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KMID : 0364020070400010008
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Korean Journal of Thoracic and Cardiovascular Surgery
2007 Volume.40 No. 1 p.8 ~ p.16
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Histidine-tryptophan-ketoglutarate Versus Blood Cardioplegic Solutions: A Prospective, Myocardial Ultrastructural Study
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Kim Si-Ho
Lee Young-Seok
Woo Jong-Soo
Sung Si-Chan
Choi Pill-Jo
Cho Kwang-Jo
Bang Jung-Hee
Roh Mee-Sook
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Abstract
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Background: We performed a prospective clinical study to evaluate the ultrastructural integrity of the myocardium after using Histidine-Tryptophan-Ketoglutarate (HTK) solution in comparison with blood cardioplegic solution during congenital heart surgery.
Materials & Methods: Twenty two patients with acyanotic heart disease, who were scheduled for elective open heart surgery, were randomized into two groups. The HTK Group (n=11) received HTK cardioplegic solution; the blood group (n=11) received conventional blood cardioplegic solution during surgery. The preoperative diagnoses included ventricular septal defect (n=9) and atrial septal defect (n=2) in each group. A small biopsy specimen was taken from the right ventricle’s myocardium, and this was processed for ultrastructural examination at the end of 30 minutes of reperfusion. Semiquantitative electron microscopy was carried out "blindly" in 4 areas per specimen and in 5 test fields per area by ’random systematic sampling’ and ’point and intersection counting’. The morphology of the mitochondrial membrane and cristae were then scored. The interstitial edema of the myocardium was also graded.
Results: The semiquantitative score of the mitochondrial morphology was 19.65?4.75 in the blood group and 25.25?5.85 in the HTK group (p=0.03). 6 patients (54.5%) in the blood group and 3 patients (27.3%) in the HTK group were grade 3 or more for the interstitial edema of the myocardium.
Conclusion: The ultrastructural integrity was preserved even better with HTK solution than with conventional blood cardioplegic solution. (Korean J Thorac Cardiovasc Surg 2007;40:8-16)
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KEYWORD
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Myocardium, Myocardial reperfusion, Microscopy, electron, Heart defects, congenital
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