Regional ischemia distal to a critical coronary stenosis during prolonged fibrillation - improvement with pulsatile perfusion

Hartzell V Schaff, R. C. Ciardullo, J. T. Flaherty, R. K. Brawley, V. L. Gott

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

In a previous study from this laboratory, regional myocardial ischemia developed distal to a critical coronary stenosis in the fibrillating heart on cardiopulmonary bypass when myocardial perfusion was non-pulsatile. To assess the effect of pulsatile perfusion on the development of the fibrillation-induced ischemia, 10 dogs were placed on total cardiopulmonary bypass with the heart in the vented fibrillating state. A critical stenosis was applied to the left anterior decending artery (LAD). Pulsatile perfusion with a pulse pressure of 35 mm Hg and a pulse rate of 100/min was produced by a new method developed in this laboratory. During the 2 hours of bypass, ischemia in the LAD-supplied myocardium was assessed by changes in intramyocardial oxygen (PmO 2) and carbon dioxide (PmCO 2) tensions and by regional arterial-coronary venous lactate difference. With linear perfusion, regional ischemia in the LAD myocardium had been evidenced by a low PmO 2 (8± 3 mm Hg), a high PmCO 2 (170 ± 25 mm Hg) and regional lactate production (9.2 ± 4.2 mg/100 ml). In contrast with pulsatile perfusion intramyocardial gas tensions remained stable during the 2 hours on bypass (PmO 2 = 21 ± 3 mm Hg, PmCO 2 = 65 ± 5 mm Hg, P<0.05 vs linear flow study) and lactate consumption was demonstrated (+17.7 ± 2.9 mg/100 ml, P<0.001 vs linear flow group). With linear perfusion, myocardial blood flow to the LAD area had decreased 56 ± 8% in the subendocardial layer and 46 ± 7% in the subepicardial layer. In the dogs receiving pulsatile flow during bypass, regional LAD blood flow remained unchanged over the 2-hour bypass period and was significantly higher than the flow with linear flow (P<0.05). These data indicate that fibrillation-induced regional myocardial ischemia distal to a critical stenosis can be prevented by maintaining pulsatile perfusion during cardiopulmonary bypass.

Original languageEnglish (US)
Pages (from-to)25-32
Number of pages8
JournalCirculation
Volume56
Issue number3 suppl. 2
StatePublished - 1977
Externally publishedYes

Fingerprint

Pulsatile Flow
Coronary Stenosis
Ischemia
Arteries
Cardiopulmonary Bypass
Lactic Acid
Perfusion
Myocardial Ischemia
Myocardium
Pathologic Constriction
Dogs
Carbon Dioxide
Arterial Pressure
Heart Rate
Gases
Oxygen
Blood Pressure

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Schaff, H. V., Ciardullo, R. C., Flaherty, J. T., Brawley, R. K., & Gott, V. L. (1977). Regional ischemia distal to a critical coronary stenosis during prolonged fibrillation - improvement with pulsatile perfusion. Circulation, 56(3 suppl. 2), 25-32.

Regional ischemia distal to a critical coronary stenosis during prolonged fibrillation - improvement with pulsatile perfusion. / Schaff, Hartzell V; Ciardullo, R. C.; Flaherty, J. T.; Brawley, R. K.; Gott, V. L.

In: Circulation, Vol. 56, No. 3 suppl. 2, 1977, p. 25-32.

Research output: Contribution to journalArticle

Schaff, HV, Ciardullo, RC, Flaherty, JT, Brawley, RK & Gott, VL 1977, 'Regional ischemia distal to a critical coronary stenosis during prolonged fibrillation - improvement with pulsatile perfusion', Circulation, vol. 56, no. 3 suppl. 2, pp. 25-32.
Schaff, Hartzell V ; Ciardullo, R. C. ; Flaherty, J. T. ; Brawley, R. K. ; Gott, V. L. / Regional ischemia distal to a critical coronary stenosis during prolonged fibrillation - improvement with pulsatile perfusion. In: Circulation. 1977 ; Vol. 56, No. 3 suppl. 2. pp. 25-32.
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abstract = "In a previous study from this laboratory, regional myocardial ischemia developed distal to a critical coronary stenosis in the fibrillating heart on cardiopulmonary bypass when myocardial perfusion was non-pulsatile. To assess the effect of pulsatile perfusion on the development of the fibrillation-induced ischemia, 10 dogs were placed on total cardiopulmonary bypass with the heart in the vented fibrillating state. A critical stenosis was applied to the left anterior decending artery (LAD). Pulsatile perfusion with a pulse pressure of 35 mm Hg and a pulse rate of 100/min was produced by a new method developed in this laboratory. During the 2 hours of bypass, ischemia in the LAD-supplied myocardium was assessed by changes in intramyocardial oxygen (PmO 2) and carbon dioxide (PmCO 2) tensions and by regional arterial-coronary venous lactate difference. With linear perfusion, regional ischemia in the LAD myocardium had been evidenced by a low PmO 2 (8± 3 mm Hg), a high PmCO 2 (170 ± 25 mm Hg) and regional lactate production (9.2 ± 4.2 mg/100 ml). In contrast with pulsatile perfusion intramyocardial gas tensions remained stable during the 2 hours on bypass (PmO 2 = 21 ± 3 mm Hg, PmCO 2 = 65 ± 5 mm Hg, P<0.05 vs linear flow study) and lactate consumption was demonstrated (+17.7 ± 2.9 mg/100 ml, P<0.001 vs linear flow group). With linear perfusion, myocardial blood flow to the LAD area had decreased 56 ± 8{\%} in the subendocardial layer and 46 ± 7{\%} in the subepicardial layer. In the dogs receiving pulsatile flow during bypass, regional LAD blood flow remained unchanged over the 2-hour bypass period and was significantly higher than the flow with linear flow (P<0.05). These data indicate that fibrillation-induced regional myocardial ischemia distal to a critical stenosis can be prevented by maintaining pulsatile perfusion during cardiopulmonary bypass.",
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AU - Gott, V. L.

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AB - In a previous study from this laboratory, regional myocardial ischemia developed distal to a critical coronary stenosis in the fibrillating heart on cardiopulmonary bypass when myocardial perfusion was non-pulsatile. To assess the effect of pulsatile perfusion on the development of the fibrillation-induced ischemia, 10 dogs were placed on total cardiopulmonary bypass with the heart in the vented fibrillating state. A critical stenosis was applied to the left anterior decending artery (LAD). Pulsatile perfusion with a pulse pressure of 35 mm Hg and a pulse rate of 100/min was produced by a new method developed in this laboratory. During the 2 hours of bypass, ischemia in the LAD-supplied myocardium was assessed by changes in intramyocardial oxygen (PmO 2) and carbon dioxide (PmCO 2) tensions and by regional arterial-coronary venous lactate difference. With linear perfusion, regional ischemia in the LAD myocardium had been evidenced by a low PmO 2 (8± 3 mm Hg), a high PmCO 2 (170 ± 25 mm Hg) and regional lactate production (9.2 ± 4.2 mg/100 ml). In contrast with pulsatile perfusion intramyocardial gas tensions remained stable during the 2 hours on bypass (PmO 2 = 21 ± 3 mm Hg, PmCO 2 = 65 ± 5 mm Hg, P<0.05 vs linear flow study) and lactate consumption was demonstrated (+17.7 ± 2.9 mg/100 ml, P<0.001 vs linear flow group). With linear perfusion, myocardial blood flow to the LAD area had decreased 56 ± 8% in the subendocardial layer and 46 ± 7% in the subepicardial layer. In the dogs receiving pulsatile flow during bypass, regional LAD blood flow remained unchanged over the 2-hour bypass period and was significantly higher than the flow with linear flow (P<0.05). These data indicate that fibrillation-induced regional myocardial ischemia distal to a critical stenosis can be prevented by maintaining pulsatile perfusion during cardiopulmonary bypass.

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