Abstract
The influence of graded perfusion pressure (30, 60, and 90 mmHg) at cardiopulmonary bypass were studied on beating empty hearts (BEH) or spontaneously fibrillating hearts (SFH) in the normothermic state. The adequacy and distribution of coronary flow and the myocardial oxygen consumption (MVO2) were examined using the tracer microsphere technique in twelve mongrel dogs. In the SFH, the left ventricular (LV) endocardium (ENDO)/epicardium (EPI) flow ratio indicated significant decrease at 30 and 60 mmHg (0.83±0.05 and 0.86±0.06, p<0.005, respectively), but was recovered to control value at 90 mmHg (1.01±0.13). In the BEH, these low perfusion pressures did not result in an abnormal flow distribution in the LV (1.03±0.03 at 30 mmHg). The flow distribution to the right ventricle (RV) relatively increased in both the BEH and the SFH (p<0.001). The ENDO/EPI ratio of the RV did not decrease at 30 mmHg in both groups (1.11±0.03 in BEH and 1.16±0.08 in SFH). Coronary blood flow and MVO2 were significantly higher in the SFH than in the BEH. Coronary blood flow increased significantly with increase in the perfusion pressure, in both groups. The MVO2 was constant in the BEH, regardless of the perfusion pressure, but increased in the SFH at increasing pressure. These results show that in the SFH, subendocardial underperfusion of the LV is induced at the perfusion pressure of 30 and 60 mmHg.
Similar content being viewed by others
References
Salerno TA, Chiong MA. Should ventricular fibrillation be induced prior to the infusion of cardiopregic solution? Ann Thorac Surg 1983; 35: 367–371.
Buckberg GD, Hottenrott CE. Ventricular fibrillation. Its effect on myocardial flow, distribution, and performance. Ann Thorac Surg 1975; 20: 76–85.
Hottenrott CE, Towers B, Kurkji HJ, Maloney JV, Buckberg G. The hazard of ventricular fibrillation in hypertrophied ventricles during cardiopulmonary bypass. J Thorac Cardiovasc Surg 1973; 66: 742–753.
Hottenrott C, Maloney JV Jr, Buckberg G. Studies of the effects of ventricular fibrillation on the adequacy of regional myocardial flow. I. Electrical vs. spontaneous fibrillation. J Thorac Cardiovasc Surg 1974; 68: 615–625.
Hottenrott C, Buckberg G. Studies of the effects of ventricular fibrillation on the adequacy of regional myocardial flow. II. Effects of ventricular distension. J Thorac Cardiovasc Surg 1974; 68: 626–633.
Brazier JR, Cooper N, McConnell DH, Buckberg GD. Studies of the effects of hypothermia on regional myocardiol blood flow and metabolism during cardiopulmonary bypass. III. Effects of temperature, time, and perfusion pressure in fibrillating hearts. J Thorac Cardiovasc Surg 1977; 73: 102–109.
McConnell DH, Brazier JR, Cooper N, Buckberg GD. Studies of the effects of hypothermia on regional myocardial blood flow and metabolism during cardiopulmonary bypass. II. Ischemia during moderate hypothermia in continually perfused beating hearts. J Thorac Cardiovasc Surg 1977; 73: 95–101.
Baird RJ, Dutka F, okumori M, de la Rocha A, Goldbach MM, Hill TJ, MacGregor DC. Surgical aspects of regional myocardial blood flow and myocardial pressure. J Thorac Cardiovasc Surg 1975; 69: 17–29.
Reuben CF, Singh HM, Tector AJ, Kampine JP, Flemma RJ, Lepley D Jr. The dynamics of subendocardial flow during cardiopulmonary bypass. J Thorac Cardiovasc Surg 1975; 70: 989–994.
Ciardullo RC, Schaff HV, Flaherty JT, Donahoo JS, Gott VL. Comparison of regional myocardial blood flow and metabolism distal to a critical coronary stenosis in the fibrillating heart during alternate periods of pulsatile and nonpulsatile perfusion. J Thorac Cardiovasc Surg 1978; 75: 193–205.
Cox JL, Anderson RW, Pass HI, Currie WD, Roe CR, Mikat E, Wechsler AS, Sabiston DC Jr. The safety of induced ventricular fibrillation during cardiopulmonary bypass in nonhypertrophied hearts. J Thorac Cardiovasc Surg 1977; 74: 423–432.
Grover FL, Fewel JG, Ghidoni JJ, Norton JB, Arom KV, Trinkle JK. Effects of ventricular fibrillation on coronary blood flow and myocardial metabolism. J Thorac Cardiovasc Surg 1977; 73: 616–624.
Kawachi Y, Tominaga R, Yoshitoshi M, Sese A, Tokunaga K, Nakamura M. Influence of perfusion pressure on oxygen supply and demand in beating empty hypertrophied dog hearts. J Surg Res 1982; 33: 103–111.
Spadaro J, Bing OHL, Gaasch WH, Laraia P, Franklin A, Weintraub RM. Effects of perfusion pressure on myocardial performance, metabolism, wall thickness, and compliance. Comparison of the beating and fibrillating heart. J Thorac Cardiovasc Surg 1982; 84: 398–405.
Nakamura M, Nakagaki O, Nose Y, Fukuyama T, Kikuchi Y. Effects of nitroglycerine and dipyridamole on regional myocardial blood flow. Basic Res Cardiol 1978; 73: 482–496.
Buckberg GD, Luck JC, Payne DB, Hoffman JIE, Archie JP, Fixler DE. Some sources of error in measuring regional blood flow with radioactive microspheres. J Appl Physiol 1971; 31: 598–604.
Lipscomb K, Gould KL. Mechanism of the effect of coronary artery stenosis on coronary flow in the dog. Am Heart J 1975; 89: 60–67.
Kleinman LH, Wechsler AS. Pressure-flow characteristics of the coronary collateral circulation during cardiopulmonary bypass. Effects of ventricular fibrillation. Circulation 1978; 58: 233–239.
Wilson HE, Dalton ML, Kiphart RJ, Allison WM. Increased safety of aorto-coronary artery bypass surgery with induced ventricular fibrillation to avoid anoxia. J Thorac Cardiovasc Surg 1972; 64: 193–202.
Buckberg GD, Towers B, Paglia DE, Mulder DG, Maloney JV. Subendocardial ischemia after cardiopulmonary bypass. J Thorac Cardiovasc Surg 1972; 64: 669–684.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Kawachi, Y., Tominaga, R., Yoshitoshi, M. et al. Relationship between perfusion pressure and myocardial microcirculation in the beating empty or spontaneously fibrillating heart. The Japanese Journal of Surgery 15, 379–386 (1985). https://doi.org/10.1007/BF02469934
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF02469934