Functional and ultrastructural evaluation of myocardial protection provided by intermittent coronary sinus perfusion in the isolated dog heart

RESUMO

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. The prepations 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 mm Hg pressure; c) control,consisting of hearts (N=9) that were not perfused with cardioplegic solution. 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 ñ 5.5 mmHg; after reperfusion 35 ñ 12 mmHg; P,0.05) and didn't vary in the aortic group (from 69 ñ 4mmHg to 65 ñ 13 mmHg P>0.05) and coronary sinus group (from 69 ñ 4.6 mmHg to 60 ñ 10 mmHg; P>0.05). Myocardial relaxation was evaluated by the +/-dp/dt ratio. In the control group there was impairment of myocardial relation as indicated by an increase of this index after reperfusion (from 1.05 ñ 0.05 to 1.46 ñ 0.23; P<0.05), whereas in the aortic (from 1.10 ñ 0.13 to 1.15 ñ 0.20; P>0.05) and the coronary sinus (from 1.03 ñ 0.14 to 1.08 ñ 0.16; P>0.05) groups there was no variation. Ultrastructural changes in the myocardium were negligible in all three groups at the end of reperfusion. 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