Functional and ultrastructural evaluation of myocardial protection provided by intermittent coronary sinus perfusion in the isolated dog heart.
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1. The protection offered by intermittent perfusion of cardioplegic solution through the coronary sinus was investigated in isovolumic blood-perfused dog heart preparations submitted to 60 min of ischemia and 45 min of reperfusion. 2. The preparations were divided into three treatment groups: a) coronary sinus, consisting of preparations (N = 10) perfused through the coronary sinus under 40 cm water pressure; b) aortic, consisting of preparations (N = 10) perfused through the aortic stump under 100 mmHg pressure; c) control, consisting of hearts (N = 9) that were not perfused with cardioplegic solution. 3. Properties of contractile capacity and relaxation were markedly impaired in the control group but were preserved to a comparable extent in the groups perfused with cardioplegic solution through the aorta and coronary sinus. Developed pressure decreased in the control group (before ischemia: 70 +/- 5.5 mmHg; after reperfusion: 35 +/- 12 mmHg; P less than 0.05) and didn't vary in the aortic group (from 69 +/- 4 mmHg to 65 +/- 13 mmHg; P greater than 0.05) and coronary sinus group (from 69 +/- 4.6 mmHg to 60 +/- 10 mmHg; P greater than 0.05). Myocardial relaxation was evaluated by the +/- dp/dt ratio. In the control group there was impairment of myocardial relaxation as indicated by an increase of this index after reperfusion (from 1.05 +/- 0.05 to 1.46 +/- 0.23; P less than 0.05), whereas in the aortic (from 1.10 +/- 0.13 to 1.15 +/- 0.20; P greater than 0.05) and the coronary sinus (from 1.03 +/- 0.14 to 1.08 +/- 0.16; P greater than 0.05) groups there was no variation. Ultrastructural changes in the myocardium were negligible in all three groups at the end of reperfusion. 4. We conclude that intermittent perfusion of a hypothermic cardioplegic solution through the coronary sinus is effective for the protection of the myocardium during total ischemia.
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