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The Annals of Thoracic Surgery, Vol 58, 822-827, Copyright © 1994 by The Society of Thoracic Surgeons
SF Bolling, DA Olszanski, KF Childs, KP Gallagher and XH Ning
Stunning (reversible myocardial ischemia without necrosis) occurs with
induced global ischemia during cardiac operations and depresses the ability
of the heart to utilize oxygen efficiently because less contractile work is
developed per unit of oxygen utilized. Interestingly, regional studies have
demonstrated dramatic infarct size reduction with stunning episodes before
prolonged ischemia, a phenomenon known as myocardial preconditioning. It is
postulated that the postischemic contractile dysfunction noted after
stunning causes reduced energy demands, which "preconditions" myocardium to
withstand a subsequent longer ischemic episode. Some evidence from regional
studies suggests that preconditioning may improve functional recovery after
ischemia. This study examined the complex relationship between stunning and
preconditioning to functional recovery in a surgical setting of global
ischemia. To study the effect of stunning, myocardial oxygen consumption,
oxygen extraction, and functional indices of contractility were measured
before and after isolated rabbit hearts were subjected to 10, 20, or 45
minutes of normothermic 37 degrees C global ischemic stun intervals. This
demonstrated that while oxygen consumption and extraction quickly recover
to prestun levels, contractility remains depressed well beyond the stun
interval. To study the effect of preconditioning using stunning, isolated
hearts were then subjected to 120 minutes of 34 degrees C
cardioplegic-induced ischemia after preconditioning. Hearts received either
modified St. Thomas cardioplegic solution as a control or cardioplegia
administered after preconditioning with 37 degrees C ischemic stunning for
5, 10, 15, 20, or 45 minutes or multiple 5- or 10-minute stuns, with
reperfusion before cardioplegic-induced ischemia.(ABSTRACT TRUNCATED AT 250
WORDS)
ARTICLES
Stunning, preconditioning, and functional recovery after global myocardial ischemia
Section of Thoracic Surgery, University of Michigan Medical Center, Ann Arbor.
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