Document Detail


Pediatric myocardial protection: a cardioplegic strategy is the "solution".
MedLine Citation:
PMID:  15283364     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
This article describes the experimental infrastructure and subsequent successful clinical application of a comprehensive cardioplegic strategy that limits intraoperative injury and improves postoperative outcomes in pediatric patients. The infant heart is at high risk of damage from poor protection as a result of preoperative hypertrophy, cyanosis, and ischemia. These factors may also make the immature (pediatric) heart more sensitive to cardioplegic arrest compared with the mature (adult) heart. The preoperative factors of cyanosis and pressure volume overload are discussed, followed by the infrastructure of the strategies of warm induction and reperfusion with substrate enhancements, multidose cardioplegia, and a "modified" integrated approach to allow ischemia only when visualization is needed in pediatric surgeries. The importance of using a blood cardioplegia solution, with reduced calcium, increased magnesium, and low perfusion pressure are also shown. A practical clinical framework based on these experimentally proven principles is then presented to allow the surgeon to apply these strategies clinically. The results of using these principles are depicted in a series of 567 patients, including 93 patients with hypoplastic left heart syndrome. Applications of these concepts should improve the safety of protection of the infant heart and reduce postoperative morbidity and mortality.
Authors:
Bradley S Allen
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Seminars in thoracic and cardiovascular surgery. Pediatric cardiac surgery annual     Volume:  7     ISSN:  1092-9126     ISO Abbreviation:  Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu     Publication Date:  2004  
Date Detail:
Created Date:  2004-07-30     Completed Date:  2004-09-28     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  9815944     Medline TA:  Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu     Country:  United States    
Other Details:
Languages:  eng     Pagination:  141-54     Citation Subset:  IM    
Affiliation:
Department of Cardiothoracic and Vascular Surgery, The University of Texas at Houston, Memorial Hermann Children's Hospital, Houston, TX, USA.
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MeSH Terms
Descriptor/Qualifier:
Cardiac Surgical Procedures / methods*
Cardioplegic Solutions
Heart Arrest, Induced / methods*
Heart Defects, Congenital / surgery
Humans
Infant
Postoperative Complications / prevention & control*
Chemical
Reg. No./Substance:
0/Cardioplegic Solutions

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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