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Circulation, Vol 82, 1020-1033, Copyright © 1990 by American Heart Association
W Ganz, I Watanabe, K Kanamasa, J Yano, DS Han and MC Fishbein
The purpose of this study was to confirm or disprove the existence of
reperfusion-induced extension of necrosis. To avoid the effect of the
variability of collateral circulation when groups of dogs are compared, we
compared the effect of reperfusion and nonreperfusion on myocardial
necrosis in a single ischemic territory, half of which was reperfused and
half of which was not. The left anterior descending coronary artery (LAD)
territory between its last diagonal branch and the apex was studied because
it was found to have uniform collateral blood flow. In 20 dogs, the LAD was
occluded for 90-240 minutes to produce necrosis of different degrees of
transmurality. Before release of this occlusion, the LAD was occluded
distally halfway to the apex to keep the distal half nonreperfused. After 5
minutes of proximal reperfusion. Monastral blue dye was injected into the
left atrium for demarcation of the reperfused region, and the heart was
arrested, excised, cut parallel to the LAD, and placed into triphenyl
tetrazolium chloride (TTC) solution for delineation of the region of
necrosis. The validity of TTC staining under the conditions of this study
was confirmed by light and electron microscopy. The transmurality of
necrosis, measured within 1 or 0.5 cm on either side of the boundary,
ranged from 30% to 88% of wall thickness and was not different in the
reperfused compared with the nonreperfused region (paired t test).
Reperfusion did not advance the epicardial edge of necrosis compared with
the nonreperfused region. In conclusion, at 5 minutes after reperfusion,
comparison of necrosis in the reperfused and nonreperfused halves of a
single ischemic territory could not demonstrate an extension of necrosis by
reperfusion.
ARTICLES
Does reperfusion extend necrosis? A study in a single territory of myocardial ischemia--half reperfused and half not reperfused
Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif.
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