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The Annals of Thoracic Surgery, Vol 58, 191-199, Copyright © 1994 by The Society of Thoracic Surgeons
K Nakanishi, ZQ Zhao, J Vinten-Johansen, JC Lewis, DS McGee and JW Hammon Jr
This study tests the hypothesis that blood cardioplegia (BCP) attenuates
endothelial dysfunction related to nitric oxide after global normothermic
ischemia, cardioplegic arrest, and reperfusion in anesthetized open-chest
dogs placed on cardiopulmonary bypass. The dogs were divided into five
groups to identify the time when endothelial injury occurred: group 1 =
control without ischemia; group 2 = 45 minutes of normothermic ischemia
only; group 3 = 45 minutes of normothermic ischemia plus unmodified
reperfusion; group 4 = 45 minutes of ischemia plus intermittent BCP without
reperfusion; and group 5 = ischemia plus BCP and reperfusion. In vitro
coronary vascular relaxation responses to the nitric oxide stimulator
acetylcholine (endothelium-dependent, receptor-dependent), the calcium
ionophore A23187 (endothelium-dependent, receptor-independent), and
acidified NaNO2 (endothelium-independent) were measured at the end of the
protocol. Maximum in vitro coronary vascular responses to acetylcholine
were similar among groups 1, 2, and 4, indicating an absence of endothelial
injury. In contrast, significantly impaired relaxations to acetylcholine
were demonstrated in the two reperfused groups (groups 3 and 5). Relaxation
responses to A23187 and NaNO2 were not altered markedly in any group.
Electron microscopy showed intact endothelium in groups 1, 2, and 4.
However, moderately severe endothelium damage was seen in groups 3 and 5.
We conclude that morphologic and functional endothelial damage occurs after
blood reperfusion with or without BCP, and 1-hour hypothermic BCP arrest
after normothermic ischemia is not associated with extension of endothelial
damage.
ARTICLES
Coronary artery endothelial dysfunction after global ischemia, blood cardioplegia, and reperfusion
Department of Cardiothoracic Surgery, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina 27157-1096.
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