Ultrastructural Change of Myocardium in Open Cardiac Surgery with Cold Blood Cardioplegia / 대한흉부외과학회지

ABSTRACT

BACKGROUND: The purposes of this study were to evaluate the effect of myocardial protection with our cold blood cardioplegic solution and to observe the relationship between ultrastructural study and other evaluation methods and its effectiveness. MATERIAL AND METHOD: We evaluated the changes of myocardial ultrastructure using semiquantitative scoring system, CK-MB fraction, SGOT and LDH1/LDH2, and EKG in 18 patients undergoing valvular heart surgery and coronary artery bypass grafting (CABG). Right atrial auricular biopsies were taken before the cardiopulmonary bypass (CPB) and shortly after the end of CPB. Myocardium-related serum enzymes & EKG were checked for 3 days of postoperative period and their postoperative peak enzyme value and observed new Q wave & ST segment elevation in EKG were choosen. RESULT: There were 8 males and 10 females, and their mean age was 55.6+/-13. Eight patients underwent valvular heart surgery and ten coronary artery bypass grafting. The mean CPB time was 119+/-29minutes and the mean aortic cross-clamp (ACC) time was 75.4+/-24 minutes. Before the start of CPB, the mean mitochondrial score was 1.28+/-0.53 and after the end of CPB, it significantly increased to 2.35+/-0.79. There was no evidence of perioperative myocardial infarction in terms of myocardiumrelated serum enzyme value and Q wave and ST change in EKG. There was no significant relationship between pre-CPB and post-CPB mitochondrial score and the mean time of CPB and ACC, and the mean value of postoperative peak CK-MB, SGOT and LDH1/LDH2, but there was relatively positive correlation of CPB time with peak LDH1/LDH2. CONCLUSION: Despite the apparent satisfactory results in myocardium-related serum enzymes & EKG, with this study using the cold blood cardioplegic solution, there were many changes in myocardial ultrastructures, and more studies are needed to obtain further information.