| Autor: |
Danetz, J.S., Davies^b, R.D., Clemo, H.F., Baumgarten, C.M. |
| Zdroj: |
Journal of Thoracic and Cardiovascular Surgery; April 2000, Vol. 119 Issue: 4 p826-833, 8p |
| Abstrakt: |
Objectives: We hypothesized that the cell volume of ventricular myocytes isolated from hearts in volume-overload congestive failure would respond differently to hypothermic cardioplegia than would sham-operated cohorts. Methods: Adult rabbits underwent either valvotomy and aortic regurgitation-induced heart failure or sham surgery. Congestive failure was confirmed clinically and by means of echocardiography. Cell volumes of isolated myocytes were measured by digital video microscopy. After equilibration in 37^oC physiologic solution, cells were suprafused with 9^oC standard or low-Cl^- St Thomas' Hospital solution followed by reperfusion in 37^oC physiologic solution. Results: Exposure to cold St Thomas' Hospital solution for 20 minutes caused sham myocytes to swell by 8% (n = 9); cell volumes fully recovered on normothermic reperfusion. In contrast, congestive failure myocytes (n = 9) maintained their cell volume in cold St Thomas' Hospital solution and during reperfusion. Lowering the [K^+][Cl^-] product of St Thomas' Hospital solution by partially replacing Cl^- with an impermeant anion prevented cellular edema in the sham group (n = 8) but caused a 4% swelling in failure myocytes (n = 10) on reperfusion. Osmotically shrinking the failure cells (n = 9) converted their behavior to that of sham cells. Conclusions: In the absence of ischemia, congestive failure myocytes are less sensitive to cardioplegia-induced edema than sham cells. Low-Cl^- cardioplegia, which prevents edema and protects the normal heart, induced swelling and may be detrimental in myopathic hearts. Differences in volume regulation in failure and sham myocytes may be due to activation of volume-sensitive channels that are turned off by osmotic shrinkage. (J Thorac Cardiovasc Surg 2000;119:826-33) |
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