery. Abstracts submitted to The Society of Thoracic Surgeons (STS) Program Committee representing research performed by residents were forwarded to the TSDA to be considered for this award. The abstracts were reviewed by the TSDA Executive Committee consisting of: Martin F. McKneally, President; Cardon F. Murray, President-Elect; Mark B. Orringer, Secretary/Treasurer; Stanton P. Nolan, Executive Committeeman; Sidney Levitsky, Executive Committeeman; and Andrew S. Wechsler, Chairman, Curriculum Committee. The third TSDA Resident Research Award was given to Dr Richard N. Gates, resident in training at UCLA Medical Center, Los Angeles, California, who received a sum of $2,500 and had his expenses paid to the STS meeting. The TSDA, with support by Medtronic, Inc, will make this award annually, using the above selection procedure. The resident author of the selected study will be recognized at the STS meeting.

In this report, explanled hearts from transplant recipients with the diagnosis of idiopathic cardiomyopathy underwent a blood cardioplegia arrest and extended subatrial resection to preserve their coronary sinus venous system. The coronary sinus and left and right coronary arteries were then cannulated and warm blood cardioplegia retrograde infused at a pressure of 30 to 40 mm Hg. Effluent from the coronary arteries and thebesian veins was then collected. Hearts were subsequently fixed with retrograde glutaraldehyde perfusion and perfused retrograde with NTB-2 (an inert intracapillary marker). Histologic sections were examined from 12 separate sites. There was no significant difference in the percentage of capillaries perfused by retrogradedelivered cardioplegia between corresponding regions of the left and right ventricles. However, effluent analysis indicated that 67.2% ± 6.4% of retrograde-delivered blood cardioplegia was shunted through thebesian veins, thereby bypassing the microvasculature, whereas 29.3% ± 6.3% and 3.5% ± 3.1% traversed the myocardium supplied by the left and right coronary arteries, respectively. The results indicate that all regions of both ventricles are perfused by retrograde blood cardioplegia. However, they also suggest that nutrient flow to the microvasculature of the right ventricle is minimal during retrograde cardioplegia.

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