Myocardial ischaemia and cardiopulmonary bypass

Benzing, George; Stockert, James; Nave, Ed; Kaplan, Samuel

doi:10.1093/cvr/7.2.186

Cited by 5 publications

(2 citation statements)

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“…42 Bicarbonate, inorganic phosphates and THAM 39 have been used as buffcring agents to minimize the ischaemic injury. Inorganic phosphates have been considered better as buffering agents than bicarbonates) 3 Cold blood cardioplegic solutions have been used both experimentally and in clinical practice with satisfactory results due to higher oxygen carrying capacity. 33 The possible demerits of cold blood cardioplegia are rouleaux formation 43 poor control of ionic composition and presence of undesirable products of extracorporeal circulation, such as catecholamines) 3 Routine screening for cold agglutinins should be done.…”

Section: Constituents Of the Cardioplegic Solutionsmentioning

confidence: 99%

Myocardial protection during cardioplegia in open-heart surgery: a review

Chatrath

Kaul

Walker

1980

Canad. Anaesth. Soc. J.

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The use of cardioplegia (pharmacologically induced electromechanical arrest) to achieve the ideal conditions for cardiac surgical operations was introduced over 20 years ago in clinical practice. Since then a number of ingredients have been added in various proportions to different cardioplegic solutions and their evaluation in experimental laboratories and clinical practice has continued. Any additive to a cardioplegic solution should be investigated in experimental laboratories and asanguinous cardioplegic solutions should be carefully formulated to avoid extremes of ionic concentrations, pH and osmolarity. Cold blood cardioplegia has not been found advantageous when compared with conventional asanguinous solutions. A combination of pharmacologically induced arrest with cold asanguinous cardioplegic solution and topical hypothermia protects the myocardium better than topical hypothermia alone or normothermic cardioplegia, and continuous infusion of cardioplcgic solutions has proved no better.than multidose administration. Multidose administration of cold eardioplegie solutions with moderate hypothermia and surface cooling has been found most satisfactory for prolonged aortic cross clamping (up to two hours). Use of cardioplegia in recent years has undoubtedly improved the prognosis of a number of patlents undergoing surgical correction of complex cardiac lesions.CARDIAC SURGICAL PROCEDURES often require a bloodless, relaxed and motionless field during operation, which is easily accomplished by ischaemic arrest induced by cross clamping the aorta. Any period of ischaemia is accomplished by metabolic and structural changes which determine the functional recovery of the heart in the postoperative period. The safe period of ischaemia for the human heart is not clearly defined but 20-30 minutes is generally considered the upper limit. When aortic cross clamping time exceeds this period substantial subendocardial necrosis may occur, with low output syndrome in the postoperative period. The need for protection of the myocardium during ischaemic arrest has been well recognized and a number of methods including local t and systemic hypothermia, 2 intermittent coronary perfusion) retrograde coronary perfusion with cold blood, 4 coronary perfusion with cold lactated Ringer's solution, s tetrodoxin, 6 acetylcholine,7 chemical asanguinous K + cardioplegia, s cold blood cardioplegia, 9 have been used in experimental studies and clinical practice. Of these, hypothermia and pharmacological arrest with cold cardioplegic solutions have now gained wide acceptance in clinical practice.Department of Anaesthesia and Cardiovascular Unit, Killingbeck Hospital, Leeds, England.Reprint requests to Dr. R.R. Chatrath, Consultant Anaesthetist, Killingbeck Hospital, Leeds, LS 14 6UQ, England.Canad. Anaesth. Soc. J., vol. 27, no. 4, July 1980 METHODS OF MYOCARDIAL PROTECTION Topical hypothermiaHypothermia has been proved to be an effective method of myocardial preservation. It provides a bloodless arrested heart, lowers the energy re...

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Section: Constituents Of the Cardioplegic Solutionsmentioning

confidence: 99%

Myocardial protection during cardioplegia in open-heart surgery: a review

Chatrath

Kaul

Walker

1980

Canad. Anaesth. Soc. J.

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“…These include continuous hypothermic coronary perfusion (Hirose and Bailey, 1969); intermittent coronary perfusion with hypothermic blood (Ebert et al, 1962) or with normothermic blood (Benzing et al, 1973); low-pressure coronary perfusion (Brown et al, 1969); and topical cardiac hypothermia (Robicsek et al, 1970), although its prolonged application may result in myocardial and pericardial damage. In direct myocardial revascularization retrograde perfusion through the coronary sinus has been employed satisfactorily (Hammond, Davies, and Austen, 1967).…”

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Myocardial ultrastructural changes during extracorporeal circulation wtih anoxic cardiac arrest and its prevention by coronary perfusion. Experimental study.

Jl¹,

Bullón²,

Fuente³

et al. 1975

Thorax

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. (1975). Thorax, 30,[371][372][373][374][375][376][377][378][379][380][381] Myocardial ultrastructural changes during extracorporeal circulation with anoxic cardiac arrest and its prevention by coronary perfusion. Experimental study. This experimental work has been carried out with the aim of studying the ultrastructural myocardial changes caused by prolonged anoxic cardiac arrest during cardiopulmonary bypass, and their prevention by means of two different techniques of coronary perfusionsystemic-pressure continuous and low-pressure intermittent perfusion.After 30 minutes of cardiac anoxia, the ultrastructural changes of the myocardial cell were reverted to normal by coronary perfusion; when anoxic cardiac arrest was prolonged up to 60 minutes there was severe myocardial damage, with marked mitochondrial changes and dehiscence of intercalated discs, which persisted in spite of restoring coronary flow. These morphological data were in accordance with the fact that no dog which underwent anoxic cardiac arrest for 60 minutes recovered.Both intermittent and continuous coronary perfusion were effective in preventing anoxic damage; cardiac muscle cells were better preserved by low-pressure intermittent perfusion than by systemic-pressure continuous perfusion, which caused intracellular and intramitochondrial oedema.

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