Application of HTK solution for myocardial protection in infants

Methods: Forty patients underwent complete repair in 2001 are included in this research work. The mean age was 10±1.9 months, mean weight was 8±1.5kg. Clinical data, biochemical and morphological markers of hypoxia were used for evaluation myocardial protection. The samples of arterial blood, vein, and coronary sinus were obtained at the following stages: initial data; beginning CPB before cardioplegia; after aortic cross clamp removal; 20–30min of reperfusion; 50–60min after aortic cross clamp removal. The specimens for electron microscopic examination were obtained from a right ventricle by a special needle. A 5-mark scale was used to evaluate a visual parameter of a mitochondrial status. The glycogen particles quantity in cardiomyocytes was evaluated on a 6-mark scale.

Results: Analysis of biochemical and morphological hypoxia markers didn't show features of expressed myocardial hypoxic metabolism in the majority of cases. The initial glycogen particles quantity in cardiomyocytes was 2.85±0.12 and a mitochondrial index was 4.27±0.26. The glycogen particles quantity (2.87±0.24) and mitochondrial index (4.22±0.26) didn't significantly differ after reperfusion compared to initial data. Analysis of ultrastructural changes in cardiomyocytes during operation demonstrated, that significant decreasing of glycogen particles quantity and mitochondrial index was marked only in one case, when the aortic cross clamping time was most long. The ultrastructural data according to intraoperative biopsies analysis demonstrate the absence of ischemic injury during reperfusion.

Conclusions: The introduced protocol of a myocardial protection allows evaluating myocardial metabolism and ultrastructure at the most important stages of operative intervention.