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KMID : 0364019910240111058
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Korean Journal of Thoracic and Cardiovascular Surgery
1991 Volume.24 No. 11 p.1058 ~ p.1067
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The Effect of Additives in the Cardioplegic Solution on the Recovery of Myocardium, Comparison among Albumin, Mannitol, and Glucose
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Abstract
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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 disordrs.
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 pro-duce satisfactory myocardiL. 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(339lmOsm/Kg). Isolated rat heart were perfused initially with retrograde nonworking mode and then changed to working mode. After measuring the heart rate, sytolic aortic pressure, aortic flow, coronary flow, ischemic arrest by aorta cross clamp and cardioplegia was made maintaing the temperature of water jaket at 101C. 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 funtional 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 mesured 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.
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