Heart preservation for transplantation -evalution of myocardial edema reduction-

在心脏移植中，保存4-5小时仍然是安全低温保存的极限。缺血/再灌注损伤引起的移植物心肌水肿影响移植后的心功能。透明质酸酶可促进间质液体的扩散，减轻水肿，在心脏移植物的治疗中被认为是有用的。在第一部分中，我们评估了透明质酸酶对心脏淋巴动力学和缺血/再灌注损伤所致心肌水肿的影响。在第二部分中，我们研究了透明质酸酶在原位心脏移植中的作用。实验1.在体外循环下，狗的心脏接受90分钟的缺血，包括30分钟的常温和60分钟的低温停搏。两种停搏液。4“*”C-St.Thomas‘s医院液加或不加3000U/L透明质酸酶，停跳时每30min顺行或逆行给药一次。C…更多的心脏淋巴是通过插管从心脏淋巴结的传入管内持续收集的。使用透明质酸酶后，无论冠状动脉顺行或逆行灌注，心脏淋巴体积均显著增加。应用透明质酸酶后，血流动力学和心肌ATP含量维持不变，心肌含水量增加幅度最小。实验2.犬心脏经下腔静脉放血后，在常温下原位留置30分钟。采用含或不含3000U/L透明质酸酶的4“*”C-Thomas‘s医院液行冠状动脉顺行冲洗，分别于4“*”C生理盐水保存3h前、3h后行冠状动脉原位移植。透明质酸酶治疗后，心功能和心肌ATP含量维持不变，心肌含水量增加幅度最小，透明质酸酶主动引流心脏淋巴可减轻心肌水肿形成，从而保护心功能。结论：透明质酸酶的应用有利于移植心脏的保存。较少

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 … More 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