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储存的极限。移植物缺血再灌注损伤引起的心肌水肿对移植物移植后心功能的影响。透明质酸酶，增加间质液的扩散，减少水肿，被认为在心脏移植的管理有用。在第一部分中，我们评估了透明质酸酶对心肌淋巴动力学和缺血/再灌注损伤引起的心肌水肿的影响。第二部分研究透明质酸酶在原位心脏移植中的作用。实验1。狗的心脏在体外循环下接受90分钟的缺血，其中包括30分钟的正常体温和60分钟的低温伴心脏骤停。两种心脏麻痹的解决方案。4“*”C St. Thomas医院溶液加或不加3000单位/升透明质酸酶，在心脏骤停时每30分钟顺或逆行给予。通过插管从心脏淋巴结的传入管连续收集更多的心淋巴。使用透明质酸酶后，无论冠脉顺行或逆行灌注，心脏淋巴体积均显著增加。使用透明质酸酶后，血流动力学和心肌ATP含量保持不变，心肌含水量增加幅度最小。实验2。经腔静脉全检查后，犬心脏在常温下原位静置30分钟。采用St. Thomas医院的4“*”C溶液（含或不含3000单位/L的透明质酸酶）顺行冠状动脉冲洗，在4“*”C生理盐水中保存3小时前后进行原位移植。在透明质酸酶处理下，心功能和心肌ATP含量得以维持，心肌含水量增幅最小。通过透明质酸酶主动引流心脏淋巴，减轻心肌水肿的形成，从而保持心功能。我们得出结论，透明质酸酶的使用有利于心脏移植的保存。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