Korean J Thorac Cardiovasc Surg.  2007 Jan;40(1):8-16.

Histidine-tryptophan-ketoglutarate Versus Blood Cardioplegic Solutions: A Prospective, Myocardial Ultrastructural Study

• Kim S
• Lee YS
• Woo JS
• Sung SC
• Choi PJ
• Cho GJ
• Bang JH
• Roh MS

Abstract

BACKGROUND: We performed a prospective clinical study to evaluate the ultrastructural integrity of the myocardium after using Histidine-Tryptophan-Ketoglutarate (HTK) solution in comparison with blood cardioplegic solution during congenital heart surgery. MATERIAL AND METHOD: Twenty two patients with acyanotic heart disease, who were scheduled for elective open heart surgery, were randomized into two groups. The HTK Group (n=11) received HTK cardioplegic solution; the blood group (n=11) received conventional blood cardioplegic solution during surgery. The preoperative diagnoses included ventricular septal defect (n=9) and atrial septal defect (n=2) in each group. A small biopsy specimen was taken from the right ventricle's myocardium, and this was processed for ultrastructural examination at the end of 30 minutes of reperfusion. Semiquantitative electron microscopy was carried out "blindly" in 4 areas per specimen and in 5 test fields per area by 'random systematic sampling' and 'point and intersection counting'. The morphology of the mitochondrial membrane and cristae were then scored. The interstitial edema of the myocardium was also graded. RESULT: The semiquantitative score of the mitochondrial morphology was 19.65+/-4.75 in the blood group and 25.25+/-5.85 in the HTK group (p=0.03). 6 patients (54.5%) in the blood group and 3 patients (27.3%) in the HTK group were grade 3 or more for the interstitial edema of the myocardium.
CONCLUSION
The ultrastructural integrity was preserved even better with HTK solution than with conventional blood cardioplegic solution.

Keyword

Myocardium; Myocardial reperfusion; Microscopy, electron; Heart defects, congenital

MeSH Terms

Biopsy
Cardioplegic Solutions*
Diagnosis
Edema
Heart Defects, Congenital
Heart Diseases
Heart Septal Defects, Atrial
Heart Septal Defects, Ventricular
Humans
Microscopy, Electron
Mitochondrial Membranes
Myocardial Reperfusion
Myocardium
Prospective Studies*
Reperfusion
Thoracic Surgery
Cardioplegic Solutions