| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
The Journal of Thoracic and Cardiovascular Surgery, Vol 95, 223-229, Copyright © 1988 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
PJ del Nido, DA Mickle, GJ Wilson, LN Benson, RD Weisel, JG Coles, GA Trusler and WG Williams
Postoperative low cardiac output is the most common cause of death in
patients undergoing elective repair of tetralogy of Fallot. The incidence
is much higher than in elective adult bypass operations for coronary artery
disease. To explain this difference, we investigated 16 children having
elective repair of tetralogy (mean age 6.3 years). Myocardial biopsy
specimens obtained during bypass before arrest, at the end of cold arrest
by blood cardioplegia, and after 30 minutes of reperfusion were studied for
adenosine triphosphate and lactate levels. Myocardium was submitted for
microscopic study shortly after the onset of ischemia. The operation was
successful in reducing right ventricular- pulmonary artery gradients from
82 +/- 28 to 9 +/- 1 mm Hg, yet seven patients required significant
inotropic support (dopamine, greater than 5 micrograms/kg/min) for more
than 24 hours and 12 patients needed prolonged use of digoxin and diuretics
for right ventricular failure. Tissue levels of adenosine triphosphate and
lactate in the tetralogy groups were compared with those in 20 adults with
coronary artery disease having similar myocardial protection techniques.
Adenosine triphosphate levels in the tetralogy group decreased during
cross- clamping (41 +/- 8 minutes) from 24 +/- 3 to 16 +/- 2 mmol/kg dry
weight (mean +/- 1 standard error), with a marked further drop after
reperfusion to 9 +/- 2 mmol/kg (p less than 0.01). Adenosine triphosphate
levels in the group with coronary disease also decreased from 20 +/- 1 to
16 +/- 1 mmol/kg after a longer cross-clamp time (70 +/- 17 minutes) but
remained at 15 +/- 2 mmol/kg after reperfusion. Tissue lactate levels in
the tetralogy group rose markedly during ischemia and remained elevated
after reperfusion. In contrast, lactate levels in the group with coronary
disease rose moderately during ischemia and returned to normal early on
reperfusion. Microscopic study revealed focal myocyte necrosis in tetralogy
of Fallot. Our findings, which demonstrate inadequate myocardial protection
of patients with tetralogy during repair, with depression of adenosine
triphosphate and increased lactate during ischemia and reperfusion, suggest
a defect in oxidative metabolism. The drop in adenosine triphosphate after
reperfusion in the patients with tetralogy implicates reperfusion injury as
a mechanism of myocardial damage.
ARTICLES
Inadequate myocardial protection with cold cardioplegic arrest during repair of tetralogy of Fallot
Division of Cardiovascular Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.
This article has been cited by other articles:
|
|
 |
|
  R. Salem, A. Y. Denault, P. Couture, S. Belisle, A. Fortier, M.-C. Guertin, M. Carrier, and R. Martineau Left ventricular end-diastolic pressure is a predictor of mortality in cardiac surgery independently of left ventricular ejection fraction Br. J. Anaesth., September 1, 2006; 97(3): 292 - 297. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Modi, M.-S. Suleiman, B. C. Reeves, A. Pawade, A. J. Parry, G. D. Angelini, and M. Caputo Basal Metabolic State of Hearts of Patients With Congenital Heart Disease: The Effects of Cyanosis, Age, and Pathology Ann. Thorac. Surg., November 1, 2004; 78(5): 1710 - 1716. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. S. Allen Pediatric myocardial protection: Where do we stand? J. Thorac. Cardiovasc. Surg., July 1, 2004; 128(1): 11 - 13. [Full Text] [PDF]
|
|
|
|
|
|
P. Modi, M.-S. Suleiman, B. Reeves, A. Pawade, A.J. Parry, G.D. Angelini, and M. Caputo Myocardial metabolic changes during pediatric cardiac surgery: A randomized study of 3 cardioplegic techniques J. Thorac. Cardiovasc. Surg., July 1, 2004; 128(1): 67 - 75. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Friehs, H. Cao-Danh, C. Stamm, D. B. Cowan, F. X. McGowan, and P. J. del Nido Postnatal increase in insulin-sensitive glucose transporter expression is associated with improved recovery of postischemic myocardial function J. Thorac. Cardiovasc. Surg., July 1, 2003; 126(1): 263 - 271. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Doenst, C. Schlensak, and F. Beyersdorf Cardioplegia in pediatric cardiac surgery: do we believe in magic? Ann. Thorac. Surg., May 1, 2003; 75(5): 1668 - 1677. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Friehs and P. J. del Nido Increased susceptibility of hypertrophied hearts to ischemic injury Ann. Thorac. Surg., February 1, 2003; 75(2): S678 - 684. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Modi, H. Imura, M. Caputo, A. Pawade, A. Parry, G. D. Angelini, and M. S. Suleiman Cardiopulmonary bypass-induced myocardial reoxygenation injury in pediatric patients with cyanosis J. Thorac. Cardiovasc. Surg., November 1, 2002; 124(5): 1035 - 1036. [Full Text] [PDF]
|
|
|
|
|
|
B. S. Allen The reoxygenation injury: Is it clinically important? J. Thorac. Cardiovasc. Surg., July 1, 2002; 124(1): 16 - 19. [Full Text] [PDF]
|
|
|
|
|
|
A. F. Corno, G. Milano, M. Samaja, P. Tozzi, and L. K. von Segesser Chronic hypoxia: A model for cyanotic congenital heart defects J. Thorac. Cardiovasc. Surg., July 1, 2002; 124(1): 105 - 112. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. S Allen The role of leukodepletion in limiting ischemia/reperfusion damage in the heart, lung and lower extremity Perfusion, March 1, 2002; 17(2_suppl): 11 - 22. [Abstract] [PDF]
|
|
|
|
|
|
M. T. Kronon, B. S. Allen, A. Halldorsson, S. Rahman, M. J. Barth, and M. Ilbawi Delivery of a nonpotassium modified maintenance solution to enhance myocardial protection in stressed neonatal hearts: A new approach J. Thorac. Cardiovasc. Surg., January 1, 2002; 123(1): 119 - 129. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. M. Torrance and C. Wittnich Postischemic functional recovery in immature hearts is influenced by performance index and assessment technique Am J Physiol Heart Circ Physiol, December 1, 2001; 281(6): H2446 - H2455. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Friehs, C. Stamm, H. Cao-Danh, F. X. McGowan Jr, and P. J. del Nido Insulin-like growth factor-1 improves postischemic recovery in hypertrophied hearts Ann. Thorac. Surg., November 1, 2001; 72(5): 1650 - 1656. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. S Allen and M. N Ilbawi Hypoxia, reoxygenation and the role of systemic leukodepletion in pediatric heart surgery Perfusion, January 1, 2001; 16(1_suppl): 19 - 29. [Abstract] [PDF]
|
|
|
|
|
|
C. Stamm, I. Friehs, A. M. Moran, D. Zurakowski, E. Bacha, J. E. Mayer, R. A. Jonas, and P. J. del Nido Surgery for bilateral outflow tract obstruction in elastin arteriopathy J. Thorac. Cardiovasc. Surg., October 1, 2000; 120(4): 755 - 763. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. T. Kronon, B. S. Allen, K. S. Bolling, S. Rahman, T. Wang, H. S. Maniar, S. M. Prasad, and M. N. Ilbawi The role of cardioplegia induction temperature and amino acid enrichment in neonatal myocardial protection Ann. Thorac. Surg., September 1, 2000; 70(3): 756 - 764. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. T. Kronon, B. S. Allen, S. Rahman, T. Wang, N. A. Tayyab, K. S. Bolling, and M. N. Ilbawi Reducing postischemic reperfusion damage in neonates using a terminal warm substrate-enriched blood cardioplegic reperfusate Ann. Thorac. Surg., September 1, 2000; 70(3): 765 - 770. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. F Corno, G. Milano, M. Samaja, L. K von Segesser, A. F Corno, G. Milano, M. Samaja, and L. K von Segesser Myocardial Damage Induced by Uncontrolled Reoxygenation Asian Cardiovasc Thorac Ann, March 1, 2000; 8(1): 34 - 37. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. K. Najm, W. J. Wallen, M. P. Belanger, W. G. Williams, J. G. Coles, G. S. Van Arsdell, M. D. Black, C. Boutin, and C. Wittnich DOES THE DEGREE OF CYANOSIS AFFECT MYOCARDIAL ADENOSINE TRIPHOSPHATE LEVELS AND FUNCTION IN CHILDREN UNDERGOING SURGICAL PROCEDURES FOR CONGENITAL HEART DISEASE? J. Thorac. Cardiovasc. Surg., March 1, 2000; 119(3): 515 - 524. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. R. Chaturvedi, D. F. Shore, C. Lincoln, S. Mumby, M. Kemp, J. Brierly, A. Petros, J. M.G. Gutteridge, J. Hooper, and A. N. Redington Acute Right Ventricular Restrictive Physiology After Repair of Tetralogy of Fallot : Association With Myocardial Injury and Oxidative Stress Circulation, October 5, 1999; 100(14): 1540 - 1547. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. T. Kronon, B. S. Allen, A. Halldorsson, S. Rahman, T. Wang, and M. Ilbawi DOSE DEPENDENCY OF L-ARGININE IN NEONATAL MYOCARDIAL PROTECTION: THE NITRIC OXIDE PARADOX J. Thorac. Cardiovasc. Surg., October 1, 1999; 118(4): 655 - 664. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. T. Kronon, B. S. Allen, A. Halldorsson, S. Rahman, T. Wang, and M. Ilbawi L-ARGININE, PROSTAGLANDIN, AND WHITE CELL FILTRATION EQUALLY IMPROVE MYOCARDIAL PROTECTION IN STRESSED NEONATAL HEARTS J. Thorac. Cardiovasc. Surg., October 1, 1999; 118(4): 665 - 673. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Ostadal, I. Ostadalova, and N. S. Dhalla Development of Cardiac Sensitivity to Oxygen Deficiency: Comparative and Ontogenetic Aspects Physiol Rev, July 1, 1999; 79(3): 635 - 659. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Merante, D. A. G. Mickle, R. D. Weisel, R.-K. Li, L. C. Tumiati, V. Rao, W. G. Williams, and B. H. Robinson Myocardial aerobic metabolism is impaired in a cell culture model of cyanotic heart disease Am J Physiol Heart Circ Physiol, November 1, 1998; 275(5): H1673 - H1681. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Kronon, K. S. Bolling, B. S. Allen, A. O. Halldorsson, T. Wang, and S. Rahman The importance of cardioplegic infusion pressure in neonatal myocardial protection Ann. Thorac. Surg., October 1, 1998; 66(4): 1358 - 1364. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Ihnken, K. Morita, and G. D. Buckberg Delayed cardioplegic reoxygenation reduces reoxygenation injury in cyanotic immature hearts Ann. Thorac. Surg., July 1, 1998; 66(1): 177 - 182. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. N. Young, I. O. Choy, N. K. Silva, D. Y. Obayashi, and H. E. Barkan ANTEGRADE COLD BLOOD CARDIOPLEGIA IS NOT DEMONSTRABLY ADVANTAGEOUS OVER COLD CRYSTALLOID CARDIOPLEGIA IN SURGERY FOR CONGENITAL HEART DISEASE J. Thorac. Cardiovasc. Surg., December 1, 1997; 114(6): 1002 - 1009. [Abstract] [Full Text]
|
|
|
|
|
|
M. Kronon, K. S. Bolling, B. S. Allen, S. Rahman, T. Wang, A. Halldorsson, and H. Feinberg THE RELATIONSHIP BETWEEN CALCIUM AND MAGNESIUM IN PEDIATRIC MYOCARDIAL PROTECTION J. Thorac. Cardiovasc. Surg., December 1, 1997; 114(6): 1010 - 1019. [Abstract] [Full Text]
|
|
|
|
|
|
K. Nakanishi, M. Inoue, E. Sugawara, and S. Sano ISCHEMIC AND REPERFUSION INJURY OF CYANOTIC MYOCARDIUM IN CHRONIC HYPOXIC RAT MODEL: CHANGES IN CYANOTIC MYOCARDIAL ANTIOXIDANT SYSTEM J. Thorac. Cardiovasc. Surg., December 1, 1997; 114(6): 1088 - 1096. [Abstract] [Full Text]
|
|
|
|
|
|
B. S. Allen, S. Rahman, M. N. Ilbawi, M. Kronon, K. S. Bolling, A. O. Halldorsson, and H. Feinberg Detrimental Effects of Cardiopulmonary Bypass in Cyanotic Infants: Preventing the Reoxygenation Injury Ann. Thorac. Surg., November 1, 1997; 64(5): 1381 - 1388. [Abstract] [Full Text]
|
|
|
|
|
|
P. J. del Nido Myocardial Protection and Cardiopulmonary Bypass in Neonates and Infants Ann. Thorac. Surg., September 1, 1997; 64(3): 878 - 879. [Full Text]
|
|
|
|
|
|
K. Bolling, M. Kronon, B. S. Allen, T. Wang, S. Ramon, and H. Feinberg MYOCARDIAL PROTECTION IN NORMAL AND HYPOXICALLY STRESSED NEONATAL HEARTS: THE SUPERIORITY OF BLOOD VERSUS CRYSTALLOID CARDIOPLEGIA J. Thorac. Cardiovasc. Surg., June 1, 1997; 113(6): 994 - 1005. [Abstract] [Full Text]
|
|
|
|
|
|
K. S. Bolling, A. Halldorsson, B. S. Allen, S. Rahman, T. Wang, M. Kronon, and H. Feinberg PREVENTION OF THE HYPOXIC REOXYGENATION INJURY WITH THE USE OF A LEUKOCYTE-DEPLETING FILTER J. Thorac. Cardiovasc. Surg., June 1, 1997; 113(6): 1081 - 1090. [Abstract] [Full Text]
|
|
|
|
 |
|
 K. Ihnken, K. Morita, G. D. Buckberg, B. Winkelmann, M. Schmitt, L. J. Ignarro, M.P. Sherman, and K. Ihnken Nitric-Oxide-Induced Reoxygenation Injury in the Cyanotic Immature Heart Is Prevented by Controlling Oxygen Content During Initial Reoxygenation Angiology, March 1, 1997; 48(3): 189 - 202. [Abstract] [PDF]
|
|
|
|
|
|
K. Bolling, M. Kronon, B. S. Allen, S. Ramon, T. Wang, R. S. Hartz, and H. Feinberg MYOCARDIAL PROTECTION IN NORMAL AND HYPOXICALLY STRESSED NEONATAL HEARTS: THE SUPERIORITY OF HYPOCALCEMIC VERSUS NORMOCALCEMIC BLOOD CARDIOPLEGIA J. Thorac. Cardiovasc. Surg., November 1, 1996; 112(5): 1193 - 1201. [Abstract] [Full Text]
|
|
|
|
|
|
W. S. McMahon, P. C. Gillette, R. B. Hinton, J. R. Stratton, F. A. Crawford, and F. G. Spinale DEVELOPMENTAL DIFFERENCES IN MYOCYTE CONTRACTILE RESPONSE AFTER CARDIOPLEGIC ARREST J. Thorac. Cardiovasc. Surg., June 1, 1996; 111(6): 1257 - 1266. [Abstract] [Full Text]
|
|
|
|
|
|
K. Takeuchi, P. Buenaventura, H. Cao-Danh, P. Glynn, E. Simplaceanu, F. X. McGowan, and P. J. del Nido Improved Protection of the Hypertrophied Left Ventricle by Histidine-Containing Cardioplegia Circulation, November 1, 1995; 92(9): 395 - 399. [Abstract] [Full Text]
|
|
|
|
|
|
J. W. Hammon Jr Myocardial Protection in the Immature Heart Ann. Thorac. Surg., September 1, 1995; 60(3): 839 - 842. [Abstract] [Full Text]
|
|
|
|
|
|
A. Corno, M. Samaja, S. Casalini, and S. Allibardi The effects of the rate of reoxygenation on the recovery of hypoxemic hearts J. Thorac. Cardiovasc. Surg., June 1, 1995; 109(6): 1250 - 1251. [Full Text]
|
|
|
|
|
|
A. Corno, R. Motterlini, L. Brenna, F. Santoro, and M. Samaja Ischaemia/reperfusion in the posthypoxaemic re-oxygenated myocardium: haemodynamic study in the isolated perfused rat heart Perfusion, January 1, 1993; 8(1): 113 - 118. [Abstract] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
