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Eur J Cardiothorac Surg 2003;24:404-410
© 2003 Elsevier Science NL

Impairment of coronary flow reserve and left ventricular function in the brain-dead canine heart

^a Department of Cardiovascular Surgery, Faculty of Medicine, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
^b Department of Cardiovascular Surgery, Fukuoka Children's Hospital and Medical Center, Fukuoka, Japan

Received 29 October 2002; received in revised form 16 April 2003; accepted 12 May 2003.

^* Corresponding author. Tel.: +81-92-642-5557; fax: +81-92-642-5566
e-mail: yooo{at}heart.med.kyushu-u.ac.jp

Objective: The mechanisms of cardiac dysfunction after brain death, which are thought to be mainly associated with massive catecholamine release, have not been fully elucidated, especially with respect to the coronary circulation. The aim of this study was to investigate the changes in function of the coronary artery and its contribution to hemodynamic deterioration in a canine brain death model. Methods: Brain death was induced by rapid inflation of a subdurally placed balloon catheter. Hemodynamic measurements including assessment of left ventricular contractility using pressure–volume relations and biochemical analyses of blood samples were performed in seven dogs. Coronary flow reserve in the same brain death model was assessed by changes in coronary flow and resistance induced by administering a vasodilator directly into the coronary artery in another eight dogs. Results: A hyperdynamic response was transiently observed after induction of brain death, followed by decreases in arterial pressure, cardiac output, and coronary blood flow. Parameters of left ventricular contractility as measured by pressure–volume relations had significantly deteriorated by 60 min after brain death. Percent changes in coronary flow by administration of acetylcholine and sodium nitroprusside were 272 and 209%, respectively, before brain death; these were decreased to 178 and 145% at 30 min after brain death, and to 192 and 153% at 60 min. Coronary resistance ratios were also significantly increased at 30 and 60 min after brain death. Conclusions: Impairment of coronary flow reserve was found in the brain-dead canine heart. This impaired coronary circulation may constitute a disadvantage of prevention and recovery of cardiac dysfunction after induction of brain death.

Key Words: Brain death • Coronary flow reserve • Heart failure • Transplantation

Abbreviations: Ach, acetylcoline • AoF, aortic flow • AoP, aortic pressure • CBF, coronary blood flow • CVP, central venous pressure • dE/dt_max, slope of dP/dt_max–V_ed relation • dP/dt_max–V_ed, maximum first derivative of LV pressure versus end diastolic volume • ECG, electrocardiogram • E_es, slope of P_es–V_es relation • LA, left atrium • LAD, left anterior descending artery • LAP, left atrial pressure • LV, left ventricle • LVP, left ventricular pressure • mAoP, mean aortic pressure • M_sw, slope of SW–V_ed relation • P_es–V_es, end-systolic pressure–volume • SNP, sodium nitroprusside • SvO₂, venous oxygen saturation • SW–V_ed, stroke work–end diastolic volume

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