J.Jpn. Surg. Soc.. 91(9): 1424-1426, 1990

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Report on the annual meeting

INTRAOPERATIVE MYOCARDIAL PROTECTION OF HYPERTROPHIED HEART WITH AORTIC VALVULAR DISEASE －CLINICAL USE OF TERMINAL BLOOD CARDIOPLEGIA AND PGE1－

We performed aortic valve replacement (AVR) in 47 cases from May, 1984 to July, 1989, and used cold blood cardioplegia followed by terminal blood cardioplegia and PGE1 as myocardial protection. The clinical results were evaluated from hemodynamics, enzymatic measurement of CK-MB, measurement of βTG on activated platelet, hospital mortality and late follow-up life activity. Severe low cardiac output syndrome did not occur in 47 cases although prophylactic postoperative IABP was used in 2 cases among them. Uncontrollable arrythmia did not appear in all cases. The released amount of CK-MB immediately after reperfusion was slightly elevated in cases with prolonged aortic clamp time, and did not suggest reperfusion injury. Postoperative β thromboglobulin (βTG) was activated correlatively with aortic clamp-time. Postoperative βTG and CK-MB values were lower in PGE1 treated patients than non-treated patients. There was no hospital death, and NYHA functional class in late follow-up was improved to NYHA I or II in 46 cases except one late death. Cardiac function on echogram in follow-up was improved in the all 7 cases with preoperative impaired left ventricular function below 25% of fractional shortening. It was concluded that terminal blood cardioplegia with combined use of PGE1 suppressed reperfusion injury, and preserved hypertrophied heart after ischemia.

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