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KMID : 0364019940270050339
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Korean Journal of Thoracic and Cardiovascular Surgery
1994 Volume.27 No. 5 p.339 ~ p.344
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Sinus Node Dysfunction after Orthotopic Dog Heart Transplantation
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박국양
홍선근/정윤섭/백완기/이원용/유재현/김혁/서필원/한재진
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Abstract
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Sinus node dysfunction is common after orthotopic heart transplantation. Electrophysiologic studies have documented a high incidence(46% to 50%) of impaired sinus node automaticity and sinoatrial conduction in the early posttransplantation
period.
Sinus
node dysfunction persists in over 20% of patients and leads to prolonged bradyarrythmias, including sinus or nodal bradycardia and sinus arrest.
The purpose of this paper was to observe sinus node dysfunction after orthotopic heart transplantation. Ten cardiac recipient dogs were monitored continuously after orthotopic transplantations between unrelated adult mongrel dogs. Crystalloid
cardioplegic solution(Choongwoi Cardioplegia # 1 solution, 20ml/kg, K=30mEq/L) and topical cold(4℃) saline were used for heart preservation. The technique described by Lower and Shumway was used. The donor sinus node was preserved by careful
stapling
and division of the superior vena cave cephalad to the superior vena caval right atrial junction. The mean ischemic time of the donor heart was 106 minutes(range, 70 to 160 minutes). The standard right atrial anastomotic technique was used in all
cases.
Electrocardiographic changes were closely observed in all cases and recorded.
Conclusively, the incidence of posttransplantation bradyarrythmia was relatively high. Variuos arrythmia was observed in 7 cases(70%) in early posttransplantation period; sinus bradycardia in one case, episodes of sinus arrest in two cases and
junctional rhythm mixed with PVCs in four cases. Further investigation is required to determine the exact cause of the arrhythmias. (Korean J Thoracic Cardiovas Surg 1994; 27:339-44)
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