Treatment of Left Ventricular Free Wall Rupture with Fibrin-glue in dogs

• Published in: Japanese Journal of Cardiovascular Surgery Vol. 24; no. 1; pp. 18 - 23
• Main Author: Ogiwara, Masanori
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society for Cardiovascular Surgery 1995
• ISSN: 0285-1474; 1883-4108
• DOI: 10.4326/jjcvs.24.18

To examine the effectiveness of fibrin-glue (FG) in fatal left ventricular (LV) free wall rupture (LVFWR), acute myocardial infarction (AMI) in the LV anterior wall was produced in 18 mongrel dogs (weighting 6.8-14.4kg) by coronary ligation under general anesthesia. A punched-out hole made in the center of the AMI area using a Scanlan aortic-punch (E.D.=5.5mm) was closed immediately with a 3-0 polypropylene stitch and a heating electrode. Hemodynamic stability was obtained within 30 minutes after closure of the pericardium and thoracotomy. Then the stitch was cut by heating the electrode with an electric power of 0.45 Watt and LVFWR was induced. Hemodynamic parameters were assessed until cardiac arrest in 12 dogs (controls), and FG therapy was performed on 6 dogs (FG group) at 20min after the rupture with pericardial centesis and drainage, and infusion of 1 unit FG into the pericardial space. FG was composed by Solution A (5, 000 units of Thrombin-Green Cross+50, 000 units of Trasyrol+10ml of Carcicol) and Solution B (1g of Fibrinogen HT-Green Cross+20ml of Saline). The administered dose of Solution A was 1ml/kg and that of Solution B was 0.7ml/kg. All dogs of the control group died within 50min, however, 4 of 6 dogs of the FG group survived. The blood pressure in the control group was 108±28mmHg before the rupture and 48±41mmHg at 20min after the rupture, but no significant blood pressure was observed at 40min after the rupture. On the other hand the average blood pressure of the 4 surviving dogs in FG group was 93±12mmHg at 40min after the rupture and 90±15mmHg at 80min after the rupture and the level of blood pressure was maintained until the end of the experiment. In conclusion, FG therapy may be a promising therapy for LVFWR instead of surgical repair, which has a extremely high mortality.