Preservation of cardiac myocytes subjected to different preconditions: a comparative morphometric study of beating, fibrillating, and cardioplegically arrested canine hearts

Functional, metabolic, and morphological aspects of continuous, normothermic heart preservation: effects of different preparation and perfusion techniques

Continuous blood perfusion of donor hearts for transplantation has been the focus of an increasing amount of research, but the optimal preparation and perfusion techniques have not been clearly defined. Therefore, we investigated the effectiveness of different preservation strategies using continuous, normothermic heart perfusion after donor heart harvesting. Hearts of 12 pigs were randomly assigned to two groups receiving a constant pressure perfusion in a modified Langendorff system after different preparation techniques. In Group 1, six hearts were arrested with Bretschneider HTK cardioplegia (4 degrees C) and then reperfused with a circulating pressure of 80 to 90 mmHg using leukocyte depleted autologous blood. In Group 2, beating hearts of six pigs were explanted while being perfused, without cardioplegic arrest. Post-harvesting perfusion was similar to Group 1 except for a lower circulating pressure (40-50 mm Hg). At different time points (baseline and 1, 6, and 12 h after reperfusion), myocardial biopsies were taken, and contractility was assessed by measuring the maximum rate of left ventricular pressure rise (Deltap/Deltat (max)). Adenosine triphosphate (ATP) concentration was measured in all biopsies using a bioluminescence technique. Additionally, ultrastructural alterations were investigated using electron microscopy. Hypothermic cardioplegia and a higher reperfusion pressure (Group 1) were associated with an earlier and sharper decline in contractile function and intracellular ATP concentration. Ultrastructural alterations in Group 1 appeared earlier and were more distinctive than in Group 2. Endothelial ultrastructure, in particular, was better preserved in Group 2. Significant alterations were present in both groups after 12 h of perfusion but were more severe in Group 1. Blood perfusion provides protection against severe ischemic damage for a limited time. The use of a lower perfusion pressure, as well as avoiding cardioplegia and hypothermia, led to significantly better and longer preservation of perfused hearts.

Ultrastructural Findings in Porcine Hearts After Extracorporeal Long-term Preservation with a Modified Langendorff Perfusion System

Preserved ultrastructure is an important precondition for functional regeneration after heart transplantation. We investigated the effectiveness of a newly developed modified Langendorff system in extracorporeal heart perfusion. (Experiment I) Cardioplegia and cold ischaemia were performed in six pigs. Hearts were connected to a modified Langendorff system, and perfused with leucocyte depleted autologous blood. (Experiment II) The untreated hearts of three healthy pigs served as controls. Forty-seven myocardial biopsies at different timepoints (I: n = 29, II: n = 18) were investigated by transmission electronmicroscopy. Cardioplegia/hypothermia (I) induced mild-to-moderate mitochondrial swelling, mild myofibrillar degeneration in cardiomyocytes and moderate endothelial oedema. After 4 h reperfusion cardiomyocytes showed moderate myofibrillar and mild sarcolemmal damage. Moderate endothelial degeneration, mild interstitial oedema and haemorrhages appeared. Untreated hearts (II) showed severely damaged mitochondria and nuclei after 30 min while the myofibrillar structure remained unaffected until 4 h later. This is a promising model for extracorporeal heart perfusion. However, ultrastructural findings indicated that some necessary modifications to prevent cellular damages during reperfusion were needed.

Intercalated clear cells or pale cells in the sinus node of canine hearts? An ultrastructural study

Two types of sinus nodal cells were responsible for the main differences in the literature concerning the ultrastructure of the sinuatrial node: the intercalated clear cells and pale cells. Canine hearts were arrested by (1) aortic cross clamping, (2) coronary perfusion with the cardioplegic solution St. Thomas, and (3) coronary perfusion with the cardioplegic solution HTK (Custodiol(R)). After fixation by immersion or perfusion the sinus node tissue was prepared for electron microscopy. Following cardioplegic arrest and perfusion fixation, three nodal cell types in the non-ischemic sinuatrial node were observed: typical nodal cells, transitional cells, and intercalated clear cells. Less than 1% of the non-ischemic sinuatrial cells were intercalated clear cells, surrounded by typical nodal cells or transitional cells. The contractile apparatus of the intercalated clear cells was extremely poorly developed. Great structural variations in the mitochondria were observed in intercalated clear cells, variations that would not appear under conditions of ischemia. In contrast, after 15-25 min of ischemia at 25 degrees C the appearance of the sinus nodal cells was strikingly different from that of the non-ischemic sinuatrial cells. More than 10% of the nodal cells showed typical ischemic alterations, e.g., mitochondrial swelling, clumping of nuclear chromatin, loss of glycogen particles, and cell swelling in varying degrees. Because they look very pale, these nodal cells have been described as pale cells in the literature. Intercalated clear cells appear mainly in non-ischemic nodal tissue. Pale cells are ischemically damaged sinus nodal cells.

Influence of different fixation procedures on the quantification of infarction and oedema in a rat model of stroke

In pharmacodynamic studies using focal ischaemia models, the size of the infarct measured by quantitative histology is the most important outcome measure. Precise, unbiased and reproducible assessment of infarct volume is of foremost importance. A frequent problem in interventional stroke models is the evaluation of infarcts in animals found dead, where instant post-mortem fixation of the brain cannot be performed. The purpose of this study was to investigate possible bias from perfusion, immediate and 3-h post-mortem delayed immersion fixation on the measured volumes of cerebral infarction, oedema and hemispheres in a rat embolic stroke model. Thirty-six male Sprague-Dawley rats were thromboembolized into the internal carotid artery. After survival for 24 h, the animals were divided into three groups: group 1 - immediate perfusion fixation; group 2 - immediate immersion fixation of the brain; and group 3 - animals left dead for 3 h at room temperature before removal of the brain for immersion fixation. Following histological preparation and evaluation, the volumes of the hemispheres and infarction were measured by quantitative histology and planimetry. Brains fixed by immersion were 7% larger than the perfusion-fixed brains. Delaying the immersion fixation for 3 h may increase hemisphere volume by a further 12%. Independent of the fixation procedure, the size of infarction was approximately 40% of the ipsilateral hemisphere, and the oedema was approximately 11% of the size of the infarct. The used planimetric technique was accurate with measured values within +/- 2% of the factual value. In conclusion, sizes of hemispheres, infarction and oedema in absolute volume measures are influenced by the effect of unwanted variation of brain size caused by biological factors and artificial shrinkage caused by fixation, dehydration and heat treatment of the specimens. Infarction and oedema expressed relatively in per cent of hemisphere and infarct, respectively, are robust measures independent of the investigated fixation procedures.

Cellular edema and alterations in metabolite content in the ischemic and reperfused canine heart following different forms of cardiac arrest

This study investigates firstly how far cellular edema correlates with parameters of the anaerobic energy turnover independent of the method used for cardiac arrest, and secondly to what extent cellular edema developing during reversible global ischemia is reduced after reperfusion. Canine hearts were arrested 1. by aortic cross clamping (ACC), 2. by coronary perfusion with St. Thomas solution, or 3. HTK (histidine tryptophan ketoglutarate) solution (Custodiol). Samples for biochemical and structural analysis were taken at different times during ischemia and after reperfusion with Tyrode solution. Cellular edema determined morphometrically and given as volume ratio of sarcoplasm and mitochondria to myofibrils (Vvsp + V vmi/Vvmf) varies significantly in the differently arrested hearts. Reperfusion after a decrease in ATP to 4 mumol/gww (revival time) leads to a nearly complete structural recovery. The relationship between cellular edema and defined over-all metabolite tissue concentrations and extracellular pHe values shows: 1. during the decrease of creatine phosphate to 3 mumol/gww, cellular edema does not change; it is, however, significantly higher after ACC and St. Thomas than after HTK perfusion; 2. at each lactate concentration, cellular edema differs significantly depending on the form of cardiac arrest; 3. during the decrease of ATP and pHe cellular edema increases and is comparable at concentrations < 4 mumol/gww and at pHe values < 6.5 independent of the form of cardiac arrest; 4. beyond 10 mumol/gww of inorganic phosphate (Pi), increasing values for cellular edema correspond to defined Pi values in the differently arrested hearts. Thus, the ratio VVSp+ VVMi/VVMf is a powerful parameter for the determination of cellular edema during ischemia, as well as for correlations with metabolic parameters.

Adverse effects of crystalloid cardioplegia and slow cooling for protection of immature rat hearts

BACKGROUND

Studies on the benefit of methods for protection of the hypertrophied immature myocardium are rare and controversial.

METHODS

We assessed the effects of (1) rapid cooling by topical hypothermia alone, (2) slow prearrest cooling by coronary perfusion hypothermia, and (3) cardioplegic cardiac arrest with St. Thomas' Hospital solution no. 2 for protection of isolated immature rat hearts (age, 28 days) during 8 hours of global ischemia at 10 degrees C. Myocardial hypertrophy was induced noninvasively by lifelong feeding of a low iron diet. Recovery of left ventricular function, metabolism, and myocardial fine structure were assessed.

RESULTS

In hypertrophied hearts, protection by topical hypothermia alone resulted in significantly improved postischemic recoveries of maximum left ventricular pressure and rate of pressure rise compared with the method of slow cooling or application of cardioplegia (40.6% +/- 5.0% and 38.1% +/- 5.9%, mean +/- standard error of the mean; p < 0.05). The same pattern of recovery was observed among nonhypertrophied control hearts. Regardless of the method of protection, hypertrophied hearts revealed a significantly larger interstitial space at the end of reperfusion than control hearts. In hypertrophied hearts, postischemic adenosine triphosphate concentrations were higher with topical hypothermia alone for protection than with the other methods.

CONCLUSIONS

Rapid cooling by topical hypothermia alone provides superior protection of hypertrophied immature rat hearts as compared with slow prearrest cooling. Application of St. Thomas' Hospital cardioplegic solution no. 2 does not improve protection and even hinders postischemic functional recovery.

Morphometric evaluation of volume shifts between intra- and extra-cellular space before and during global ischemia

BACKGROUND

It is well known that all forms of cardiac arrest lead to global ischemia combined with alterations in cellular and interstitial volume. The aim of this study was to investigate the nature of these alterations with respect to different methods of cardiac arrest and establish the extent of their mutual influence at the onset as well as during the course of global ischemia.

METHODS

Three tested clinical methods were employed to induce cardiac arrest by a) aortic cross clamping, b) coronary perfusion with the cardioplegic solution St. Thomas, and c) coronary perfusion with the cardioplegic solution histidine-tryptophane-ketoglutarate (HTK). The arrested hearts were subjected to global ischemia at 25 degrees C. The size of the myocytes, as well as the interstitial space of myocytes, was determined morphometrically. The contraction state of myocytes was evaluated according to a score.

RESULTS

We found that the degree of contraction, as well as nature of alterations in the cellular and interstitial volumes, depended both on the form of cardiac arrest and on the duration of ischemia. The following relationships were established. High contraction at the onset of ischemia leads to expulsion of fluid from the interstitium between bundles of myocytes into the tissue clefts increasing their size. The decrease in contraction during ischemia leads to narrower tissue clefts. Cellular swelling at the onset of and during ischemia is caused by volume shifts between intracellular and interstitial space. An increase in cellular volume during global ischemia and/or additional contraction reduce the interstitium within bundles of myocytes. Sufficient relaxation and/or interstitial edema enlarge the interstitium.

CONCLUSIONS

Cellular and interstitial alterations seen at the onset and during the course of ischemia are dependent upon the method of cardiac arrest. Furthermore, a considerable mutual influence is exerted by the alterations in cellular and interstitial spaces.

Evaluation of lanthanide tracer methods in the study of mammalian pulmonary parenchyma and cardiac muscle by electron energy-loss spectroscopy

Lanthanum (La) has widely been used as a tracer to study the integrity of plasma membranes. With conventional transmission electron microscopy (cTEM), the absence of electron scattering deposits from the cytoplasm has generally been assumed to reflect an intact cell membrane. However, the application of electron spectroscopic imaging (ESI) and electron energy-loss spectroscopy (EELS) reveals that electron scattering deposits may be present which do not contain La. However, La could be detected in regions of pulmonary parenchyma and cardiac muscle that were devoid of electron scattering deposits. Therefore, to exclude misinterpretations based on cTEM the application of microanalytical techniques is strongly recommended for the study of the integrity of plasma membranes by means of La tracers. In addition, ESI and EELS are shown to distinguish between different tracers in simultaneous applications of La and terbium (Tb) which were used at the different faces of the pulmonary air-blood barrier. The analysis of the distribution of both tracers which form electron scattering deposits, indistinguishable by cTEM, may help us to understand the different functional significances of cellular alterations of both cellular borders of the barrier. As was shown for La, however, strictly controlled conditions are mandatory during the fixation procedure because an increase in the incubation time to more than 1 h in samples of pulmonary parenchyma may result in the occurrence of La deposits within the cytoplasm. In the absence of electron scattering deposits, the presence of La in glycogen granules and ribosome-containing areas of various types of alveolar septal cells even after 15 min incubation indicates that the absence of deposits does not necessarily correspond to the absence of the tracer.

The contraction state of myofibrils during global ischemia and after reperfusion following different forms of cardiac arrest. Correlation with metabolic parameters in the canine heart

This study was undertaken in order to obtain information on the mode of reaction of the contractile apparatus after different forms of cardiac arrest, global ischemia and reperfusion, as well as on possible correlations between the contraction state of myofibrils and biochemical parameters. During the survival time, before the level of 3 mumol/gww creatine phosphate (CP) is reached, the contraction state shows only minor changes. During the revival time in which ATP tissue concentrations decay to 4 mumol/gww, the contribution of ATP, lactate, anorganic phosphate (Pa) and acidosis to the degree of relaxation depends on the method of cardiac arrest. At defined biochemical values, the degree of relaxation is comparable after aortic cross clamping (ACC) and St. Thomas perfusion, but significantly different compared to HTK perfusion. Thus, during the revival time, the relaxation of sarcomeres depends predominantly on the composition of the solutions used for cardiac arrest. The re-entry of contraction below 3 mumol/gww ATP is correlated with the ATP concentration, independent of the form of cardiac arrest. Reperfusion after HTK or St. Thomas cardioplegia and reversible ischemia leads to the focal formation of contraction bands, which do not occur during ischemia. This contraction state is significantly more pronounced after reperfusion of St. Thomas arrested hearts. Thus, the contraction state of myofibrils is influenced not only by alterations in metabolite concentrations, but also by the composition of cardioplegic solutions and by the characteristic conditions (sufficient energy, oxygen and Calcium) during reperfusion.