Document Detail


Does myocardial protection work?
MedLine Citation:
PMID:  7004127     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
H B Barner
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Publication Detail:
Type:  Clinical Trial; Journal Article; Review    
Journal Detail:
Title:  Advances in cardiology     Volume:  27     ISSN:  0065-2326     ISO Abbreviation:  Adv Cardiol     Publication Date:  1980  
Date Detail:
Created Date:  1981-02-19     Completed Date:  1981-02-19     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0270063     Medline TA:  Adv Cardiol     Country:  SWITZERLAND    
Other Details:
Languages:  eng     Pagination:  223-36     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Chelating Agents / 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:
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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