Monitoring changes in heart tissue temperature and evaluation of graft function after coronary artery bypass grafting surgery

Thermography is a relatively new contact-free method used in experimental and clinical studies and in cardiovascular surgery to investigate the myocardium and coronary artery function. Objects of complex study included mongrel dogs and patients with coronary artery disease who underwent cardiac surgery. For active dynamic thermography, we used a thermovision camera "A20V" (FLIR Systems, USA). Our data indicate that both experimental and clinical study performed on beating hearts could be an important approach to interoperation inspection of autovenous graft function. An infrared camera also can be successfully used to determine the extent of ischemic damage to the myocardium, heart, and blood vessels during surgery as a significant prognostic tool for evaluating outcome after cardiac operation.

Free radical-scavenging activities of Crataegus monogyna extracts

The aim of this study was to investigate antiradical activity of aqueous and ethanolic hawthorn fruit extracts, their flavonoids, and flavonoid combinations.

MATERIAL AND METHODS

Total amount of phenolic compounds and the constituents of flavonoids were determined using a high-performance liquid chromatography. The antioxidant activity of Crataegus monogyna extracts and flavonoids (chlorogenic acid, hyperoside, rutin, quercetin, vitexin-2O-rhamnoside, epicatechin, catechin, and procyanidin B(2)) quantitatively was determined using the method of spectrophotometry (diphenyl-1-picrylhydrazyl (DPPH.) radical scavenging assay and 2,2'-azino-bis (3-ethylbenzthiazoline-6-sulphonic acid)(ABTS.+) radical cation decolorization assay). The level of tyrosine nitration inhibition was determined using a high-performance liquid chromatography.

RESULTS

Ethanolic hawthorn fruit extract contained 182+/-4 mg/100 mL phenolic compounds, i.e. threefold more, as compared to aqueous extract. The antioxidant activity according to DPPH. reduction in the ethanolic extracts was higher 2.3 times (P<0.05). The ABTS.+ technique showed that the effect of ethanolic extracts was by 2.5 times stronger than that of aqueous extracts. Tyrosine nitration inhibition test showed that the effect of ethanolic extracts was by 1.4 times stronger than that of aqueous extracts. The investigation of the antiradical activity of the active constituents in aqueous and ethanolic extracts revealed that epicatechin and catechin contribute to radical-scavenging properties more than other components. Procyanidin B(2) only insignificantly influenced the antiradical activity of the extracts.

CONCLUSION

Both aqueous and ethanolic hawthorn extracts had antiradical activity, but ethanolic extract had stronger free radical-scavenging properties, compared to the aqueous extract. The antioxidant activity of the studied preparations was mostly conditioned by epicatechin and catechin. The individual constituents of both extracts had weaker free radical-scavenging properties than the combination of these substances did.

Evaluation of ischemic injury of the cardiac tissue by using the principal component analysis of an epicardial electrogram

Monitoring and control of the heart tissue viability is of crucial importance during heart surgery operations. In most cases the heart tissue suffers from an ischemic injury that causes a decrease in the velocity of electrical excitation propagation in it and influences the shape of the excitation wave front that spreads over the injured area. It is reflected in a more complex shape of the registered epicardial electrogram as compared to normal. A method for quantitative evaluation of the complexity of the shape of the epicardial electrogram based on the principal component analysis is here proposed for evaluation of the ischemic injury of the cardiac tissue. A minimal, yet sufficient, number of the principal components (the optimal basis functions) for truncated expansion of the epicardial electrogram signals could be used as an estimate of signal complexity. The method for determination of such a minimal, yet sufficient, number of principal components were developed by using epicardial electrograms registered during in situ experiments on dogs in which local ischemia was evoked by ligation of a coronary vessel.

Heart tissue viability monitoring in vivo by using combined fluorescence, thermography and electrical activity measurements

A prototype system for in vivo monitoring of the heart tissue viability by using combined measurements of fluorescence, thermography and electrical activity has been elaborated for cardiac surgery. The fluorescence imaging of nicotinamide adenine dinucleotide NAD(P)H in the blue light range (lambda=467 nm) by using UV light (lambda=347 nm) excitation was used to detect metabolic disturbances. The method of the principal component analysis was used for the processing of the fluorescence image sequences. Far infrared (lambda=7.5-13 microm) imaging was used to evaluate temperature dynamics of the tissue surface during circulation disturbances. Evaluation of the epicardial electrogram shape by using continuous wavelet transform was used to detect and evaluate ischemia-caused disturbances of the electrical activity of the tissue. The combination of temperature, fluorescence and electrical activity estimates obtained from synchronically registered parameters during the experiments on model systems and experimental animals yielded qualitatively new results for the evaluation of cardiac tissue viability and enabled to achieve a versatile evaluation of the heart tissue viability.

[Changes of heart electrophysiological parameters after destruction of epicardial subplexuses that innervate sinoatrial node]

The aims of present study were to verify the topography of the intracardiac nerve subplexuses (INS) by using electrophysiological methods, its relations with sinoatrial (SA) node function and to investigate possibility of selective surgical SA node denervation. Fifteen mongrel dogs of either sex weighing 8 to 15 kg were used for electrophysiological studies. Both cervical vagosympathetic trunks were isolated and crushed by tight ligatures. Nervus subplexuses destructions were performed by cryocoagulation in three zones located around the right superior vena cava: ventral, lateral and dorsal. The sinus rhythm, SA node function recovery time, AV node conductivity, AV node and atrial effective refractory period were measured. Five experiments in each of three zones were performed. Experimental data show that destruction of the epicardial nerves has different effect on electrophysiological parameters. After destruction of the anterior zone of the right atrium the sinus rhythm decreased on an average by 11.6%; SA node function recovery time prolonged by 7.2%; AV node conductivity decreased by 13.1%; AV node effective refractory period prolonged by 12.9% and atrial effective refractory period, by 10.9 %. Measurements of electrophysiological parameters after intravenous injection of atropine sulphate show that sinus rhythm decreased on an average by 23.4%; SA node function recovery time increased by 9.1%; the conductivity of AV node decreased by 10.2%; AV node effective refractory period prolonged by 15.4% and atrial effective refractory period, by 13.2%. After destruction of the intracardiac nerves of the lateral zone, the sinus rhythm decreased by 15.7%; SA node function recovery time increased by 16.3%; AV node conductivity decreased by 8.3%; AV node effective refractory period and atrial effective refractory period prolonged by 11.9% and 10.0%, respectively. After the atropine sulphate intravenous injection, the sinus rhythm decreased on an average by 7.1%, SA node function recovery time prolonged by 7.1%, AV conductivity decreased by 9.1%, AV node effective refractory period increased by 12.4%, and atrial effective refractory period prolonged by 12.5%. After destruction of the nerves in the dorsal zone the changes of electrophysiological parameters were opposite to those obtained after destruction of the nerve tracts in the anterior or lateral zones: the sinus rhythm increased on an average by 4.3%; SA node function recovery time shortened by 8.8%; AV conductivity increased by 9.7%; AV node and atrial effective refractory period decreased by 12.3% and 12.1%, respectively. After intravenous atropine sulphate infusion, sinus rhythm decreased on an average by 8.3%; SA node function recovery time prolonged by 9.6%; AV node conductivity decreased by 5%; AV node and atrial effective refractory period prolonged by 4.2% and 5.2%, respectively. The average changes of electrophysiological parameters before and after INS destruction shows that cryocoagulation of ventral and lateral zones eliminates the effects of sympathetic tone to SA and AV nodal activity. Cryocoagulation of dorsal zone eliminates the effects of nervus vagus to both nodal structures. These findings shows the possibility alter or correct SA node function by making selective surgical SA node denervation.

[Changes of cardiac electrophysiological parameters after destruction of epicardial nervous plexi innervating sinoatrial node]

Electrophysiological methods were used in experiments on 15 dogs for the study of topography of right atrial epicardial nerves, their connections with sinoatrial node, and possibilities of selective surgical denervation of sinoatrial node. Epicardial nerves were electro-coagulated or cryo-destructed in ventral, lateral and dorsal atrial zones near base of vena cava inferior. The following parameters were registered: heart rate, time of restoration of sinus node function, conduction through atrioventricular node, refractoriness of atria and atrioventricular node. Comparison of cardiac parameters before and after destruction of epicardial nerves showed that in lateral and ventral zones sympathetic nerves reach sinus node through lateral and ventral zones while parasympathetic -- along dorsal zone. Selective surgical destruction allows to modify sinus node function in a desired way.

Extrapotentials and allorhythmias as an expression of experimental parasystole

The aim of the study was to investigate the dynamics of experimental parasystole taking into consideration the peculiarities of recurrent arrhythmias recorded in clinical settings.

MATERIAL AND METHODS

The experiments were conducted on isolated right atria of seven chinchilla rabbits. Parasystolic arrhythmias using periodical one-site electrostimulation were provoked in one atrium, where the sinus node was not affected, and in two atria with the spontaneous low value activity of pacemakers. The parasystolic arrhythmias by the dual-site periodical pacing were provoked in four atria, in which the spontaneous activity had disappeared, while the membrane potential of cardiomyocytes remained at the level of 70 to 80 mV.

RESULTS

The parasystolic arrhythmias of the shape of single extrapotentials were obtained in atria when the periods of excitation impulses were within the limits of 0.9-1.2 s, and the differences between these periods being relatively small (0.04-0.2 s). The increase of these differences resulted the various allorhythmias. In cases of single extrapotentials, the recurrence periods of arrhythmias reached 5.6-29 s; while in cases of allorhythmias they shortened to 2.4-4.8 s.

CONCLUSION

The parasystoles in isolated atria of rabbits can be induced by two competitive excitation sources. They may manifest themselves through single extrapotentials or allorhythmias, whose form depends on the duration of the periods of excitation impulses, the difference between these durations, as well as on effective refractory periods of atrial cardiomyocytes. The determination and evaluation of the recurrence period of these arrhythmias can serve in any given clinical situation as a supplementary criterion.

[Characteristics of general anesthesia in the investigation of heart electrophysiology]

Investigating electrophysiological properties of the heart under acute experimental conditions, dogs are affected by operative stress because of traumatic surgical manipulations, so investigations are performed under general anaesthesia. Many anaesthetics together with their main function have desintegrating influence on autonomic regulation mechanisms. That is why anaesthetics used during experiments must fullfil such requirement--have minimal influence on autonomic nervous system (ANS) and heart conductivity system (HCS) interaction parameters or to make this influence insignificant. We did not found common anaesthesia methodics that can fullfil that requirements, so we decided to prepare new common anaesthesia methodics, which could fullfil requirements mentioned above. We choose medicaments according to their pharmacokinetics and pharmacodynamics action. For methodics optimization we've used 2 groups of dogs (mongrel dogs males weight 7-15 kg) (n = 10). We've applied different anaesthesia schemas on each group. Premedication in the I-st group was performed with intramuscle (i.m.) combination of diazepam, ketamine and phentanyl and for anaesthesia continuous intravenous (i.v.) infusion of thiopental and ketamine. In II-nd group premedication was performed with i.m. injection of ketamine/phentanyl combination and for anaesthesia--continuous i.v. infusion of thiopental. Induction in both groups was performed with i.v. thiopental injection. Suitability of premedication and anaesthesia was valued by adequativity of haemodynamics (heart rate 1/min) and surgical manipulations during experiments. Our conclusion is: investigating interaction of ANS and HCS methodics used in the I-st group of dogs is more suitable.

[Trace elements, cholesterol and ultrastructural alterations of aorta in hypodynamic stress]

Hypodynamic stress of 48-day duration was provoked by permanent and periodically recurrent intervention (the hypodynamics periodically exchanged to physically activity) for Chinchilla rabbits (weight 2.5-3.0 kg) (n=19) by placing them in metal hutches according to B. V. Fiodorow. Rabbits (n=10) of the control group which had no intervention were kept in vivarium conditions. The concentration of trace elements (Zn, Mn, Cu) in the blood plasma and thoracic aorta was assessed by atomic absorption spectrophotometer (Perkin-Elmer 503, USA). The level of cholesterol was determined by enzymatic analysis. Ultrathin sections of thoracic aorta were examined with electron microscope "Tesla BS-500" (Italy). After 48 days of permanent hypodynamic stress the concentration of Zn and Mn in blood plasma of rabbits was found to be significantly decreased while the cholesterol and Cu level was greater than before the stress. In case of permanent stress significant decrease also was found in the concentration of Cu and Mn in aorta in comparison with that in the case of periodically recurrent stress. The mentioned changes of the trace elements and cholesterol concentration in tissues of rabbits in case of permanent hypodynamic stress were accompanied by ultrastructural alterations in endothelium--desintegration of cells, and winding and fragmentation of internal elastic lamina, accumulation of lipids. In case of periodically recurrent hypodynamic stress of the some duration these changes were less expressed.

Diagnosis and surgical treatment of ectopic atrial tachycardia

Eighty-two patients with ectopic atrial tachycardia (EAT) were subjected to radical closed heart surgery (without cardiopulmonary bypass). The age of the patients ranged from 1 to 51 years. Permanent EAT was present in 19 patients, incessant EAT in 14, and paroxysmal EAT in 49 patients. Preoperative electrophysiological study included computed analysis of the P wave vector. Ectopic foci were established in the right atrium in 34 patients, in the left atrium in 11, in the interatrial septum in 32, and extracardially in 5 patients. For ablation or isolation of the foci, the cryogenic technique was used in 74 patients, cryo- and laser techniques in 4, and the laser technique alone in 1 patient. In 3 patients resection of the atrial auricles including the ectopic focus was undertaken. In 4 patients complete AV block was induced and a cardiac pacemaker implanted. After primary surgery, favourable results were obtained in 71 patients. In 11 patients recurrences were observed; 8 of these patients underwent successful repeat surgery. In 3 patients medical treatment was effective. Finally, the follow-up results have been promising-79 patients (96.4%) (including 4 patients in whom a complete AV block was created) have become arrhythmia-free. When EAT is resistant to medical treatment, closed heart ablation of the ectopic focus has proved to be safe (no mortality or morbidity) and effective. It can therefore be recommended not only for the termination of EAT but also for the prevention of dilated cardiomyopathy.