Abstract
Electromicroscopic examinations were carried out on 30 myocardial biopsies taken from 22 human donor hearts immediately after excision (prestorage) or immediately before transplantation (post-storage). All electron micrographs were independently examined by two morphologists. Eleven structures were examined in each micrograph, and each structure was scored according to the degree of injury. A good interobserver correlation was obtained in 84 % of the structures scored. In the prestorage left ventricular biopsies (n = 11), approximately 20 %–25 % showed moderate to severe ultrastructural injury. The ultrastructural injury observed in the poststorage left ventricular biopsies (n = 15) was no different from that in the prestorage group, particularly injury to the sarcomere and mitochondria. A similar degree and pattern of injury was seen in the right ventricle (n = 4). There was no evidence that an ischemic storage period of less than 6 h increased the degree of injury seen. However, there was a higher incidence of moderate to severe injury in those hearts excised from donors initially dependent on high inotropic support.
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References
Billingham ME, Baumgartner WA, Watson DC, Reitz BA, Masek MA, Raney AA, Oyer PE, Stinson EB, Shumway NE (1980) Distant heart procurement for human transplantation, ultrastructural studies. Circulation 62 [Suppl I]:I–11-I–18
Cheung WY (1980) Calmodulin plays a pivotal role in cellular regulation. Science 207:19–27
Cruickshank JM, Degaute JP, Kuurne T, Vincent JL, Neil-Dwyer G, Hayes Y, Kytta J, Carruthers ME, Patel S (1987) Reduction of stress/cathecholamine-induced cardiac necrosis by beta 1-selective blockade. Lancet II: 585–589
Davis PJ, Davis FB (1993) Acute cellular actions of thyroid hormone and myocardial function. Ann Thorac Surg 56 [Suppl 1]: S16-S23
Dyke CM, Ding M, Abd-Elfattah AS, Loesser K, Dignan RJ, Wechsler AS (1991) Triiodothyronine-enhanced left ventricular function after ischemia injury. Ann Thorac Surg 52: 14–19
Ferrans VJ, Levitsky S, Buja LM, Williams WH, McIntosh CL, Roberts WC (1970) Histological and ultrastructural studies on preserved hearts. Circulation 41 [Suppl 5]: II–104-II–109
Lurie KG, Billingham ME, Masek MA, Ginsburg R, Bristow MR, Harrison DC, Reitz BA (1982) Ultrastructural and functional studies on prolonged myocardial preservation in an experimental heart transplant model. J Thorac Cardiovasc Surg 84: 122–129
Novitzky D, Wicomb WN, Cooper DKC, Rose AG, Fraser RC, Barnard CN (1984) Electrocardiographic, hemodynamic and endocrine changes occurring during experimental brain death in the Chacma baboon. J Heart Transplant 4: 63–69
Novitzky D, Cooper DKC, Wicomb WN, Rose AG, Fraser RC, Reichart B (1986) Prevention of myocardial injury during brain death by total cardiac sympathectomy in the Chacma baboon. Ann Thorac Surg 41: 520–524
Novitzky D, Cooper DKC, Reichart B (1987) Haemodynamic and metabolic responses to hormonal therapy in braindead potential organ donors. Transplantation 43: 852–854
Novitzky D, Cooper DKC, Reichart B (1987) Prevention of myocardial injury by pretreatment with verapamil hydrochloride following experimental brain death in the baboon. Am J Emerg Med 15: 11–18
Novitzky D, Cooper DKC, Rose AG, Wicomb WN, Becerra E, Reichart B (1987) Early donor heart failure following transplantation from myocardial injury sustained during brain death. Clin Transplant 1: 108–113
Novitzky D, Wicomb WN, Rose AG, Cooper DKC, Reichart B (1987) Pathophysiology of pulmonary edema following experimental brain death in the Chacma baboon. Ann Thorac Surg 43: 288–294
Novitzky D, Cooper DKC, Morrell D, Isaacs S (1988) Change from aerobic to anaerobic metabolism after brain death, and reversal following the administration of triiodothyronine. Transplantation 45: 32–36
Novitzky D, Rose AG, Cooper DKC (1988) Injury of myocardial conduction tissue and coronary artery smooth muscle following brain death in the baboon. Transplantation 45: 964–966
Novitzky D, Horak A, CooperDKC, Rose AG (1989) Electrocardiographic and histopathologic changes developing during experimental brain death in the baboon. Transplant Proc 21: 2567–2569
Rudinger A, Mylotte KM, Davis PG, Davis FB, Blas SD (1984) Rabbit myocardial membrane Ca2+-adenosine triphosphatase activity: stimulation in vitro by thyroid hormone. Arch Biochem Biophys 229: 379–385
Shanlin R, Sole MJ, Rahimifar M, Tator CH, Factor SM (1988) Increased intracranial pressure elicits hypertension, increased sympathetic activity, electrocardiographic abnormalities and myocardial damage in rats. J Am Call Cardiol 12: 727–736
Shivalkar B, Van Loon J, Wieland W, Tjandra-Maga TB, Borgers M, Plets C, Flameng W (1993) Variable effects of explosive or gradual increase of intracranial pressure on myocardial structure and function. Circulation 87: 230–239
Taniguchi S, Kitamura S, Kawachi K, Doi Y, Aoyama N (1992) Effects of hormonal supplements on the maintenance of cardiac function in potential donor patients after cerebral death. Eur J Cardiothorac Surg 6: 96–101
Warnick PR, Davis FB, Cody V, Davis PG, Blas SD (1988) Stimulation in vitro of rabbit skeletal muscle sarcoplasmic reticulum Ca2+ ATPase activity by thyroid hormone and by pyridines (abstract). Proceedings of the Annual Meeting of the Endocrine Society, New Orleans, p 356
Wartovsky L, Beerman KD (1982) Thyroid function in patients with systemic illness: “The Euthyroid Sock Syndrome”. Endocr Rev 3: 164–217
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Novitzky, D., Rhodin, J., Cooper, D.K.C. et al. Ultrastructure changes associated with brain death in the human donor heart. Transplant Int 10, 24–32 (1996). https://doi.org/10.1007/BF02044338
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DOI: https://doi.org/10.1007/BF02044338