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心功能。透明质酸酶可促进间质液的扩散，减少水肿，被认为是心脏移植物管理的有效方法。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。犬心脏在体外循环下接受90分钟的缺血，包括30分钟的单纯常温和60分钟的低温和心脏停搏。两种心脏停搏液。在心脏停搏过程中，每30分钟顺行或逆行给予4”*“C St.托马斯医院溶液（含或不含3000单位/L透明质酸酶）。C 关于我们 通过插管从心脏淋巴结的输入管连续收集心脏淋巴。使用透明质酸酶，无论是顺行还是逆行冠状动脉灌注，心脏淋巴液量显着增加。血流动力学和心肌ATP含量得到维持，心肌含水量随着透明质酸酶的使用显示出最小的增加。在通过腔静脉完全放血后，将狗的心脏在常温下原位单独放置30分钟。在4”*“C生理盐水中保存3小时之后和原位移植之前，使用含有或不含有3000单位/L透明质酸酶的4”*“C St.托马斯医院溶液进行顺行冠状动脉冲洗。透明质酸酶治疗后，心功能和心肌ATP含量得到维持，心肌含水量增加最小，透明质酸酶主动引流心脏淋巴液可减轻心肌水肿的形成，从而保护心功能。我们的结论是，透明质酸酶的使用是有益的保存心脏移植。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