phosphocreatine and Heart-Valve-Diseases

The relationships between cell metabolism and both hemodynamics and oxygen transport/utilization (VO2/DO2) pattern were evaluated intra and postoperatively in eight patients undergoing major valvular heart surgery with the aid of moderately hypothermic cardiopulmonary bypass (CPB). Quadriceps femoris specimens were obtained by the needle biopsy technique for muscle ATP, ADP, AMP, phosphocreatine (PCr), creatine and lactate determination at anesthesia induction, after CPB, as well as in the ICU 18 h after surgery. Moreover, hemodynamic variables, oxygen transport and utilization indices, and plasma lactate were measured at the same intervals and throughout the CPB period. After CPB, muscle ATP and PCr contents were reduced (p less than .05) as compared to those of both pre-CPB patients and healthy control subjects; muscle and plasma lactate levels were increased (p less than .05). Mean VO2 and DO2 values measured during CPB significantly decreased (p less than .05), but VO2 reduction was proportionally greater than that of DO2 (-62% vs. -41%). No correlation was found between VO2 and DO2 at that time, but a significant relationship (p less than .05) was found at the end of CPB. A further decrease in muscle ATP and PCr levels was measured in the ICU, as muscle and plasma lactate levels were still elevated. At that time, VO2 and DO2 were not significantly different from pre-CPB values, but were significantly (p less than .05) correlated with each other.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adenine Nucleotides; Aged; Cardiopulmonary Bypass; Creatine; Female; Heart Valve Diseases; Hemodynamics; Humans; Intraoperative Period; Lactates; Male; Middle Aged; Muscles; Oxygen; Oxygen Consumption; Phosphocreatine; Postoperative Period

We determined representative enzyme activities of glycogenolysis (glycogen phosphorylase) glycolysis (d-glyceraldehyde-3-phosphate dehydrogenase, GAPDH), beta oxidation of free fatty acids (1-3-hydroxyacyl CoA dehydrogenase, HADH), citric acid cycle (citrate synthase, CS), lactate fermentation (lactate dehydrogenase LDH), and creatine phosphate metabolism (creatine kinase, CK) in left ventricular samples of 36 patients to investigate if the metabolic capacities of the energy-supplying pathways are differently affected in different heart diseases. There were 17 patients with mitral valve diseases (MVD), 8 patients with aortic valve diseases (AVD), and 11 patients who suffered from dilative cardiomyopathies (DCM). The main metabolic characteristic on the level of enzymatic organization in patients with DCM was an increased ratio of GAPDH/HADH activities and a decreased ratio of HADH/CS activities compared to the valve-diseased patients. This result indicates that the capacity of glucose oxidation is enhanced at the expense of fatty acid metabolism in patients with DCM. Furthermore, we determined significantly lower myocardial CK activities in this group of patients, most probably reflecting a diminished content of myofibrils. Citrate synthase activity was lowest in patients with AVD. Although we cannot rule out that the impaired left ventricular function is in part responsible for the shift of the capacities of the energy-supplying metabolism in patients with DCM, we favor the assumption that it is a specific feature of this myocardial disease.

Topics: 3-Hydroxyacyl CoA Dehydrogenases; Cardiomyopathy, Dilated; Citric Acid Cycle; Creatine Kinase; Energy Metabolism; Enzymes; Fatty Acids; Glycogen; Glycolysis; Heart Valve Diseases; Heart Ventricles; Humans; Isoenzymes; L-Lactate Dehydrogenase; Lactates; Lactic Acid; Middle Aged; Myocardium; Phosphocreatine

Results of morphological and biochemical examination of 153 myocardium biopsies from 42 patients with the intraoperational heart ischemia that developed during the correction of cardiac valves disturbances under the condition of artificial circulation and cardioplegia with the blood based solution are given. Phosphocreatin ("neoton" produced by Schiapparelli Company, Italy) was added as a cardioprotector to the cardioplegic solution in 24 patients. The high efficiency of the drugs for the cardiomyocytes sarcolemma is shown by means of colloidal lanthanum. A full retention of the macroergic phosphates is also shown biochemically when the standard solution was modified for the heart protection.

Topics: Adenosine Triphosphate; Adult; Creatine; Heart Arrest, Induced; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Intraoperative Care; Middle Aged; Myocardium; Phosphocreatine; Sarcolemma

Topics: Adenosine Triphosphate; Animals; Cardiac Surgical Procedures; Coronary Disease; Dogs; Evaluation Studies as Topic; Extracorporeal Circulation; Heart Arrest, Induced; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Myocardial Contraction; Myocardial Revascularization; Myocardium; Phosphocreatine; Postoperative Complications