Myocardial protection during cardiac ischemia by coronary perfusion with cold lactated Ringer's solution plus mannitol.

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Abstract
This experimental and clinical study evaluates the degree of myocardial protection afforded by coronary perfusion with cold lactated Ringer''s solution plus mannitol. In the experimental study, diluted blood at 30.degree. C (control G.), lactated Ringer''s solution at 4.degree. C (G. A), 1000 ml lactated Ringer''s solution plus 200 ml of 20% mannitol at 4.degree. C (G. B), and 1000 ml lactated Ringer''s solution plus 500 ml of 20% mannitol at 4.degree. C (G. C) were used for coronary perfusion. The myocardial-protecting effect of each perfusate was evaluated by examining serum isoenzymes (CPK-MB [creatine phosphokinase], LDH [lactate dehydrogenase]1+2), left ventricular function (Vmax, LVEDP [left ventricular end-diastolic pressure], CO [cardiac output]), and the ultrastructure of myocardium. There were no significant differences in myocardial changes between the control group, G. A and G. B. LVEDP increased significantly in G. A and a significant increase in CPK-MB was seen in G. C. Mitochondrial scores for each group were 98 (control G.), 86 (G. A), 93 (G. B) and 51 (G. C). Minimal myocardial change was seen in G. B. In the clinical study aortic root perfusion with cold lactated Ringer''s solution (400 mosm) under aortic cross clamping (27-144 min) was employed in 25 patients. They all survived and CPK-MB returned to preoperative values within 49 h after operation. In 6 cases, the ultrastructure of left ventricular papillary muscle was examined. No significant mitochondrial changes developed during aortic cross-clamping.