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The current views of the authors regarding the relationship of the cardiac performance and its myocardial oxygen consumption and the relationship of the latter to coronary blood flow are presented. Recent attempts, including our own, to devise an index of total cardiac effort that will relate to the myocardial oxygen consumption are discussed. It is concluded that the cardiac performance requiring oxygen determines coronary flow while the arteriovenous oxygen difference across the bed remains constant. However, the level of the arteriovenous oxygen difference is altered by local conditions of oxygen and carbon dioxide concentrations, and the presence of catecholamines. Hence, the level of coronary flow for a given amount of cardiac oxygen consumption is altered by these circumstances.

(1) This study demonstrates that a major component of the injury that occurs when the hypoxic heart is abruptly reoxygenated is caused by oxygen radicals produced by white blood cells; (2) this injury can be prevented by a leukocyte-depleting filter; and (3) avoidance of this injury improves postbypass myocardial and pulmonary function. These data suggest that leukocyte depletion should be used routinely in all children undergoing operations for cyanotic heart disease or extracorporeal membrane oxygenation.

After 2 hours of warm pulmonary ischemia, (1) a severe lung injury occurs after uncontrolled reperfusion, (2) controlled reperfusion with either a modified reperfusion solution or white blood cell filter limits, but does not avoid, a lung reperfusion injury, (3) reperfusion using both a modified reperfusate and white blood cell filter results in complete preservation of pulmonary function. We therefore believe surgeons should control the reperfusate after lung transplantation to improve postoperative pulmonary function.

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