1998 Fiscal Year Final Research Report Summary
Heart preservation for transplantation -evalution of myocardial edema reduction-
| Project/Area Number |
08457351
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| Research Category |
Grant-in-Aid for Scientific Research (B)
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| Allocation Type | Single-year Grants |
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| Section | 一般 |
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| Research Field |
Thoracic surgery
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| Research Institution | Kagoshima University |
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Principal Investigator |
TAIRA Akira Faculty of Medicine, Kagoshima University, Professor, 医学部, 教授 (30041289)
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| Co-Investigator(Kenkyū-buntansha) |
MASUDA Hiroshi University Hospital, Kagoshima University, Research Associate, 医学部・附属病院, 助手 (10253866)
MORIYAMA Yukinori University Hospital, Kagoshima University, Assistant Professor, 医学部・附属病院, 講師 (80221638)
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| Project Period (FY) |
1996 – 1998
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| Keywords | Heart transplantation / Heart preservation / Myocardial ischemia / Hyaluronidase / Myocardial edema / Graft viability |
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| Research Abstract |
In heart transplantation, preservation for 4-5 hr remains the limit for safe hypothermic storage. Myocardial edema of the graft produced by ischemia/reperfusion injury affects on the posttransplant cardiac function. Hyaluronidase, which augments diffusion of the interstitial fluid and reduces the edema, is considered usefully in the management of cardiac graft. In the first part, we evaluate the effects of hyaluronidase on cardiac lymph dynamics and on myocardial edema due to ischemia/reperfusion injury. In the second part, we study the effect of hyaluronidase in orthotopic heart transplantation.
Experiment 1. The dog's heart received 90 minutes of ischemia under cardiopulmonary bypass consisted of 30 minutes of normothermia alone and 60 minutes of hypothermia with cardioplegic arrest. Two kinds of cardioplegic solution. 4"*"C St. Thomas' Hospital solution with or without 3000 units/L of hyaluronidase, were given antegradely or retrogradely every 30 minutes during cardioplegic arrest. C
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ardiac lymph was collected continuously from the afferent duct of the cardiac lymph node by cannulation. With the use of hyaluronidase regardless of antegrade or retrograde coronary perfusion, cardiac lymph volume was significantly increased. Hemodynamics and myocardial ATP contents were maintained and the myocardial water content revealed a minimum increase with hyaluronidase use.
Experiment 2. The dog's heart was left alone in situ in normothermia for 30 minutes after total exanguination via Vena Cava. Antegrade coronary washout was performed using 4"*"C St. Thomas' Hospital solution with or without 3000 units/L of hyaluronidase, before and after 3 hr preservation in 4"*"C saline followed by orthotopic transplantation. With hyaluronidase treatment, cardiac function and myocardial ATP contents were maintained, and the myocardial water content revealed a minimum increase.
Active drainage of cardiac lymph by hyaluronidase alleviate the myocardial edema formation, thereby preserving cardiac function. We conclude that hyaluronidase use is beneficial to the preservation of the heart graft for transplantation. Less
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