SEQUENTIAL ELECTROCARDIOGRAPHIC ANALYSIS OF STONE HEART SYNDROME IN A PATIENT SUPPORTED SIX DAYS WITH AN ABDOMINAL LEFT VENTRICULAR ASSIST DEVICE (ALVAD)

A 21-year-old male patient underwent aortic and mitral valve replacement for progressive cardiac failure due to acute bacterial endocarditis. Ischemic myocardial contracture developed during attempts to restore cardiac activity following hypothermic, ischemic, cardioplegic arrest. An abdominal left ventricular assist device (ALVAD) was implanted and supported the circulation for nearly six days prior to cardiac transplantation. The preoperative EKG showed sinus tachycardia with left anterior hemiblock. Postoperatively, there was complete electromechanical dissociation. The postoperative EKG showed a superior and leftward shift of the axis. There was a marked loss of QRS voltage and variable degrees of atrioventricular block. At times, only P waves were present. On the fourth postoperative day, there was an axis shift to the extreme right. Prior to transplantation, sinus rhythm returned, and the axis shifted leftward once again. The common denominator of all the abnormal postoperative electrocardiograms was the conspicuous low voltage that probably signified early and extensive myocardial damage. To our knowledge, this is the first instance wherein a sequential electrocardiographic analysis of stone heart syndrome has been undertaken.     

Myocardial lysosomes in pressure-overload hypertrophy

Summary Combined electron microscopic and cytochemical studies were used to investigate the effects of chronic-pressure overload hypertrophy on myocardial lysosomes, mitochondria, and myofibrils in the left ventricle of the cat. Myocardial hypertrophy was induced by an 84% banding constriction of the ascending aorta. After one month of aortic constriction the experimental animals demonstrated a 51% increase in left ventricular mass. No qualitative ultrastructural differences were noted between the myocardial tissues of the hypertrophy and normal group. However, the cytochemical reaction product to acid phosphatase appeared more frequently in the myocardium of the hypertrophy group compared to that of the normal group. By use of quantitative morphometry the percentage of mitochondria, myofibrils and lysosomes per myocardial cell was determined in both hypertrophy and normal groups of animals. Despite significant increases in the left ventricular mass of hypertrophy animals, a normal balance of mitochondria and myofibrils was maintained within the myocardium. Further analysis indicated an enhanced lysosomal population in the hypertrophy group compared to the normal group.This research was supported by a grant from the California Affiliate of the American Heart Association     

Effects of allopurinol pretreatment on myocardial ultrastructure and arrhythmias following coronary artery occlusion and reperfusion

The effect of the xanthine oxidase inhibitor, allopurinol, on myocardial ultrastructure after left circumflex coronary artery occlusion (40 min) with or without reperfusion (60 min) was examined in rabbits. Pretreatment of rabbits for 7 days with allopurinol (0.1% in the drinking water) resulted in a lower incidence of ventricular fibrillation in both ischemic and reperfusion phases. However, the number of Q waves, ST-segment elevation and premature ventricular contractions were similar in both groups of animals. Examination of hearts from allopurinol-treated animals revealed a distinct decrease in ultrastructural alterations following ischemia and reperfusion. Among the subcellular organelles studied, allopurinol had a preferential protective effect on the mitochondria both during the ischemic and reperfusion phases. In the allopurinol-treated animals, most mitochondria were intact and the cristae network preserved. Our study suggests that the preservation of mitochondrial structural and functional integrity by allopurinol may be an important determinant of its protective actions in myocardial ischemic/reperfusion injury.     

Pathological findings of cardiac rhabdomyomatosis in the guinea pig

Cardiac rhabdomyomatosis of Hartley guinea pigs was examined by light and transmission electron microscopy, and its incidence and distribution were also described. Cardiac rhabdomyomatosis was found in 58 cases out of 345 animals, aged from 1.5 to 17 weeks. A few small lesions were noted in many cases, but large lesions were rare. Most lesions noted in the ventricle were found to measure from 1 mm2 to 5 mm2 in area. The larger lesions were seen near the cardiac apex. In terms of distribution of the lesions, they were observed most frequently in the left ventricular free wall. They were also distributed less frequently in the ventricular septum and in the right ventricular free wall. In bilateral free walls and the ventricular septum, this lesion was frequently noted on the endocardial side and in the tunica muscularis, respectively. Light microscopically, this lesion had a characteristic nodular-reticular structure with large vacuolated cells. Electron microscopy of cardiac rhabdomyomatosis revealed two cell types, A and B. Type A cells were characterized by large aggregates of glycogen particles distributed loosely in the cytoplasm and by myofibrils and mitochondria located at the periphery of the cytoplasm. Type B cells were characterized by large aggregates of mitochondria near the nucleus and at the periphery of the cytoplasm and by large aggregates of glycogen particles with a similar distribution to those in type in type A cells. Myocardial cells in the marginal regions of rhabdomyomatosis lesions showed mitochondrial swelling and rupture of myofibrils.(ABSTRACT TRUNCATED AT 250 WORDS)     

Ultrastructure of isoproterenol-induced myocardial damage in chick embryos

Isoproterenol is known to cause severe myocardial lesions when given in toxic doses to adult homoiotherms. Previous studies on chick embryos revealed myocardial damage with scattered necroses in the outer layer of ventricular myocardium. The present ultrastructural study, performed on embryos 6 to 20 days old, has shown various types of cellular lesions; mainly cellular oedema, mitochondrial swelling, necroses of isolated cardiac muscle cells, fatty degeneration, accumulation of glycogen, and signs of increased proteosynthesis in the surviving muscle cells. Morphological features of the lesions differed from those which are known to be induced by isoproterenol in adult animals and seemed to depend on the stage of embryonic development.     

慢性心力衰竭大鼠心肌毛细血管密度及血管内皮生长因子变化

目的观察慢性心力衰竭大鼠心肌毛细血管密度及血管内皮生长因子(VEGF)变化,探究冠脉微循环障碍的病理特点及病因机制.方法实验组(n=15)皮下注射异丙肾上腺素,对照组(n=10)皮下注射生理盐水,间隔24h,连续2次.12周后测定血液动力学;计算左心室重量/体重;HE染色、Masson染色分别观察左心室病理改变、胶原变化;西非单叶豆素组织化学染色结合图像分析确定心内膜下心肌毛细血管密度、心肌细胞密度、毛细血管密度与心肌细胞密度的比值(毛细血管/心肌细胞);观察心内膜下心肌VEGF免疫组织化学变化.结果同对照组比较,实验组左心室收缩、舒张功能下降(P<0.05);左心室重量/体重升高(P<0.001);心内膜下心肌散在坏死,胶原沉积;心内膜下心肌毛细血管密度、心肌细胞密度、毛细血管/心肌细胞下降(P<0.05);VEGF合成增加(P<0.001).结论慢性心力衰竭大鼠心内膜下心肌毛细血管分布稀疏;该区域毛细血管代偿性生成减少与心肌VEGF表达无关.     

The features of mitochondria of cardiomyocytes from rats with chronic heart failure

Electron-microscopy study of rat myocardium 2 weeks after a heart attack revealed significant alterations in the ultrastructure of cardiomyocytes than for the control. The location of myofibrils was less regular than for normal cells. The population of interfibrillar mitochondria decreased. Mitochondrial cristae were located less densely and formed cellated structures. Swollen mitochondria were observed in the periinfarction and intact areas, indicating the development of ischemia in the myocardium as a whole. Six months after the occlusion of coronary vessels alterations in the location of myofibrils and mitochondria were mainly observed in the peri-infarction area. Mitochondria also formed cellated structures. A 30% decrease in the density of the arrangement of the inner membranes of mitochondria on an area unit was found in the periinfarction zone. The ratio between the relative volumes of mitochondria and myofibrils in the cardiomyocytes of the peri-infarction area was increased by 20%. The area of mitochondria in the intact zone of the left ventricle was 30% greater than for the control. A study of isolated living cardiomyocytes revealed that the mitochondrial- membrane potential in the rats subjected to myocardial infarction half a year ago previously was significantly lower than for the mitochondrial-membrane potential in the control rats. Thus, cardiomyocytes that were similar to healthy cardiomyocytes in their morphology exhibited lower total mitochondrial-membrane potential, indicating their decreased energy state.     

Effect of chronic stress on the ultrastructure of the myocardium and hypothalamus of "emotional" and "nonemotional" rats

The influence of chronic stress on the ultrastructure of the myocardium and hypothalamus was studied in experiments on male rats with different levels of emotional-behavioral reactivity. "Emotional" rats manifested a pronounced increase in glycogen granules in myocytes and intercellular space, appearance of the areas of overcontraction of myofibrils, conglomerates of aggregated platelets in myocardial capillaries, and red cell egress from myocardial and hypothalamic capillaries. Alterations in the ultrastructure of the myocardium and hypothalamus in "nonemotional" rats were less marked and consisted in the appearance of the areas of overcontraction of myofibrils, enlargement of sarcoplasmic reticulum caverns, and in an increase in the lipid content in cardiomyocytes. The ultrastructural changes in the myocardium and hypothalamus of "emotional" and "nonemotional" rats indicate different reactivity of the animals and are likely to be accounted for by different levels of activation of their adrenergic systems.     

Isoproterenol-induced myocardial ischemic injury in the rabbit: functional and ultrastructural alterations

The functional and ultrastructural changes observed during myocardial ischemic injury (MII) in the rabbit are described. MII was induced by repeated subcutaneous injections of increasing doses of isoproterenol (ISO; 0.5 mg/kg on day 1, to 15.5 mg/kg on day 15). Measurement of cardiovascular changes revealed a significant decrease in the mean arterial pressure and an increase in heart rate of the ISO-treated animals. ISO treatment also initiated a variety of atrial and ventricular arrhythmias, including ventricular fibrillation, as well as significant ST segment elevations and the appearance of Q waves. Electron-microscopic analysis of hearts from ISO-treated animals showed accumulation of lipid and depletion of glycogen. The myofibrils had poorly defined Z bands and appeared as a homogeneous mass. The most marked effects of ISO treatment were on the mitochondria, which appeared swollen and fragmented. The mitochondrial cristae were also disrupted and fragmented. A few amorphous electron-dense bodies were observed in and around the mitochondria. The changes observed in this study are qualitatively similar to those observed in the rabbit following coronary artery ligation.     

缺血后功能低下大鼠心肌钙与水含量的变化及高渗甘露醇的影响

缺血后心室功能减低(myocardial stunning)的发生机制迄今尚不明了。本实验以 Lang-cndorff 法在离体灌流的大鼠心脏,研究了全心缺血20min 及再灌注40min 后心肌 Ca~(2+)、Na~+K~+、Mg~(2+)及 H_2O 含量的变化,以及高渗甘露醇对缺血后功能低下心肌的影响。实验发现:(1)缺血/再灌注后心肌组织中 Ca~(2+),H_2O 的含量与非缺血组相比分别增加42%(P<0.01)及7.6%(P0.05)。(2)于再灌注同时给予12%高渗甘露醇可明显改善缺血后心室功能:再灌注40min 时,心率-左室压乘积恢复达缺血前的85%,而不给甘露醇仅恢复66.3%(p<0.01);高渗甘露醇同时消除了缺血后功能低下心肌中 Ca~(2+)超负荷与心肌水肿,此现象提示缺血/再灌注引起的肌膜非特异性通透性改变,很可能是钙进入细胞内的路径之一。本研究结果表明,心肌 Ca~(2+)超负荷及轻度心肌水肿参与了缺血后心室功能低下,高渗甘露醇在离体大鼠心脏可明显改善缺血后功能低下心肌的功能,此作用至少部分是由于其具有减低心肌钙与水含量的效应。     

Lesions of ventricular cardiomyocytes in experimental massive pulmonary embolism]

The damage of ventricular myocardial cells during acute experimental massive pulmonary embolism (MPE) was studied by light, polarization and electron microscopy on anaesthetized dogs. In cases, when MPE was followed by heart failure, the deep ir reversible damage of myofibrils took place, and the relative volume of myofibrils decreased in both ventricles. The damage of right ventricular myocardium, which works against increased postload during MPE, may be reason of right ventricular insufficiency.     

Prevention of disorders of cardiomyocyte ultrastructure in experimental myocardial infarction in immobilization-induced stress by administration of thyroid hormones

In the experiment, carried out on 48 non-inbred male rats ultrastructural changes in cardiomyocytes in non-ischemized parts of the heart at experimental infarction of myocardium under conditions of immobilization stress have been studied, as well as possibility to correct these changes by means of thyroid hormones. The stress intensifies dystrophic processes, developed outside the infarction zone, increases the mass of the necrotized tissue, essentially decreases the areas occupied by mitochondria and myofibrils, as well as their ratio in the section area. Small doses of thyroid hormones prevent the heart from the damaging effect of the stressor: decreasing area; occupied by mitochondria, myofibrils and their relation in the section, as well as they stimulate intracellular regenerative processes (accumulation of polymorphous mitochondria with clearly manifested cristae, membranes of the endoplasmic reticulum) and decrease the myocardial necrotized zone). Thus, structural lesions, resulted from the effect of ischemic necrosis and stress, can be prevented by small doses of thyroid hormones+.     

Ultrastructure of the myocardial junctions of the chick embryo at an early stage in the organogenesis of the heart

The ultrastructural features of the myocardiocyte junctional systems have been studied in the heart right myocardium of 6 day chick embryos in order to analyze the relationships between the spatial arrangement of the myocardial fibres and the formation of the myocardiocyte junctions. The myocardiocytes are remarkably branched, joined in small fibres to form a loose network with large intercellular spaces and appear well differentiated, rich in organelles, myofibrils and glycogen. Adherent-type junctions and well differentiated desmosomes are detectable at the level of the termino-terminal contacts between myocardiocytes, where the plasma membranes appear more or less complicately interconnected; nexus-type junctions are seen in the latero-lateral contact regions. The results indicate that already at an early stage of the heart organogenesis the myocardium intercellular junctions are similar, on the whole, to those described in the adult, so that they would not seem to be transitory or modifiable structures. The changes in the spatial orientation of the myocardial fibres, which take place after the 6th incubation day, could be allowed by the network-like arrangement of the primitive myocardium and presumably conditioned by the blood flow in the developing heart.     

葛根素对糖尿病心肌细胞的保护及其机制研究

观察葛根素（Puerarin）对链脲佐菌素（streptozotocin,STZ）诱导的糖尿病大鼠心肌细胞的保护作用,并探讨血小板反应素1（Thrombospondin-1,TSP-1）的表达改变及其作用。雄性SD大鼠45只随机分为三组（n=15）：糖尿病组和葛根素治疗组采用一次腹腔注射链脲佐菌素（STZ）65mg／kg制备糖尿病模型,其中葛根素治疗组于造模后葛根素腹腔注射4周（100mg/kg/day）,正常对照组仅腹腔注射等量生理盐水（6ml／kg）,同样喂养4周。四周后各组大鼠处死。H—E染色及透射电子显微镜观察三组大鼠心肌细胞纤维显微结构和超微结构的病理改变．免疫组化和实时荧光定量PCR法观察大鼠心肌细胞中TSP-1蛋白和mRNA表达的变化．同时利用Langendorff离体心脏灌流法测定各组大鼠心室肌细胞功能。结果发现葛根素治疗组较糖尿病组大鼠的体重增加明显,同时血糖下降,有显著性差异（P〈0．01）。H—E染色显示糖尿病大鼠多处心肌肌丝紊乱伴少量炎症细胞浸润,电镜下发现有线粒体嵴消失溶解,肌丝排列紊乱等病理改变,而葛根素治疗组大鼠偶见上述病理变化。免疫组化显示葛根素治疗组心肌内TSP-1阳性细胞密度小于糖尿病大鼠,TSP-1 mRNA表达也比糖尿病大鼠要低。此外葛根素治疗组大鼠的左室收缩末压（LVSEP）、左心室舒张末期压（LVEDP）等心功能指标均明显低于正常组（P〈0．01）,但较糖尿病组有显著改善（P〈0．01）。上述结果显示葛根素能保护糖尿病大鼠心肌细胞的高糖损伤和维持心室肌细胞的功能,而该机制可能与抑制心肌细胞TSP-1表达的水平有关。     

中海拔地区慢性暴露大鼠心肌及肝脏的光镜及电镜观察

目的 探讨中度海拔高度地区慢性低氧大鼠心肌、肝的组织学及超微结构变化。方法 本实验用Wistar大鼠20只,雌雄各半,六日内从海拔5米运至海拔3418米饲养,8周后断头处死大鼠,留取心肝组织作光电镜观察,同时高原暴露前后测定血RBC数及Hb含量。结果 心肝组织学改变主要为细胞水肿,即心肌颗粒变性,肝细胞疏松化,其次为心肌、肝细胞嗜酸性变。心肌组织有少量小灶状坏死,肝组织中未见坏死。超微结构主要有肌浆网扩张,线粒体肿胀,糖元颗粒减少,未见不可逆性损伤如线粒体出现杆状嵴、三膜嵴及核染色质边聚现象。毛细血管内皮细胞多有突起伸向管腔,胞质空泡变性,微饮泡较少。另外,高原暴露后RBC数及Hb含量明显升高。结论 该海拔地区慢性低氧大鼠心肌、肝组织及毛细血管的病变是可逆性的; 左右心室病变程度无显著性差异; 肝组织的病变程度明显轻于心肌组织。     

Myocardial Dysfunction Induced by Food Restriction is Related to Morphological Damage in Normotensive Middle-Aged Rats

Summary Previous works from our laboratory have revealed that food restriction (FR) promotes discrete myocardial dysfunction in young rats. We examined the effects of FR on cardiac function, in vivo and in vitro, and ultrastructural changes in the heart of middle-aged rats. Twelve-month-old Wistar-Kyoto rats were fed a control (C) or restricted diet (daily intake reduced to 50% of the control group) for 90 days. Cardiac performance was studied by echocardiogram and in isolated left ventricular (LV) papillary muscle by isometric contraction in basal condition, after calcium chloride (5.2 mM) and beta-adrenergic stimulation with isoproterenol (10⁻⁶ M). FR did not change left ventricular function, but increased time to peak tension, and decreased maximum rate of papillary muscle tension development. Inotropic maneuvers promoted similar effects in both groups. Ultrastructural alterations were seen in most FR rat muscle fibers and included, absence and/or disorganization of myofilaments and Z line, hyper-contracted myofibrils, polymorphic and swollen mitochondria with disorganized cristae, and a great quantity of collagen fibrils. In conclusion, cardiac muscle sensitivity to isoproterenol and elevation of extracellular calcium concentration is preserved in middle-aged FR rats. The intrinsic muscle performance depression might be related to morphological damage.     

Myocardial ultrastructure and electrocardiograms of the sloth (Bradypus tridactylus) under normal and experimental conditions

Adult sloths (Bradypus tridactylus) were studied by electrocardiography and by light and electron microscopy under normal conditions and under experimental conditions as provided for by injection of 2,4-dinitrophenol (DNP) and ether anesthesia. ECG's of the animals indicated heart rates of 45–71/min, which can be considered as the normal heart rate of the sloth under laboratory conditions. Under normal conditions, the contracted ventricular myocardium of the sloth exhibited (a) a wrinkled sarcolemma, (b) the usual pattern of myofibrils and of sarcoplasmic reticulum, (c) small mitochondria with spiked and branched, often anastomosed cristae, including a few small intramitochondrial dark bodies, (d) an amount of sacrcosomes smaller than the amount of myofibrils, (e) many glycogen granules, isolated, in the form of a chain, or as clusters, in subsarcolemmal, intermyofilamentous and perimitochondrial positions, (f) few multivesicular bodies and (g) large flat sections of the transverse tubular system. Injection of DNP (1 mg/kg) caused tachycardia. With ether anesthesia, the ECG showed monophasic action potential of myocardial injury and prolongation of inter or intraventricular condition. Electrically, the sloth's heart responded to hypoxia as do other mammalian hearts. The administration of DNP produced (a) derangement and reduction in number and length of the mitochondrial cristae, (b) disappearance of spikes, connections between the cristae and, consequently, the honeycombed arrangement, (c) increased matricial space in the center of mitochondria which was often filled with a grayish substance, (d) disappearance of small dark intramitochondrial granules, (e) depletion of glycogen particles and (f) few dilations in the sarcoplasmic reticulum.     

Gene expression of adrenomedullin in failing myocardium: comparison to atrial natriuretic peptide.

The expression of adrenomedullin (AM) and atrial natriuretic factor (ANF) were investigated in the myocardium of a rat model of chronic ischemic heart failure (CHF) compared with sham-operated controls. In addition, human myocardium of patients with end-stage heart failure due to idiopathic dilated cardiomyopathy compared with myocardium of normal subjects (NF) was studied. In CHF, similar AM levels but increased ANF expression were observed in left ventricular myocardium, as assessed by semiquantitative PCR. Functional experiments with freshly excised papillary muscles showed no influence of AM on myocardial contractility. In NF human myocardium, the expression of AM mRNA was threefold higher in atrial compared with ventricular tissue. In analogy, ANF mRNA was increased by approximately 15-fold in atrial tissue. In dilated cardiomyopathy, the expression of AM was significantly increased in right and left ventricles compared with NF. In parallel, ventricular ANF expression was enhanced.     

Role of mitochondrial swelling in the energetic effectiveness of intact myocardial cells (according to electron microscopy data)]

The myocardium of the left and the right cardiac ventricles was studied at various seasons on 20 rabbits. There was found a distinct seasonal dynamics of a number of quantitative indices of electronograms. In particular, there was found a relationship between the coefficients of energy efficacy of the mitochondria (integral value--calculated by multiplying the mitochondrial area by the number of mitochondrial cristae) and the mitochondrial area. With increase of the latter to 0,85 mc2 this relationship is positive and linear. With further swelling of the mitochondria this relationship disappears, however.     

缺血预处理降低大鼠心室易颤性

本实验应用离体大鼠Ｌａｎｇｅｎｄｏｒｆｆ灌流模型,研究模拟缺血预处理（ＩＰ）对心脏的保护作用。发现ＩＰ可引起心室颤动阈（ＶＦＴ）升高、心律失常发生率和严重程度降低、心室有效不应期短时延长。ＩＰ对心脏的保护作用在预缺血后３０ｍｉｎ已基本消失。提示ＩＰ对离体大鼠心肌有保护作用,且时间较为短暂。