Myocardial preservation in the neonate: Beneficial effects of cardioplegia and systemic hypothermia on piglets undergoing cardiopulmonary bypass and myocardial ischemia

B. L. Ganzel, S. L. Katzmark, Constantine Mavroudis

Research output: Contribution to journalArticle

Abstract

This study examined anatomic differences between the adult and the newborn heart as they relate to myocardial preservation and compared standard techniques of myocardial preservation used in operations for congenital heart disease. The biventricular endocardial surface area/ventricular mass ratios were calculated in 10 neonatal (2.5 ± 0.2:1) and 10 adults (0.6 ± 0.1:1) pigs (p < 0.001). Three groups of neonatal pigs underwent 1 hour of global myocardial ischemia while being supported by cardiopulmonary bypass. Myocardial protection was by deep systemic hypothermia (group 1), moderate systemic hypothermia and cardioplegia (group 2), or by deep systemic hypothermia and cardioplegia (group 3). Left ventricular end-systolic pressure-dimension and end-diastolic pressure-dimension relationships were measured before and after cardiopulmonary bypass. Septal temperatures remained below 20°C in groups 1 and 3 but rose above 20°C in group 2. Groups 1 and 2 had moderate and mild ventricular stiffening respectively, whereas group 3 showed no diastolic dysfunction. Ventricular contractility was increased (p < 0.05) in group 3. Techniques for myocardial preservation used during operations for congenital heart disease must consider the large endocardial surface area/mass ratio and the rewarming effects of systemic blood. The combination of deep systemic hypothermia and cardioplegia provided superior myocardial protection compared with the other techniques tested.

Original languageEnglish (US)
Pages (from-to)414-422
Number of pages9
JournalJournal of Thoracic and Cardiovascular Surgery
Volume96
Issue number3
StatePublished - Jan 1 1988
Externally publishedYes

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Induced Heart Arrest
Hypothermia
Cardiopulmonary Bypass
Myocardial Ischemia
Heart Diseases
Swine
Blood Pressure
Rewarming
Temperature

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

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abstract = "This study examined anatomic differences between the adult and the newborn heart as they relate to myocardial preservation and compared standard techniques of myocardial preservation used in operations for congenital heart disease. The biventricular endocardial surface area/ventricular mass ratios were calculated in 10 neonatal (2.5 ± 0.2:1) and 10 adults (0.6 ± 0.1:1) pigs (p < 0.001). Three groups of neonatal pigs underwent 1 hour of global myocardial ischemia while being supported by cardiopulmonary bypass. Myocardial protection was by deep systemic hypothermia (group 1), moderate systemic hypothermia and cardioplegia (group 2), or by deep systemic hypothermia and cardioplegia (group 3). Left ventricular end-systolic pressure-dimension and end-diastolic pressure-dimension relationships were measured before and after cardiopulmonary bypass. Septal temperatures remained below 20°C in groups 1 and 3 but rose above 20°C in group 2. Groups 1 and 2 had moderate and mild ventricular stiffening respectively, whereas group 3 showed no diastolic dysfunction. Ventricular contractility was increased (p < 0.05) in group 3. Techniques for myocardial preservation used during operations for congenital heart disease must consider the large endocardial surface area/mass ratio and the rewarming effects of systemic blood. The combination of deep systemic hypothermia and cardioplegia provided superior myocardial protection compared with the other techniques tested.",
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