Title EXPERIMENTAL STUDIES ON ELECTIVE …EXPERIMENTAL STUDIES ON ELECTIVE CARDIAC ARREST 373 SU 自 ciently sinus rhythm, 1.0 cc of : 10,000 epinephrine was injected into the left

Title EXPERIMENTAL STUDIES ON ELECTIVE CARDIACARREST FOR OPEN HEART SURGERY

Author(s) KAWASHIMA, SADAAKI

Citation 日本外科宝函 (1959), 28(2): 371-393

Issue Date 1959-03-01

URL http://hdl.handle.net/2433/206789

Right

Type Departmental Bulletin Paper

Textversion publisher

Kyoto University

EXPERIMENTAL；二STUDIEs:oNELECTIVE CARDIAC ARREST FOR OPEN HEART SURGERY

by

SADAAKI KA w ASHIMA

From the !st. Surgical Division, Yamaguchi Medical School (Director: Prof. Dr. AKCRA MATSUMOTO) (Received for publication Nov. 6. 1958.)

I INTRODUCTION

371

For any surgical pro巴edure,it is ide'.11 to obtain a motionless as well as

bloodless operative field with goo企exposure. From this point of view, attempts to use artificially induce1 ventricular fibrillation or cardiac arrest as an adjunct for

open heart surgery and then to resuscitate the heart by means of cardiac massage and countersho~k following the completion of intracradiac surgery were made, and it was reported that both adjuncts provide some advantages.9)19)創刊 However,SASAKI

in our clinic,27J demonstrated that the clinical application of these techniques cannot

be recommended on the basis of the experimental data, which revealed that the results of cardiac exclusion during ventricular 白brillation and cardiac arrest are

worse than during sinus rh~ァthm a:1d cardiac resuscitation consisting of massage and coutershock, sometimes, produces serious myocardial damages such as fragmenta-tion, hemorrhage, degeneration and necrosis.

Recently, the attempt has been made to stop the heart with potassium citrate 3l6J7>s>u 6>22> or acety lcholine雪）Iη18

extracorporeal circulation and then to restart it b~’ reestablishing coronar）’ perfusion with RINGER solution or blood to wash out potassium, or, by neutralizing intraco・

ronary acetylcholine with atropine. Since EFFLER’s success (1956), brilliant achie-

vements have been brought about by this technique in the province of open heart surgery. However, it has not yet gained general acceptance. Theoretically, cardiac

arrest seems句 haveobvious advantages. Would unforeseen difficulties arise with

this new method? The present studies are concerned with this problem.

II METHODS

(1) Elective Cardiac Arrest under Norma and Hypother例叩

Healthy mongrel dogs weighing 6.5-17 kg, were anesthetized with pentobarbital

(30-40 mg/kg). Lung inflation was maintained by intermittent positive pressure

with pure oxygen through an endotracheal tube. Some animals were used under normothermia. The others were cooled by immersion in ice water except their heads

until a rectal temperature of 30-32°C was obtained. After removal from the

water bath the body temperature dropped further to 26-30°C, where it stabilized.

With steril technique, the chest was entered through the right fourth intercostal

space. After the azygos vein was cut between double ligatures, the brachiocephalic

372 日本外科宝函第28巻第2号

artery was completel~’ isolated from the surrounding tissue under local anesthesia

with 0.5% pro~ain solution to prevent ventricular fibrillation due to vagal stimu-

lation. The pericardium was widely opened parallel to the right phrenic nerve. A

catheter filled with heparinized physiologic saline solution was introduced through

an incision of the brachiocephalic artery into the ascending aorta for coronary

perfusion of cardioplegic agent and RINGER solution, respectively, to stop and then

to restart the heart (Fig. 1). The superior and inferior ca val veins were occluded

Fig-. 1 Diagram Illustrating the Method of Stopping and Restarting the Heart

CAT百ETEl¥FOR

CORO百.ll!YPEBF口HON

、、、、、

with tapes (inflow occlusion). After a few l>cats were allowed for cardiac emptying,

the aorta and the pulmonary artery wc1℃ at once occluded with a rubber cord

passed through the tran日versepericardial sinuぉoverthe catheter (out孔owocclusion).

Then cardioplegic agent was rapid l~· petfused until the heart was completely stopped. After cardiac arrest for five and fifteen minutes, respectivel~＇ . in the normo・and

hypothermic state, or, the formation and repair of ventricular septal defect during

cardiac arrest under hypothermia had been performed, coronary perfusion of R1NGER

solution was instituted by gravity白山町 undera difference of 90 cm in elevation.

The perfused solution was aspirated through a right atrial or ventricular incision.

In the second half of this stucl>・ intermittent positi¥'e pressure breathing was not

interrupted even during cardiac exclusion, in order to prevent complications, such

ぉ hemorrhagicatelectasis and hemothorax.

After restarting the heart, inflow occlusion was released so that bubbles were

completely driven out from the opened heart by the blood which would pour into

the cardiac cavity, and then the cardiotomy was sutured just prior to release of

outflow occlusion. Blood was properly allowed to escape from the opened heart to

avoid the over-dilatation of the right heart. When the heart did not regain

EXPERIMENTAL STUDIES ON ELECTIVE CARDIAC ARREST 373

SU自cientlysinus rhythm, 1.0 cc of 1 : 10,000 epinephrine was injected into the left ventricle. The catheter in the ascending aorta was removed. The chest wall was firmly closed with two layers of suture after intrapleural application of penicillin crystal of 200,00 units. No drainage was practised.

(2) Elective Card切cA.rrest with E:xtracorporeal Circulat£o1包

Healthy mongrel dogs weighing 12-17 kg, ＂’er~ anesthetized exactly the 回 meas before. A polyeth)・lene catheter was placed in the femoral artery for direct

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TABLE I. Results of Cross Matchings of Canine Blootl

GROUP

n rn N v (7) (7) (8) (9) (9) l40J

22 30 15 49 45 161

Hemagglutination i l土。 2 11 4 18

]+ 19 7 39 10 16 91

¥ ＋ト。 5 。 2 7 14

Total 284

The figures in parenthesis show the number of dogs.

generally, far slighter than in man. (iii) Out of 284 cross matchings, only 14 (5%) showed distinct hemagglutination (two

plus), a sign whicl】d巴finit巴lyrej巴ctsblood trζ1

The animal was first on the pump-ox:~＇genator “run" with gradually increasing

但ow(the 1st. partial perfusion) . J¥ fter flow an cl arterial pressure had been stabil・

lizcd, inflow and then outflow occlusion were made. Injection of cardioplegic agent

was rapidly performed with a syringe into the proximal aorta through its wall,

where a purse string suture had been previously placed, and continued until the

heart was stopped. The organs other than the heart were protected by extracor-

poreal circulation during cardiac arrest. After twenty minutes of cardiac arrest,

the heart was restarted simpl ；，’ b~： releasing outflow occlusion and allowing coronary

perfusion to resume with oxygenated blood. The blood having flowed into the cardiac cavity from the sinus was aspirated through a right atriotomy which was to be

closed following the resumption of the heart beat. The inflow occlusion was released.

Thus the 2 nd. partial perfusion was instituted. If the heart beat was effective,

the pump-oxyアgenator"run" was discontinued for a trial period. If the heart was

¥Jy itself able to maintain an adequate arterial pressure, the operation was termi-

nated. As previously described, attempts to p1℃vent pulmonary complications and

over-dilatation of the right heart were made. To counteract the heparin e仇ct,

3-4 mg per kilogram of protamine sulfate diluted in 20 cc of 5% glucose was

slowly administered intravenously. The cannulae placed in both caval veins and

the carotid artery were withdrawn. The chest wall was fir・mlyclosed after 200,000

units of penicillin crystal was applied in the pleural cavity, in which a rubber tube was left for drainage.

(3) H istopathological Exanii附 tionson the Heart

When the clogs survived, they were killed. Pieces of cardiac tissue were re・

sected from both ventricular walls and the apex: and then fixed in a 10% formalin solution. From each block, microscopical specimens stained with hematoxylin-eosin were made.

(4) Cardiac Exclusion under Coronary Perfusion with Oxygenated Blood in Hypothermic State

For comparison of the results of the above mentioned studies, this study was carried out.


In hypothermic dogs having a rectal temperature ranging from 25加 27.8°C,

the chest was entered through the right fourth intercostal space, and then a

catheter for coronary perfusion was introduced via the right subclavian branch of

the brachiocephalic artery into the ascending aorta (Fig. 3).

Fig. 3, Diagrammatic Illustration of the Method of Cardiac Exclusion during Sinus Rhythm with Coronary Perfusion of Oxygenated Blood

CAT!iETER FO?. CO五υ目AF.YPEFSUSIO!I

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The blood for perfusion was obtained by bleeding normal dogs from the carotid

artery, after the~’ had been lightl~’ anesthetized with pentobarbital. The blood was

collected in glass bottles containing 29 mg of heparin per 1000 cc of blood and

saturated by bubbling through it a jet of 100 per cent oxygen. Cross-matchings of blood were not undertaken.

Venous in自ow occlusion was made at first. Snaring of the aorta over the

catheter caused all of the blood to enter the coronary arteries by gravity flow

under a di百erence of 1-2 m in elevation. During coronary perfusion, the blood

自owinginto the cardiac cavity from the sinus wぉ allowedto escape through the opened heart.

After twenty minutes of cardiac exclusion, inflow occlusion was released, and

then the cardiotorny was sutured prior to reopening the aorta, taking care to prevent air embolism. At the completion of the operation, protamine sulfate was

not given. The chest wall was firmly closed. No drainage was practised.


III RESULTS

(1）「omparisonof th「Cardioplegic Eff釘tsof a 10% Solution of Potassium

Chloride aJU！“YOUNG Solution＇’

The ideal cardioplegic agent for cardiac surgery should have the following

（・harnctcrist ic日： rapidand complete induction of cardiac arrest, rapid restoration of

cardiac activit~， on re-establishment of coronary perfusion, absence of ventricular

fibrillation, no occurrence of myocardial damage and lack of toxicit~， even if the

entire cardioplegic dose was absorbed into general circulation.

A solution containing 0.54 g per cent potassium citrate and 2.47 g per cent

magnesium sulfate is recommended lη， YouNG et al.23>33> as an excellent solution for

producing cardiac arrest, because these chemicals are more e百ectivein combination

than when used alone, due to their 日Y11Cl＇εi日tic effects. Just prior to using this

solution, small quantities of prostigmin (1 mg per 100 cc) are added. For conveni-

ence we call this mixture “YouNG solution”． To compare the cardioplegic e仔ectsof a 10% KC! solution and “Y ouNG solution”，

the heart in the normothermic state was stopped for 5 minutes with these solutions

and was restarted bγcoronary perfusion with RINGER solution. An experiment

using 18 dogs in all n’as carried out, in which one cardioplegic solution was us凶

for 9 dogs, and the other solution used for the other 9 dogs.

(i) Cardiac Arrest Induced with Potassium Chloride Solution (Table 2, and

Fig. 4)

TABLE 2. Results of Cardiac Arrest Induced with Ten per Cent Potassium Chloride for Five Minutes under Normothermia

Dog No. l恥ei ~olutior I Ventricu凶Fibrillation

η’unvハUqada宅FDヴtoo111111

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(kg) Total (cc)

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11.0 10 0.9

6.5 4 0.6 240 144

9.5 5 0.5 320 144

8.5 5 0.6 140 47

9.5 5 0.5 620 323

8.5 10 1.2 650 300

12.5 15 1.2 1200 260

9.0 10.4 1.2 646 261

＋

＋ No recovery

＋

＋

＋

The amount of the cardioplegic solution perfused to stop the heart ranged

from 4 to 25 cc (10.4 cc on tl淀川℃rage'),i. e., from 0.5 to 3.6 cc per kilogram

(l.2 cc on the a¥'crap:c). On coro11ar.¥・ perfusion with RINGER solution, one of 9

animals did not regain the heart beat. The remaining 8 resumed the cardiac

activit,¥・, but 5 of them had ventricular自brillationafter 20 seconds lasting up to

3 minutes. The time requi1℃d to restart the heart ranged from 4 7 to 630 seconds

(261 seconds on the average) and the amount of RINGER solution perfused to do

EXPERIMENTAL STUDIES ON ELECTIVE CARDIAC ARREST

Fig. 4. Electrocardiographic tracin邑：sinLe企dll made before, and after injection of a 10% KCl solutio恒 intothe coronary circulation (dog No・181. l, Before injection. 2,

Seven seconds after injection : the arrow points out the onset of cardiac arrest. 3, The heart was restarted 4 minutes after coronary perfusion with RINGER solution. 4, Cardiac arrest reappeared 40 seconds after recovery.

Dog No.

TABLE 3. Results of Cardiac Arrest Induced with 11YoUNG Solution" for Five Minutes under Normothermia

W自ght 1---2竺竺竺竺~－－＇一一竺ザ竺n£ Heart I Ventricular I I I R問。E I Fibrillation

(kg) / Total I Per kg [ Solution tee J Time (Sec. J 1

14 I 1.6 I 50 I 25

10 I 1.4 I zoo I 38

20 I 2.0 I zoo I 25

10 I 1.1 I 150 I 65

35 I 3.7 I 250 I 165

10 I 1.4 I 50 I 19

55 I 5.8 I 250 I 49

50 I 3.1 i 50 I IO

20 I 2.1 I 220 I 82

24.9 2 .6 I 158 I 53 I

so from 140 to 1200 cc (646 cc on the average).

377

(ii) Cardiac Arrest Induced with "YouNG Solution" (Table 3, and Fig. 5)

The amount of the cardioplegic solution perfused to stop the heart ranged

from 10 to 55 cc (24 9 cc on the average), i. e, from 1.1 to 5 8 cc per kilogram

(2.6 cc on the average). All 9 animals regained the heart beat. None of them

had ventricular fibrillation thereafter. The time required to. restart the heart

ranged from 10 to 165 seconds (53 seconds on the average) and the amount of

RINGER solution perfused to do田 from50 to 250 cc (158 cc on the average).

378 白木外科宝函第28巻第2号

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Fig・. 5. Electrocardiographic tracings in Lead IT made before, and after injection of “YouNG solution ’into the coronary circulation (dog No. 16). 1, Before injection. 2,

Eleven seconds after injection : the arrow points out the onset of cardiac arrest. 3,

The heart was restarted one minute and 22 seconds after coronary perfusion with Rr~GER solution. 4, Ten minutes after resumption of the heart beat.

In the group of“YouNG solution”， all animals resumed cardiac activity and

thereafter had no ventricular fibrillation. On the contrary, only 3 of 9 cases in

which the heart had been stoppad with potassium chloride permanently regained

the heart beat, 5 had ventricular fibrillation, after having made a transit-0ry

recovery, and one remained in the state of cardiac arrest. The hearts which had

been stopped with“YouNG solution" were far more rapidly restarted than those which had been stopperl with potassium chloride, i. e., the time required to restart

the former was, on the avcrnge, about one司自fthof the time required to restart the

latter.

To sum up，“YouNG solution" was, compared with the potassium chloride

solution, found to be far more beneficial in regard to speed and completeness of recovery.

(2) Cardiac Arrest Induced with “YOUNG solution”for Fifteen M仇utesin

Hypothermic State

Hereafter, only "YouNG solution" was used to stop the heart, because this

solution had been found to be superior to the potassium chloride solution. Eighteen

dogs were divided into 2 group of 9 each. In the second half of this study, the

canlioplegic solution was aspirated 部 much出 possibleimmediately after the heart

had been completely stopped.

(i) Results in the First Half of the Stucly (Table 4)

The amount of“YouNG solution”perfu問 clto stop the heart ranged from 20 to

80 cc (43.9 cc on the average), i. e., from 2.3 to 5.2 per kilogram (3.6 cc on the


TABLE 4. Results of Cardiac Arrest Induced with "YouNo Solution" for Fifteen Minutes under Hypothermia in the First Half of the Study

I YouNG Solution I I ITime of 1 Weight! ccc> / R凶加'ting-Heart I Ventri叩larlcardia~

Dog No・I I I I RcNoE~ So-I Time I Flbrillationlf~clus n (kg) I Total jPer kg! lution (cc) I (Sec.) I 「（Min.)

19 I 1.5 I 20 I 2.1 I sso I 323 I ー I2t.6

Outcome

r

ρLV

ATU

EEA

ミJ

aE

d

∞

児

hD7 20 8.5 I 40 4.7 260 95 16.8 Died after

, 1 hour.

16.3 Killed after , 10 days.

21 16.0 I 40 2.5 120 23

22 10.5 30 2.9 280 53 ＋ 16.2 ! Died of ventri-' cular fibrillation.

23

24

13.0

10.5

30

40

2.3

3.8

220

110

63

22 ＋ 17.2

16.4

//

25 15.5 80 5.2 80 25 17.0

I Died after ! 5 days.

i Di巴dafter I 12 hours. ' // 26 15.0 70 4.7 220 52 17.0

Mean i山 I43.9 I 3.6 i 234 I s2 17.3

average). The time required to restart the heart ranged from 22 to 323 seconds (82 seconds on the average) and the amount of RINGER solution perfused to do

so from 80 to 580 cc (234 cc on the average). The period of cardiac exclusion

ranged from 16.2句 21.6minutes (17.3 minutes on the average). In 2 of 8, ventricular fibrillation occurred following resumption of the heart

beat, 10 and 16 minutes after, respectively. Cardiac resuscitation was not attempted.

Four animals, after having made a good immediate recovery, died within 12 hours after surgery with hemothorax and hemorr・hagicatelectasis. Only 2 survived, but

one of them (No. 25) was killed in an accident 5 days after the operation.

TABLE 5. Results of Cardiac Arrest Induced with 11YooNo Solution" for Fifteen Minutes under Hypothermia in the Second Half of the Study

YooNo Solution Restarting Heart Time of Weight (CC) Ventricular Cardiac Dog No.

~~~~~喫（~~）I Time (Sec.) Fibrillation Exclusion Outcome

(kg〕 Total Per Kg (Min.) 27 17.0 60-30 3.5-1.8 220 50 16.9 Died after

3 days. 28 7.0 20"'-10 2.8-1.4 100 25 16.4 ，， 29 9.5 20-15 2.1-1.6 220 55 16.7 Killed after

13 feal8. 30 9.5 20-15 2.1-1.6 550 215 一 22.0 Kil after

12 t:r~ 31 10.0 20-12 2.0-1.2 60 13 16.3 Kil fter 22 feads. 32 12.0 40-32 3.3-2.7 270 165 18.4 Kil after 19 days.

33 6.8 15-10 2.2-1.5 80 60 17.4 Died after

6 d<ly!! 34 6.0 15-10 2.5-1.7 160 100 17.4 Die ter 3 hours.

Me佃 l9.7 :z6.3吋 2山 208 85 勺，マd唱’A

In the second half of the study "YouNo solution" Wぉ reabsorbedas muchぉ possibleimmediately after the onset of cardiac arrest. The minus figures show the amount Of 11YouNo solution＇’reabsorb巴d.

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第28巻380

(ii) Results in

the Study (Table 5)

The amount of “YouNG solution"

perfused to stop the heart ranged from 15

to 60 cc (26.3 cc on the average), i. e.,

from 2 to 3.3 cc per kilogram (2.7 cc on

the average), and the amount of this

solution aspirated ranged from 10 to 30 cc

(16.8 cc on the average), i. e., from 1.2 to

2.7 cc per kilogram (1.8 cc on the

average).

The time recquired to restart the

heart ranged from 25 to 215 seconds (85

second on the average) , and the amount

of RINGER solution perfused from 60 to

550 cc (208 cc on the average). The period

of cardiac exclusion ranged from 16.3 to

22 minutes (17.7 minutes on the average).

In an:-dog, there wa日 no ventricular

fibrillation following resumption of the

heart beat. Out of 8 animals, one died 3

hours after ぉlll"江er:・,3 died 3 to 6 cla:-s

after with hemorrhagic atelectasis, and 4

日llI・＼＇ivcrl.

The amount of“Y ouNG solution” kilogram which wa日 usedin the

half of the ぉtu<lγ，m’a日，on the average,

three-fourths of that which was used in

the first half. But the amount of RINGER

solution perfused, and the time required to

reト＇tartthe heart were almost the same in

each half.

The improvement in results w川 brou-

ght about I>.¥-: a) the aspiration of as much

of the cardioplegic solution as possible after

stopping the heart; b) the prevention of

the cardiac over-dilatation on the right ;.:idc

purposely Ii:-bleeding the heart from the

atrial incision after release of inflow and

outflow o〔・clusio11s; c) the sufllcicnt perfusion

of RINGER :-.olutiけ11 until complete I仁CO＼＇仁1・y

of the heart, an【ld) balancing the amount

of RINGER solution which 11-a只 perfused

Half of

per

second

目本外科宝函

Second the


TABLE 7. Results of Formation and Repair of Ventricular Septa! Defect during Cardiac Arrest Induced with "YOU>JG Solution" under Hypothermia

i YOUNG Solution Dog No. I Weightl

(kg) To凶 jPerkg

35ホ 12.0 40-5 3.3-0.4

36 15.5 60-35 3.9-2.2

37 12.0 30-25 2.5-2.1

38* 12.5 30-15 2.4-1.2

39 12.3 30-15 2.4-1.2

40 12.0 25-0 1.1-0

41 13.0 35-10 2.7-0.8

42* 10.8 20-10 1.8-0.9

es ar mg ear Ventricul Cardiac

R… lut10n （~~ J (Min.)

80 155 13.0

40 15 11.8

250 100 7.3

180 80 10.0

50 15 7.5

220 50 7.7

160 55 9.7

200 80 9.0

Outcome

[ Killed after 1-1 days. Killed after 12 days. Died after 5 days. Died after 16 hours. Killed after 14 days. Killed after 13 days. Killed afte:r 12 days. Died after

43* I 10.2 I 60-15 I 5.9-r.5 I 180 I 10 1 一 i 10.1 I 12 hours. Killed after 14 days. Killed after 13 days.

44* I 山 I35-15 I 3川 280 I 90 - I 13.5 I

Mean j ロ.2136.5-14.313.0-1.31 161- I 71 : 9.9 I

As in Table 5, the minus figures show the amount of '・ Ynl'.~＂ solution" real:;sorb£d. The cぉesmarked with asterisks were injected with 1: 10,000 epinephrine into the left ventricle

because of an insufficient reco11ery.

into the coronary arteries and that which was allowed to flow into the right

atrium from the sinus, in order to prevent pulmonary edema which might to be

caused by the solution flowing into the pulmonary vci11s beyond the aortic and

mitral valves from the catheter in the ascending aorta.

If pulmonary edema had developed, tracheotomy was u日efulin curing it.

Histological examinations of all hearts subjected to this 日tud~－ revealed that

there were found no myocardial degeneration and necrosis, but there ¥¥'as interstitial

382 日ド外科宝山j第28巻第2号

Fig-. 8. Intimal hyperplasia of myocardium, from <log l'¥o・ 32,which was subjected to cardiac arrest induced with “Y<)L'川； solution”for 15 minutes under hypothermia and killed 19 days after operation.

Fig. 9. Myocardial necrosis with granulocyte infiltration and ca‘ ~ification surrounded by degenerated muscle fib巴rsin the cordial apex, from dog i'¥o. 36, which wぉ killed12 days after operation.

and perivascular edema, and intimal hyperplasia in a small number of dogs, perhaps due to coronary perfusion with RINGER and cardioplegic solutions (Table 6 and Fig. 6, 7 and 8).

3) Formαtion and Repair of Vcntriculal Septal Defect during （＇αrdiac Arrest

in Hypother仰zicState

Ten dogs were used (Table 7). The heart was stopped with“Y ouNG solution" and delivered from the pericardia! sac. 入bout4 cm of a right ventriculotomy was made. After sucking blood from the cardiac ca\'it~ · . 1 to 2 cm of a superficial incision was made in the upper portion of the ventricular septum and then was penetrated into the left ventricular chamber 川 atip of hemostat, whe1℃ a small amount of the arterial blood gushed out from this wound. The defect was closed

with a few interrupted sutures. At the completion of surge1下 the heart was

restarted on coronar~· perfusion with RINGER J州 lution.

The amount of “YOUNG solu lion" required to stop the heart ranged from 20 to

60 cc (36.5 cc on the average), i. e., from 1.1 to 5.9 cc per kilogram (3.0 cc on

the average), and the amount of the solution aspirated after stopping the heart

from 0 to 35 cc (14.3 cc on the average), i. e., from O to 1.5 cc per kilogram

(1.3 cc on the average). The time required to perform the intracardiac procedure

ranged from 3.5 to 10.3 minutes (6.3 minute日 onthe average and the peri吋 of

cardiac exclusion from 7.3 to 13.5 minutes (9.9 minutes on the average). The

time required to restart the heart ranged from 15 to 155 second日（71seconds on

the average), and the amount of RINGER solution perfused to do so from 40 to

280 cc ( 164 cc on the average) .

None of 10 animals had ventricular fibrillation, after having regained the

heart beat. Two died, 16 and 12 hours after operation, respective］~＂ with hemor-

1・hagicatelectasis. Eight survived. Thereafter one of them died of p~·othorax 5

【laysfollowing the日urgery,after haYing made a good recover＞・・

The intracardiac procedure, the formation and repair of ventricular septa!

defect, was achieved easily, because the heart had been stopped in the atonic state.

EXPERIMENTAL STUDIES ON ELECTIVE CARDIAC ARREST 3掛

TABLE 8. Histological Findings of Myocardium Resulting from Formation and Repair of Ventricular Septa! Defect During Induced Cardiac Arrest Nnder Hypo-thermia

Dog No. 1 35 1 36 I 37 1 38 I 39 1 40 I 41 i 42 I 43' Time of Cadiac Exclusion (Min.) 13.0 11.8 7.3 10.0 7.5

l(ji·~I~：； 10:1

Survival Period 14 12 5 16 14 14 グ

Ea~ ta~ ta~ Hours ta~ fa~ LI]a~ Heart L R Degeneration

＋＋＋＋＋十＂・＂一；ーJ~－·弓’J念t::: ー：弓"・タNecrosis 一一＋＋＋一一一件＋＋＋一一一－~ ・- I~ § Interstitial Edema 可司』::l

Perivascular Edema

互選

~ Intimal Hyperplasia 一一一一一一一一一一一一一一市I心明 iM-:fll Fragmentation .;

E雪Hemorrhage

Leucocyte Infiltration

Fig. 10. Circumscribed myocardial necrosis with granulocyte infiltration surrounded by normal muscle fibers in the left ventricular wall, from the same dog as in Fig. 9.

｜一一一一－ _j~irff :fl'

Fig. 11. Extensive myocardial necros路 wit,hgranulocyte infiltration and calc:ification ac-companied by degenerated mu平cle fib匂事

(vacuolization of protoplasm) i~ the: riε}it ventricular wall, from dog 1¥o. 0 39, which was killed 14 days after operation(! ' nwil/I

Histological examinations of the hearts subjected to this study revea\q~l, 0~肝hmyocardial necrosis and degeneration in 2 and onl~’ degeneration in 2 others,

whereas in the remaining 6 the myocardium was almost normal (TatlJ.eci8f' and

Fig. 9, 10, 11, 12, and 13). , (9-g.s・wvβ

(4) Defibrillation by Stoppi仰gand then Restarting the Heart仇 Hypbkhet’捕容tfState fH1ee9.'.l.'.lJJe

We happened to experience that the fibrillating heart can be stopf3~ 榊:iiilit“YouNG solution" and then converted into the normal rhythm by coronary peflfl描胡F

with RINGER solution. This stucl~· was carried out to confirm such a8血t脱出(Table 9). ・110写I

Ventricular fibrillation spontaneously developed in 2 animals during ifc・labi醐 I

of the brachiocephaUc artery through which a catheter was to be introduceif) into

the ascending aorta for coronary perfusion, and was electrically induced in lf1 lt'¥1J11


Fig. 12. Myocardial degenerat10n lPY’cnos1s, loss of transverse striae and deeply stained protoplasm) in the left ventricular wall, from dog i'¥o. 41, which was killed 12 days after operation.

defect, was achieved casil>・, because the heart had been stopped in the atonic state.

thermia

TABLE 9. Results of Defibrillation by Stopping and then Restarting the Heart on Coronary Perfusion with ”y＂＇川；” and Rr引；ER Solutions under Hypo-

Dog N~ ~：；•：＜ヱt45本 11.0 Spontan- I 10 I 25 2.3 1 80 I 15 I 7.4

eousty I I I I I 46 7.3 // I 60 I 20-10 i 2.8-1.4 I 60 I 19 I 1.8

47 11.5 Electrically! 35 I 40-25 3.5-2.2 I 90 I 25 I 2.4

48

49

8.6 ハUn

U

A

U

EA晶言

内

べ

u

n

ぺU

// 50-30

7.5 45-20

20-5

五γ

50 8.2 ，，

80 3.2 : 133.0-15.ol 3.8-2.1 I Mean 9.0 //

The case marked with an asterisk wぉ subjectedto cardiac massag0.

Outcome

Killed after 10 days. Died after 2 days. Killed after 11 days. Died after 2 days. Killed after 10 days.

グ

120

60

70

40 2.6

15

30

2.1

3.0

The duration of fibrillation ranged from 10 to 60 seconds (34 seconds on the

average), and the amount of “YouNG 州 Iu t io11” required to stop the fibrillating

heart from 20 to 50 cc (33 cc on the average). In all animals, the heart wa日

successfully resuscitated. The time required to re日tartthe heart ranged from 15

to 40 seconds (24 seconds on the a ¥'Craどり， theamount of RINGER solution to do

so from 60 to 120 cc (80 cc on the a \'C J刊~e) , and the period of cardiac exclusion

from 1.8 to 7.4 minutes (3.2 minutes on the aver乱問）．

Four animals survived and 2 cliccl, both 2 cl日.＼・s after the operation, with

hemorrhagic atclα・tasis.

（ら） Cardiac I:;:i:rlus ir! 11 for Twc11ty lfi11u /cs du r i ng.1・ .Sin us Rh yt/1111 with Coro-

何aryPerf usio何 ofOxy5;c1Wtcd Blood u111/cr Hypotli「rmia(Table 10)

EXPERIMENTAL STUDIES ON ELECTIVE CARDIAC ARREST

TABLE 10. Results of Cardiac Exclusion for Twenty Minutes durin且・Sinus Rhythm with Coronary Perfusion of Oxygenated Blood under Hypothermia

385

' Perfuse~ Blood I Heart Beat

Dog No., ~~：：~t t Total＜怯ぷ During加山｜ A山 ele制

Outcome

101 I 7.0 ' 800 i 5.7 'Rhythmical 'cardiac Arrest－参；Died

102* 12.0 900

!OSホ 11.5 : 98Q

104 7.5 600

105本 9.5 850

106* 9.5 500

Resuscitatedー•Cardiac immediately.

3.8 Ventricular Fibrillation 1Cjust after〕→Normal'Beat on Perfusion

An℃st // ，，

3.7 .1Rhy伽 i叫 VentricularFibrillation Died of p州 1orax；→Resuscitated !5 days after.

4.0 Ventricular Fibrillation ~ot resuscitated ;pied 1(6.5 min.) !(hemo伽

puh】】onaryedema) 4.5 Ventricular Fibrillation Resuscitat巴d

](18 min.) 2.6 Ventricular Fibrillation'Resuscitated

1(13.5 min.)

Died of Hemotho・

!rax 10 days after. .Died of hemorrha-lgic atelectasis and ・hemothorax ,z days after.

The animals marked with asterisks were injected with 1: 10,000 epinephrine into the left ventricle because of an incomplete recovery. All the hearts except one were resuscitated by means of cardiac massage and countershock.

The blood perfused ranged from 2.6 to 5.7 cc per kilogram per minute (4.1 cc

on the average). In all cases, ventricular fibrillation and/or cardiac arrest occurred during cardiac exclusion or just after release of it. All the hearts but one were

resuscitated l乃’ meansof cardiac massage and countershock. Three of 6 cases died

immediately after the operation. The remaining 3 died of complications such as hemothorax, hemorrhagic atelectasis and pyothorax within 10 da~·s following the

surgery, after having made a good recoverγ． (6) Card印cExclusion for Twenty Minutes duri仰g Card臼cArrest I何duced

初 ith“YOUNGsolution”under Extracor poreal Circulation Six dogs were used in this study (Table 11). The amount of “Y ouNG solution”

required to stop the heart ranged from 16 to 60 cc (32 7 cc on the average), i. e.,

from 1.3 to 4.6 cc per kilogram (2.4 cc on the average).

In 5 cases, the heart beat was regained by re-establishing corona1、3・circulation.

The time required to restart the heart ranged from 9 to 50 seconds ( 42 seconds on the average). In one, ventricular fibrillation occurred just after release of

outflow occlusion. Defibrillation was successfull ,. achieved b~· means of cardiac

mas回 geand countershock.

Out of 6 animals, 2 survived, 2 died, 2.5 and 10 hours after the operation,

respectively, and the remaining 2 both died 3 da>・s following the surger~· ， after having made a good recoven". In these cases, the cause of clcath was p1・ofuse intrapleural hemorrhage.

The period of the 1st. partial perfusion ranged from 1 to 4.9 minutes (2.9

minutes on the average), that of the total perfusion from 20.3 to 27.8 minutes

(22.2 minutes on the average), and that of the 2nd. partial perfusion from 2.5 to

15.2 minutes (5.9 minutes on the average). The flow rate during total perfusion

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述極端ゆ溌 N 叩・

Outcome r

e

＆ E U

S E A a e a

－川町ι H

－ H ， d

l ・l t

K M

21

40

!Died after

'3 days.

[Died a伽

2.5

hours.

Died after

10 hours.

Died after

3 days.

420

＋

3.4

4

2.1

30

12

I幻

140～

I

31.0

120

Dog

No. 204 w

as resuscitated by m

eans

of cardiac

massag

e and countershock.

38

2.5

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1.3

16

(kg)

a － q r u に d n u．．．．

η r u q δ っ “ 勺 3

1 1 1 1

DogiWeight

No・

TABLE 11.

Results of Cardiac Exclusion for Twenty Minutes during Cardiac A

rnst

Induced ＂’ith

"YouN

u Solution”

under Extracorporeal Circulation

YouN<i Solutio

i

,

I

n I I

Partial Perfusion I

Total

Perfusion

I II

Partial

Perfusi

I

I

I_

－」一一

n ,Ventri-¥Time Requi-

I

IB!ood ;Rectal1

.

I

!Blood TRectall

I

iFlow

[Blood Rectal!

I la

ired to

Res-

Total

!Per kg

l~r昨日

mp~！~

~p1l［~u叫

p刈remp

－！~~~il

IR~~a-

jcc/

[Pr仕

Temp－［恕

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3 I 2.0 I 80

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s1l40～

gol 36.5 I z I 5.s

1301

I

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80～

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i.o

I so～

137.5→

12→4

1201

I

!

I 1001

37.0

50～

I 37.o

I 1→

3 I 3.3 !

30～

136.8→

I 1→

2

701

I

I

I

801 38.0

75～

I 38.0

I 1

I

3.0

I 30～

I 37.5

1001

I

I

I

60

120

I 39.0 I

2 I

4.9

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701

70～

138.5→

I i→

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901

37.0

203

204

205

90

5.5

2

55

21.5

4.6

60

206

50

9

3.2

15.2

2→1

2→

1

38.0

60

47

77

20.9

21.0

2→3

3.3

90～

I 39.o

110

1.7

1.4

28

22

16.7

15.5

207

2081

387

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EXPERIMENTAL STUDIES (J;¥J ELECTIVE CARDIAC ARREST

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ventricular fibrillation occurred during

the recovery phase. In contrast, none

of nine in the series using of“YouNG solution" had such a complication.

Moreover, the time required to restart

the heart in the latter was on the

average less than one-fifth of that in

the former.

Consequently, as cardioplegic agent,

“YouNG solution" containing two com-

ponents, potassium citrate and magル

esium sulfate, is found to be superior

to potassium chloride solution in rega-

rd to speed and completeness of recov-

er~·. and particularly in regard to the

absence of troublesome complications

such as ventricular fibrillation. This

matter is brought about lηthe fact

that 日＞・ncrgist::; act more effective!>・

and less harmfully when used in com・

bination than when used alone.

The same principle is, generally,

employed in combined anesthesia. In

this point of view, combination of

potassium citrate and acetylcholine is

re~ommended.12'

Histological Findings of Myocardium Resulting from Induced Cardiac ;¥I'!' 引 tfor Twenty Minutes under Extracorporeal Circulation

と！こI20s ! 206 I日_, 20.3 I 27.8 I 21.6 I 21.5 I 20.9 ! 21.0

I I '2.5 I ' 114 T〕乳ys;l4Days[ 3 Days1 Ho凹 sl!OHours3 Days

LRILRILRJLRILR LR

土－！一一｜一一 lー

+ -I一一 lー

第2号第28巻日本外科宝函

TABLE 12.

388

208 203

＋

Time of cardiac Exclusion 1Min1

Sun・ival Period Heart

I Dege…ti on :'¥ccrosis Interstitial Edema Perivascular Edema Intimal Hyperplasia Fragmentation Hemorrhge Leucocyt巴 Infiltration

Ez－－Z4・当－rHJト

＋

発 Thedog was resuscitated by cardiac massage and countershock.

Cardiαc Arrest lndured with “you入’G solution”for Fifteen Minutes under

Hypothermiα．一一Inthis stud~＇， oni>・ two of eighteen dogs had ventt允ularfibrillation

during the 1・ccovcr>・phase. This complication is apt to follow cardiac exclusion

during sinus rh:dhm under hypothermia cyen with coronary perfusion of oxrnenated

blood. This matter will be discussed in detail.

According to ".¥lELROSE et al., the addition of stimulants, such as calcium

chloride or adrenaline, is unnecessar＞’and may be dangerous in resuscitating potas-

sium arrest: spontaneous heating- starts again usually with pure LocK solution

perfusion. 1¥lso, we used oni.'・ RINGER solution with sati日factor.¥・results.

BERMAN et al.U demonstrated that quinidine given preoperatively decreases

the incidence of ventricular fibrillation following cardiac arrest induced with aceth-

ylcholine in h;>pothermic dogs. This method seem日 tobe worth tr・.＇・ing-.

As described under“：＼lcthods＇’，there were many causes of improvement of the

sur¥'ival rate. The most important of these was the aspiration of the cardioplegic

solution immediately after the induction of cardiac arrc日t. No fibrillation was

encountered since having- emplo）’eel this technique. Con日cquentl.¥・,the minimum

quantity of cardioplegic a広entshould be used.

It was found that the right atrial pi℃ssu re m日＿，.rise to dangerously high levels

when the heart is released from arrest. The川、er-distension of the right atrium

is eliminated purpose］：γiJ.'・ bleeding the heart from the right atriotorny prior to its complete closure.

During the rccn¥'er.¥・ phase, a part of RINGER solution mれγflow back adversely

into the pulrnonai・.＼.veins beyo1ul the aortic and mitral ¥'al¥'cs, causing pulmonary

edema. This complication can be prevented IJ_,. maintaining the balance between

the amount of RINGER Rolution perfu日eeland that aspirated.

Formαti rmαIll! Repαir of Vcntrirulαy Septa[ Defect durinρCardiac Arrest u11der

Hypothermiα.－1¥ complete¥.¥ motionless and blooclless operation field ＇＇引 obtained.

The heart could be free ！~· handled, particularly placing exact sutures when repairing

the ventricular c;cpta I defect becauseりrits complete flacciclitγ. In I℃suturing the

＋＋


cardiac wound, the elimination of coronary air embolism was almost counted for nothing. It is noticeable that none of ten animals having undergone the surgery had ventricular fibrillation in spite of direct manipulation of the heart. The operation was achieved quite easily and waR followed by good results (an eighty per cent survival rate).

The one disadvantage incidental to this technique is that a certain time is required to restart the heart following completion of the operation. However, this period seems to be negligible, because it was, on the average, on ！~’ one minute and eleven seconds.

Crossmatching Donor and Recipient Dogs.一一一Theexperiments of carqiac arrest with extracorporeal circulation and cardiac exclusion during sinus rhythm with coronary perfusion of oxygenated blood were carried out without regard for the possibility of blood incompatibility among dogs. We carried out 284 times of crossmatching according句 SAKAUCHI and :VIATSUHAsm,26> and round that five per cent of the tests showed distinct agglutination. (Suspicious and faint reactions were excluded.) HERMSWORTH et al.ゆ reported that strong agglutination was noted in about twenty-five per cent of the examinations in which the recipients cells were matched with plasma from the prospective donors and replacement transfusion with the blood known to be incompatible caused renal ischemia and infarction, and severe pulmonary edema. SHoTsu29> demonstrated that massive exchange of such blood is an important factor of postoperative bleeding.

Accordingly, there is little doubt that better results would be obtainεd if the determination of blood incompatibility had been carried out.

Cardiac Exclusion during S印us Rhyth1”for Twenty Minutes with Coronary Perfusion of Blood under Hypothermia.一一The coronary perfusion is carried out to prolong the回 feperiod of cardiac exclu~ion and to avert ventricular fibrillation. However, troublesome complications occur frequently even with this technique.10ns> 25)30)32)"

In all six animals subjected to this experiment, fibrillation and/or arrest occur-red during exclusion or after release of it. ＼司7iththe exception of one, resuscitation was successfully achieved h~・ means of massage and countershock. Nevertheless, there was no long-term survivor.

The causes of death were hemothorax, hemorrhagic atelectasis and pyothorax. Postoperative bleeding seemed to be due to perfusion of incompatible blood or no application of protamine sulfate.

The blood perfused ranging from 2.6 to 5.7 cc per kilogram per minute was adequate, judging from the experimental data reported l巧ーRIEERIet al..

Induced Card叩cArrest for Twenty Minutes with Extracorporeal Circulation. 一一Perusalof the literature on extracorporeal circulation γieldecl a surpri~ing variation in the reported flow rate (cc per kilogram per minute), i. e., GrnsoN 83-124, KIRKLIN 50-80, KAY 40-80, LILL回目 26-60. In this stud~·， the blood perfused during total perfusion ranged from 4 7 to 81 cc per kilogram per minute.

One of six animals had ventricular fibrillation during the recover＞’phase, but W制 resuscitatedby means of massage and countershock. This animal was able


to survive fairly well. KoLFF et al. reported that a second arrest with p6tassium

citrate is more effective procedure than electric shock to defibrillate the heart.

The cause of death in two animals which died three da:;s after the surger~－，

was, in spite of postoperatiYc application of protarnine aulfate, profuse intrapleural

hemorrhage perhaps due to incompatible blood transfusion. It is recommenclccl by

KAPLAN et al.14l that the left Cl l l・iumcannulatecl and kept at normal pressure during

potassium citrate cardiac arrest in order to remove the blood with a high potassfom

content in pulmonar.；・circulationand to prevent postoperative complications, inclu-

ding pulmonary collapse and hemorrhage. Such a technique was not employed in

the present study. Microscopical Examinations of Hearts.一一一Inthe experiments of cardiac arrest

induced with“YouNG solution" for fifteen minutes under hypothermia, there were

found no myocardial clegenerntion or necrosis, but interstitial and perivascular edema,

and intimal hyperplasia in Cl small number of dogs. These histological changes are

supposed to result from coronary perfusion of the cardioplegic agent and RINGER

solution. In six of ten hearts subjected to the formation and repair of ventricular septa!

defect during cardiac arrest under hypothermia, the m~·ocardium was almost normal

and in the remaining four, degeneration and/or necrosis perhaps due to incidental

trauma were found.

Cardiac exclusion during induced arrest for twenty minutes with extracorporeal

circulation did not cause any histological change of the myocardium in the large

majorit~’ of animals. On the other hand, it is known that only four to six minutes

of inflow and outflow occlusion, if carried out under normothermia, will result in

moderate m ≫ocardial damage. Con問quentl~·， it ma:-・ be said from the histological

point of view, that twent:-・ minutes of cardiac exclusion under such circumstances

is within the safe time limit. IよoLLFdemonstrated that a dog’s heart will resume

a sinus rhythm after three hours of ar同日t. It is of interest to know this maxim-

um safe time.

Defibrillation by Induced Cardiαc Arrest.-i¥s described already, defebrilla-

tion was successfully achieved Ii,¥・ stopping and then restarting the heart with

coronan・ perfusion of, respective].¥", carclioplegic agent and RINGER solution. This

technique is of practical use in regm-cl to absence of ill e宵ecton the heart, even

though it does not act a日 promptl,¥'a日 theresuscitation con日islingof massage and

countershock which may produce seyere myocardial damage.

V SUl¥L¥IARY

(1) The present studies hnve been carr色cl out to know whether elective

cardiac arrest can be an useful acljunct to open heart surger:;.

(2) In dogs, a catheter waバ introduced tin・OU江h the brachiocephalic artcr¥

into the ascending aorta for coronarJ’ perfusion of cardioplegic agent and RINGER

solution, 1℃ト；pectively,to stop an<l then restart the heart.

(i) To compare the cardioplegic e百ectsof 10% potassium chloride and a


solution containing 2.47 Gm per cent magnesium fulfate and 0.54 Gm per cent

potass~nm citrate (YouNG solution), the heart in the normothermic state was

stopped with these solutions for 5 minutes and then I℃started. The latter proved

to be more beneficial in regard to speed and completeness of recovery, as well as

causing no provocation of ventricular fibrillation.

(ii) In hypothermic dogs, cardiac arrest for 15 minutes was induced with

“YouNG solution”and followed b~・ resuscitation. In the first half of the experim-

ents, only 2 of 8 animals, but in the second, 7 of 8 survived. The improvement

was brought about bγ：a) the aspiration of as much of the cardioplegic rnlution as

possible after stopping the heart; b) the prevention of the over-diぉtensionof the

right atrium by purposely bleeding the heart from the atrial incidion; c) the

sufficient perfusion of RINGER solution until the accomplishment of a complete

recovery, and d) the prevention of pulmonary edema which might be cam・cd bプ

RINGER solution flowing back into the pulmonary veins bey’ond the aortic and

mitral valves from the catheter in the aorta.

In no case was there found myocardial degeneration or necrosis, but in a few,

interstitial and perivascular edema and intimal h~’perplasia.

(iii) Under hypothermia, the formation and repair of ventricular septal

defect during induced cardiac arrest was achieved easily and with excellent results.

No ventricular fibrillation was encountered. Histologicallyア myocardialdegeneration

and necrosis were found only in a small number of animals.

(iv) Defibrillation was successfull~· achi€\·ed b~・ stoppin広 and then restarting

the heart with coronary perfusion of, respectiYel~－， canlioplegic agrnt and RINGER

solution. This technique, which produces no myocardial damage, is of practical use.

(3) For comparison, the experiments of cardiac exclusion for 20 minutes with

coronary perfusion of oxygenated blood under hypothermia were carried out. In all

animals, ventricular fibrillation occurred during exclusion or after release of it. The

results were poor.

( 4) Under extracorporeal circulation, the heart was excluded during induced

cardiac arrest for 20 minutes and then restarted bY re-establishment of coronan-

circulation. In onlJ-’ one of 6 animals, ventricular fibrillation developed. On histol-

ogical examination, the myocardium was normal in almost all animals.

I am greatly indebted to Assist. Prof. Dr. RrKIO YA＂ほ 1of our clinic for his constant, kind guidance during the course of the present studies. An abstract of this article has been reported by Dr. Y AllAIU at the 11th Annual Meeting of

the Japanese Association for Thoracic Surgery on Sept. 26, 1958.

REFERENCES

I) Berman, E. J., Taylor, 1¥1. T., and Fisch, C.: Experimental Prevention of Ventricular Fibrillation Following Hypothermia and Induced Cardiac Arrest. J. Thorac., 1!5 .. 483, 1958.

2) Brockman, S. K., and Fonkalsrud, E.: Experimental Open Heart Surgery Employing Hypothermia, Mecholyl Arrest, and Carotid Perfusion. Surg., 43, 815, 1958.

3) Darby, T. D., Parker, E. F., Lee，羽T.H., Jr., and Ashmore, J. D.: The Inflence of Cardio-Pulmonary Bypass with Cardiac Arrest and Right Ventri:culotomy on Myocardial Contra-ctile Force. Ann. Surg., 147, 596, 1958.

4) Dewall, R. A., Warden, H. E., Gott, V. L., Read, R. C., and Lillehei, C. ¥V.: Total Body

392 日本外科宝函 U¥28巻第2号

P巴rfosionfor Open Cardiotomy Utilizing the Bubble Oxygenator. Physiologic Responses in

Man. J. Thorac. Surg., 32, 591, 1956.

5) D2wall, R. A., 可司Tard巴n,H. E., Read, R. C., Gott, V. L., Ziegler., N. R., Varco, R. L., and

Lillehei, C. W.: A Simple, Exp~ndabl e, Arti日cial Oxygenator for Open Heart Surgery.

Surg. Clin. ~orth Amer., 36, 1025. 1956.

6) Effler, D. B., Grove~. L. K., Sones, F. l¥I., Jr., and Kollf, W. J.: Elective Cardiac Arrest

in Open Heart Surgery; Report of 3 Cases. Cleveland Clin. Quart., 23, 105, 1956.

7) Effler, D. B., Groves, L. K., Sones, F. :II., Knight, H. F., Jr., and Kollf, W. J. K.: Elective

Cardiac Arrest. An Adjust to Open-Heart Surεcry. J. Thorac. Surg., 34, 500, 1957.

8) Effler, D. B., Knight, H. F., Jr., Gro¥・es, L. K., and Kollf, W. J.: Elective Cardiac Arrest

for Open-Heart Surgery. Surg. Gyn. & Obst., 105, 407, 1957.

9) Glenn, W. L., and Swell, ¥V. H., Jr.: Experimental Cardiac Surgery, N The Prevention

of Air Embolism in Open Heart Surgery; Repair of Intraauricular Septal Defect. Surg.,

34, 195, 1956. 10) Grow, J. B., Demonε，C. V., and Ha＼＼’cs, C. R.: Surgical Treatment of Ventricular Septal

Defects: A l¥1Ethod Utilizing Selecti＼・e C可or・onary Perfusion and Hypothermia. J. Thorac.

Surg., 32., 669, 1956. 11) Hale, D. E., l¥loraca, P. P .. and Wasmuth, C. E.: Elective Cardiac Arrest during Cardio-

tomy. Sunrniar｝・ of37 Cases. Anesthesiol., I~ . :r1s. 1957.

12) Hase, K.: Rroceeding oi the 22 ml. Annual Meeting of the Japanese Circulation Society,

1958. 13) Hermsworth, J. A., Clark, L. C., Kalant, S., Sherman, R. T., and Largen, T.: Arti品cial

Oxygenation and Circulation during Complete By-pass of the Heart. J. Thorac. Surg., 24,

117, 1952.

1-!) Kaplan, S., Clark, L. C., Mathews, E. C., Echrnrds, F. K., Schwal, L., and Helmsworth, J.

A.: A Compairsion of the Results of Total Body Perfusion in Dogs during Potassuim

Citrate Cardiac Arrest, Sinus Rhythm, and Induced Ventricular Fibrillation. Surg., 43, 14,

1958.

15) Kay, J. H., Gaertner, R. A., Isa日目，J.P., and D引 er.R. : Coronary and Carotid Artery

Perfusion During Total By-Pass of the Heart. J. Thorac. Surg., 33, 526, 1957.

16) Kollf, W. J., Effler, D. B., Groves, L. K., and Moraca, P. P.: ElectiYe Cardiac Arrest with

Potassium Citrate during Open-Heart Operations: Report of Thirty-seven Cases. J. A. M.

A., 164, 1653, 1957.

17) Lam, C. R., Gahagen, T., !¥Iota, C., and Green, E.: Inciuced Cardiac Arrest (Cardioplegia)

in Open Heart Surgical Procedures. Surg., 43, 7, 1958.

18) Lam, C. I:.. Gahagan, T., Sergeant, C. K., and Green, E.: Experiences in the Use of

Cardioplegia (Induced Cardiacλ1-rest) in the Repair of Ir.L・aventricular Septa! Defects.

J. Thorac., 34, 509, 1957.

19〕 Lam,C. R., Geoghegan, T., and Lepore, A. : Inducell Cardiac Arrest for Intracardiac

Surgical Procedures, An Experimental Study. J. Thorac Surι，30, 620, 1955.

20) L'.im, C'. ！~ .， Thomas, G., Charles, S., and Edward, G.: Clinical Experiences "・ith Induced

Cardiac Arrest during Intracar<liac Surgical Procedures. Ann. Surg., 146, 439, 1957.

21) Lillehei, C. W., D,•\rnll, R. A., Read, R. C., ¥Va1・den, H. E., and V丘町。，R L. : Direct Vision

InLracardiac Surgery in Tlfan Using a Simple, Disposable Artificial Oxy広enator.Dis. Ches., 29, ] , 1956.

22) l¥Ierlos巴， D.G., Dreyer, B., Bentall, H. H., and Baker, J. B. E.: Electi¥・e Cardiac Arrest. Lancet, 2, 21. 1955.

23) Menitt, D. M. H., Sealy, W. C., Young, W. G., Jr., and Harris, J. S.: Potassium, .Magne-

sium, and Neostigmine for Controlled Cardioplegia: Evaluation with Isolated Perfused Cat Heart. Surg., 7li. 365, 1958.

24) Mould己r,P. ¥'., Th"・npson, R. G., Smith. C、A., Siegel, B. L, and Adams, W. E. : Cardiac

Surgery with Hypcthe1-.nia and Ant1lcholin Arrest. J. Thorac. Surg., 32, 360, 1956.

25) Riberi, A., Grice, P., Rodriguez, R., Kajikuri, I-I., and Shumacker, H. B., Jr.: Prolongation• of Safe Period of Venりu~ Inflow Occlusion in ll.vpothermi仁 Stateby Coronary and Carotid


Artery Perfusion v:ith Oxygenated Blood. J. Thorac. Surg., 32, 399, 1956.

26) Sakauchi, G. and Matヨuhasi,T.: St~ul ies on Cross-mat~hing of the Do;(s Blood Concerning ロ’ithExtracorporeal-circulation. Medicine and Biolog-y, 37, 171, 1955.

27) Sasaki, K.: Experimental Studies on Artificially Induced Ventricular Fibrillation and

Cardiac Arrest for Open Heart Surgery under Direct Vision. Arch. Jap. Chir., 26, 835,

1957. 28) Senning, A. : Ventricular Fibr‘illation During Extracorporeal Circulation. Act瓦Chir.Scand.

Supp., 177, 22, 1952. 29) Shotsu, A.: Studies on the artificial Heart-Lung System, w:th Special References to

the Influence against the Individuals and the Causes of D2ath. J. J. A. T. S., 6, 745, 1958.

30) Shumway, N. E., Gliedman, M. L., and Lewis, F. J. :. Co'ronary Perfusion for Longer

Periods of Cardiac Occlusion Under Hypothermia. J. Thorac. Surg., 30, 598, 1955. 31) Shumway, N. E., and Lewis, F. J.: Induced Ventricular Fibrillat：りnfor Experimental

Intracardiac Surgery under Hypothermia. Ann. Surg,. 143, 230, 1956. 32) Spencer, F. C., Jude, J. R., and Bahnson, I-I. T.: Th巴 Useof Coronary Perfusio:1 and

Carbon Dioxide Regulation in Intracanliac Operations Performed under Hyp心t:1ermia.

Surg., 42, 76, 1957. 33) Young, W. G., Jr., Sealy, W. C., Brown, I. W., Jr., Hewitt, W. C., Jr., Callaway, H. A.,

Jr., Merritt, D. H., and Harris, I. S. : A Method for Controlled Cardiac Arrest as An

Adjunct Open Heart Surgery. J. Thorac. Surg., 32, 604, 1956.

和文抄録

直視下心内手術に於ける任意心持停止

の応用に関する実験的研究

Jll

山口県立医科大学外科学教室第l講座（主任：松本彰教授）

日召

1. 任意心持停止が直視下心内手術に於て有用な補

助手段であるかどうかを実験的に検討した．

2. 犬を用い腕頭動脈より大動脈起始部までポリエ

チレン管を挿入し Inflow-Outflow閉鎖後直にこれよ

り心縛停止剤を冠動脈内に；iニ入して心待停止を起こさ

しめ，一定の時間後或は心内操作終了後リンゲル氏液

の冠滋流によって心蘇＇L~行った．i) 心待停止剤として10%KC！溶液と.2.47Gm

硫酸マグネシウム及び0.54Gm%クエン酸カリの混

合溶液（YOUNU氏液〕を用いp 常温下5分間の任意

心持停止実験により両者を比較した．心蘇生の迅速

なこと，心室細動を誘発しないことに於て YouNG

氏液が透かに優れている．

ii）全身冷却犬に対し You:-;u氏液を用い15分間

の任意心持停止実験を行った．実験の前半期では8

例中僅か2例が生存したが後半期では8例中 7例が

生存した改善の原因は心博停d1をrn:に注入された

心持停止剤を吸引排除したことp 心持再開後心房．切

開創を完全に閉鎖するに先立ち漸時出血せしめ右房

の拡張を防止したこと，完全に心持が再開するまで

充分リンゲル氏液の辺；.~！＇／；［を行ったこと，リンゲル

氏液の冠海流に際しこれが大動脈弁更に僧帽弁を逆

島貞

流し肺静脈に流入して起こる蹄浮腫の予防に留意し

たことである．組織学的には少数例に心筋の間質及

びj血管周囲浮腫，動脈内膜肥厚を認めた．大多数例

では心筋は正常であった．

iii）全身冷却犬を用い Yov：＞＜＞氏液による任意心

持停止下に心室中隔欠損作成並に閉鎖実験を行っ

た．手術は容易で結果良好であった．心室細動を起

こした例は 1例もなく，緩く少数例に心筋の変性壊

死が見られたに過ぎない．

iγ）任意心持停止下にリンゲル氏液の冠濯流によ

る心持再開は心室細動除去に利用できる．本法改心

筋を障害しないので｜ね11~1'!'-J応用の価値があると恩わ

れる．

3. 以上の実験と比較するためlこーな身冷却犬で酸素

加血冠潅流下に20分間心血流遮断を行った．全例に心

血流遮断中或は遮断解除後心室組動を発生し結果は不

良であった．

4. 体外循環下に Y< 11 •：－.•：氏液を用い20分間の心持

停止実験を行川冠血流の再開により心蘇生を行っ

た． 6例中 1例に心室細動が発生した．殆ど全例に於

て心筋は正常像を示した．

Documents

Title EXPERIMENTAL STUDIES ON ELECTIVE …EXPERIMENTAL STUDIES ON ELECTIVE CARDIAC ARREST 373 SU 自 ciently sinus rhythm, 1.0 cc of : 10,000 epinephrine was injected into the left