Circulation, Vol 87, 230-239, Copyright © 1993 by American Heart Association
B Shivalkar, J Van Loon, W Wieland, TB Tjandra-Maga, M Borgers, C Plets and W Flameng
BACKGROUND. Studies done in potential donors for heart transplantation and
in experimental animals have suggested that brain death can have major
histopathological and functional effects on the myocardium. METHODS AND
RESULTS. We developed experimental models of brain death using dogs to
study the hemodynamic and catecholamine changes, the extent of myocardial
structural damage, and the recovery potential of donor hearts obtained from
brain-dead donors. Brain death was caused by increasing the intracranial
pressure (ICP) suddenly or gradually by injecting saline in an epidural
Foley catheter. In a first series of experiments, dogs given a sudden rise
in ICP (n = 5) showed a hyperdynamic response and a 1,000-fold increase in
the level of epinephrine after brain death. Histology revealed 93 +/- 2% of
the myocardium to be severely ischemic. Dogs given a gradual rise in ICP (n
= 6) showed a lesser hyperdynamic response, almost 200-fold increase in the
level of epinephrine after brain death, and mild ischemic damage to the
myocardium (23 +/- 1%). In a second series, hearts obtained from brain-dead
and non-brain-dead donors were transplanted in recipients, and the weaning
and recovery potential were studied. All four recipients with hearts from
non-brain-dead donors were weaned with good functional recovery. Also, all
four recipients with hearts from brain- dead dogs given a gradual rise in
ICP were weaned with only moderate functional recovery. However, only two
of four recipients with hearts from donors given a sudden rise in ICP were
weaned and showed poor functional recovery. CONCLUSIONS. Our results
indicate that a sudden rise in ICP can cause irreversible myocardial
damage.
ARTICLES
Variable effects of explosive or gradual increase of intracranial pressure on myocardial structure and function
Department of Cardiac Surgery, Katholieke Universiteit Leuven, Belgium.
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