ABSTRACT
Recently, ischemic preconditioning (IPC) for myocardial protection in heart surgery, has been used intensively. However, no data are available concerning the effect and influence of reperfusion temperature during IPC. To estimate the effectiveness of re-perfusion temperature during IPC, we performed an experiment using pigs. Twenty male pigs (40-50kg in body weight) were used. After establishing cardiopulmonary bypass (CPB), IPC was made, cross-clamping the ascending aorta twice for 3min and performing re-perfusion for 5min. According to the re-perfusion temperature, we divided this model into four groups as follows; 37°C of the re-perfusion temperature with IPC (warm IPC, <i>n</i>=5), 37°C without IPC (warm NIPC, <i>n</i>=5), 32°C with IPC (tepid IPC, <i>n</i>=5) and 32°C without IPC (tepid NIPC, <i>n</i>=5). After the IPC procedure, all the hearts underwent global ischemia by cross-clamping for 15min under ventricular fibrillation, and re-perfusion with 32°C blood temperature was done for half hour. We measured myocardial levels of adenosine triphosphate, troponin-T, serum nitrous oxide, and other myocardial enzymes. After sacrificing animals, biopsy of the left ventricular free wall was made, and its histological changes were evaluated by scanning electron microscopy (SEM). Blood sampling was made before CPB, at the end of IPC, end of global ischemia, 10 and 30min after re-perfusion. In warm IPC, adenosine significantly increased, and serum troponin-T was significantly lower than other groups. The myocardium of warm IPC showed a normal SEM image, while ischemic damage was revealed in other groups. These results suggested that warm IPC induced effective myocardial protection. however tepid IPC did not protect the myocardium.
ABSTRACT
A 66-year-old woman with aortic stenosis and idiopathic thrombocytopenic purpura (ITP) underwent concomitant splenectomy and aortic valve replacement (AVR). High-dose trans-venous gamma-globulin therapy (400mg/kg/day) was performed for five days before surgery. The number of platelet, which was 6.0×10<sup>4</sup>/mm<sup>3</sup> on admission slighty increased to 7.0×10<sup>4</sup>/mm<sup>3</sup> before surgery. The aortic valve was replaced by an ATS 19mm prosthesis using cardiopulmonary bypass. Platelets were transfused postoperatively. Perioperative hemorrhage was moderate, and the postoperative course was uneventful. This was the second case we treated by concomitant cardiac surgery and splenectomy. It was safely performed after high-dose trans-venous gamma-globulin therapy.