| Does myocardial protection work? | |
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MedLine Citation:
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PMID: 7004127 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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These data would suggest that hypothermia combined with potassium cardioplegia enhances protection of the ischemic myocardium over other available techniques. The ideal conduct of this myocardial protection is not yet apparent but certain aspects are worthy of emphasis. (1) With the onset of ischemia cardioplegia should be immediately induced to abolish contractile activity and conserve energy. An advantage of blood cardioplegia is that there is no ischemia or it is trivial priorto cardioplegia. (2) The greater the degree of myocardial cooling the better. Although a myocardial temperature of 20 degrees C can commonly be achieved with perfusion hypothermia and topical hypothermia, it is possible to reduce myocardial temperature to 10 degrees C or lower with these same modalities. Because perfusion hypothermia provides fairly uniform rapid myocardial cooling, this should be maximally utilized by cooling of the systemic perfusate to 20 degrees C and cooling the cardioplegic infusate to 4-10 degrees C. Cardiac hypothermia should be maintained with crushed ice made from electrolyte solution or irrigation of the pericardial sac with cold electrolyte solution. The greater the degree of systemic hypothermia the less tendency for the myocardium to warm. (3) The ideal concentration of potassium is unknown at this time with a range of 15-40 mEq/l having been utilized without apparent potassium injury. (4) The ideal composition of the vehicle may never be defined and may not be of great importance. Whole blood would appear to offer physiological and pragmatic advantages over asanguinous vehicles. (5) The safe duration of ischemia has been moderately well defined. 1 h is well tolerated in the dog using profound cardiac hypothermia, whereas 30-45 min with lesser degrees of hypothermia is acceptable. When the interval of ischemia is to be 2 or 3 h reinfusion of potassium every 20-30 min has proven safe both experimentally and clinically. |
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Authors:
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H B Barner |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Review |
Journal Detail:
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Title: Advances in cardiology Volume: 27 ISSN: 0065-2326 ISO Abbreviation: Adv Cardiol Publication Date: 1980 |
Date Detail:
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Created Date: 1981-02-19 Completed Date: 1981-02-19 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0270063 Medline TA: Adv Cardiol Country: SWITZERLAND |
Other Details:
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Languages: eng Pagination: 223-36 Citation Subset: IM |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Chelating Agents
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administration & dosage Clinical Trials as Topic Heart Arrest, Induced* Humans Hypothermia, Induced Myocardium / metabolism* Neuromuscular Depolarizing Agents / administration & dosage Potassium / metabolism Procaine / administration & dosage |
| Chemical | |
Reg. No./Substance:
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0/Chelating Agents; 0/Neuromuscular Depolarizing Agents; 59-46-1/Procaine; 7440-09-7/Potassium |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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