Regional ischemia during hemodilution in flow compromised myocardium: evidence for incomplete metabolic recovery. 1994

B J Leone, and D R Spahn
Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710.

The hypothesis that mild decreases in myocardial function may occur with preservation of normal levels of intramyocardial ATP was tested. A model of single vessel coronary stenosis using eight mongrel dogs in an open chest preparation was used. Myocardial oxygen supply was altered by performing acute normovolemic hemodilution with a colloid solution. The results demonstrated significant alterations in myocardial ATP content with hemodilution-induced mild regional dysfunction, which was not in line with the hypothesized effects of ischemia on myocardial function. In addition, restoring myocardial function by minimal reinfusion of shed blood in this study did not restore myocardial energy stores, an effect that may be called metabolic stunning. The results suggest that myocardial stunning may not be an important and ubiquitous process during intraoperative myocardial ischemia. Further, myocardial function appears to be capable of quickly recovering from mild ischemia although metabolic function may be slower. Finally, the concept of decrements in myocardial function occurring in order to preserve myocardial metabolic stores does not appear to occur universally, which may be significant in the prevention or treatment of mild perioperative ischemia.

UI MeSH Term Description Entries
D009206 Myocardium The muscle tissue of the HEART. It is composed of striated, involuntary muscle cells (MYOCYTES, CARDIAC) connected to form the contractile pump to generate blood flow. Muscle, Cardiac,Muscle, Heart,Cardiac Muscle,Myocardia,Cardiac Muscles,Heart Muscle,Heart Muscles,Muscles, Cardiac,Muscles, Heart
D004195 Disease Models, Animal Naturally-occurring or experimentally-induced animal diseases with pathological processes analogous to human diseases. Animal Disease Model,Animal Disease Models,Disease Model, Animal
D004285 Dogs The domestic dog, Canis familiaris, comprising about 400 breeds, of the carnivore family CANIDAE. They are worldwide in distribution and live in association with people. (Walker's Mammals of the World, 5th ed, p1065) Canis familiaris,Dog
D006321 Heart The hollow, muscular organ that maintains the circulation of the blood. Hearts
D006438 Hemodilution Reduction of blood viscosity usually by the addition of cell free solutions. Used clinically (1) in states of impaired microcirculation, (2) for replacement of intraoperative blood loss without homologous blood transfusion, and (3) in cardiopulmonary bypass and hypothermia. Hemodilutions
D006439 Hemodynamics The movement and the forces involved in the movement of the blood through the CARDIOVASCULAR SYSTEM. Hemodynamic
D000255 Adenosine Triphosphate An adenine nucleotide containing three phosphate groups esterified to the sugar moiety. In addition to its crucial roles in metabolism adenosine triphosphate is a neurotransmitter. ATP,Adenosine Triphosphate, Calcium Salt,Adenosine Triphosphate, Chromium Salt,Adenosine Triphosphate, Magnesium Salt,Adenosine Triphosphate, Manganese Salt,Adenylpyrophosphate,CaATP,CrATP,Manganese Adenosine Triphosphate,MgATP,MnATP,ATP-MgCl2,Adenosine Triphosphate, Chromium Ammonium Salt,Adenosine Triphosphate, Magnesium Chloride,Atriphos,Chromium Adenosine Triphosphate,Cr(H2O)4 ATP,Magnesium Adenosine Triphosphate,Striadyne,ATP MgCl2
D000818 Animals Unicellular or multicellular, heterotrophic organisms, that have sensation and the power of voluntary movement. Under the older five kingdom paradigm, Animalia was one of the kingdoms. Under the modern three domain model, Animalia represents one of the many groups in the domain EUKARYOTA. Animal,Metazoa,Animalia
D017202 Myocardial Ischemia A disorder of cardiac function caused by insufficient blood flow to the muscle tissue of the heart. The decreased blood flow may be due to narrowing of the coronary arteries (CORONARY ARTERY DISEASE), to obstruction by a thrombus (CORONARY THROMBOSIS), or less commonly, to diffuse narrowing of arterioles and other small vessels within the heart. Severe interruption of the blood supply to the myocardial tissue may result in necrosis of cardiac muscle (MYOCARDIAL INFARCTION). Heart Disease, Ischemic,Ischemia, Myocardial,Ischemic Heart Disease,Disease, Ischemic Heart,Diseases, Ischemic Heart,Heart Diseases, Ischemic,Ischemias, Myocardial,Ischemic Heart Diseases,Myocardial Ischemias
D017682 Myocardial Stunning Prolonged dysfunction of the myocardium after a brief episode of severe ischemia, with gradual return of contractile activity. Hibernation, Myocardial,Myocardial Hibernation,Stunned Myocardium,Myocardium, Stunned,Stunning, Myocardial

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