Echocardiographic Imaging of Myocardial Inflammation
Robert J. Gropler, David K. Glover, Albert J. Sinusas, Heinrich Taegtmeyer in Cardiovascular Molecular Imaging, 2007
Endothelial dysfunction is a hallmark of other cardiovascular disease states. Endothelial disease is not limited to the larger epicardial coronary arteries and there is evidence that functional endothelial derangements in atherosclerotic disease extend distally into the microcirculation (20,21). Endothelial dysfunction occurs in the setting of ischemia-reperfusion (22). Crystalloid hyperkalemic cardioplegia infusions result in endothelial disruption (23), and regenerated endothelium after coronary angioplasty exhibits reduced endothelium-dependent relaxation (24). Hypercholesterolemia results in endothelial dysfunction that may reverse with lipid-lowering interventions (25). Heart transplant rejection is associated with the upregulation of leukocyte adhesion molecules (26,27). Thus, functional aberrations in the endothelial lining of the coronary vascular tree underlie a host of cardiovascular disease states encountered in clinical practice.
CABG in acute coronary syndrome
K Sarat Chandra, AJ Swamy in Acute Coronary Syndromes, 2020
Myocardial protection: Cold blood, hyperkalaemic, antegrade, intermittent cardioplegia initially, followed by retrograde cardioplegia through the coronary sinus, is probably the best method of myocardial protection [18]. Buckberg et al. have described various protocols to actively ‘resuscitate’ severely ischaemic heart undergoing emergency surgery and various elements of these protocols can be incorporated into the myocardial protection strategy depending on operating surgeons philosophy and logistics of availability. Using his own protocol, Buckberg reported an in-hospital mortality of 7% for patients operated within 18 hours of AMI with restoration of LV function [19]. Similarly, Sintek et al. [20] reported in-hospital mortality of 4.4% using Buckberg's protocol.
Surgical treatment
Neeraj Parakh, Ravi S. Math, Vivek Chaturvedi in Mitral Stenosis, 2018
The essential prerequisite for open-heart surgical procedure is a bloodless and motionless surgical field. Therefore, during open-heart surgical procedure, the heart is stopped and blood is drained out of the heart. To achieve this, cardiopulmonary bypass (CPB) using a heart-lung machine temporarily substitutes the pumping and ventilatory functions of the heart and lungs. The basic components of the heart-lung machine include the oxygenator (for gas exchange) with integral heat exchanger (for temperature regulation) and flow pumps for whole-body perfusion, cardioplegia delivery, and suction from the operative field (Figure 14.9). Other components are one or more venous cannula, a venous reservoir, arterial line filter, and arterial cannula. The heparinized blood of the patient is drained into the venous reservoir by inserting cannula in the venous side of the heart (right atrium, superior vena cava, inferior vena cava, femoral vein, internal jugular vein). This venous blood passes through the oxygenator for gaseous exchange (oxygenation and removal of CO2). The mechanical pump returns the oxygenated blood to the arterial side of circulation (the aorta or one of the major arteries). To arrest the electromechanical activity of the heart, cardioplegia solution (especially formulated hyperkalemic solution) is delivered to the coronary circulation by a cardioplegia delivery system. In addition, a cardiotomy suction system aspirates blood from open cardiac chambers and the surgical field. With a modern CPB circuit, it is possible to regulate flow rate, gaseous exchange, temperature of perfusate, hematocrit, water and electrolyte contents, oncotic pressure, and pH.
Inducing systemic hyperkalemia for cardiac arrest during cardiopulmonary bypass with patent cardiac circulation
Published in Baylor University Medical Center Proceedings, 2022
Altaf Panjwani, Mitesh J. Patel, Colten Youngblood, Alessandro Lione, Justin Schaffer, Robert Smith
Systemic hyperkalemia provides myocardial protection evenly throughout the heart without the fear of having the cardioplegia “washout.” The goal is to provide a quiescent and bloodless surgical field for the surgeon. An alternative would be to administer continuous retrograde. As the cardioplegia gets washed out from the blood of the patent LIMA, new cardioplegia is present to rearrest and/or maintain cardiac arrest. There are many disadvantages to this approach, notably the hemodilution that takes place with continuous retrograde cardioplegia.2 Yet another alternative is obtaining a ventricular fibrillation arrest, which still causes hemodilution, prevents a quiescent and bloodless field, and does not provide a complete electromechanical arrest. With the systemic cardioplegia approach, the “washout” blood coming from the patent LIMA contains a high level of potassium, which maintains the electromechanical arrest of the heart. Nearing cross-clamp removal, the process of zero balance ultrafiltration and administration of glucose and insulin can be used to lower the systemic potassium back down close to 5 mmol/L. The ease of administering systemic potassium to achieve and maintain cardiac arrest as well as the ease of removal of excess potassium with the above-described techniques simply solves the problem of operations with the presence of a patent LIMA graft. Although we highlight the use of systemic hyperkalemia in the setting of a “live” LIMA, this protocol can be a part of a surgeon’s repertoire in other intraoperative conditions such as an unclampable or “porcelain” aorta.
St. Thomas and del Nido cardioplegia are superior to Custodiol cardioplegia in a rat model of donor heart
Published in Scandinavian Cardiovascular Journal, 2021
Gulsum Karduz, Muhittin Onur Yaman, Mehmet Altan, Gulderen Sahin, Fevzi Toraman, Ugur Aksu
Cardioplegic solutions provide a stable surgical area during cardiac surgery and transplantation. Another use of cardioplegic solutions is to create an immediate arrest and to preserve the tissue during an extended period of ischemia. Various solutions with different protective and chemical properties have been developed [3–5]. Ion concentrations of crystalloid cardioplegic solutions are similar to the cytoplasm as low sodium (<1.6 g/L) and high potassium (>3.9 g/L). It has been shown that hyperkalemic crystalloid cardioplegia solutions keep the cell membrane in the depolarization phase of the action potential, leading to diastolic cardiac arrest [6]. However, they may cause calcium entry into the cell and immediate vasoconstriction. Also, endothelial damage can occur following solution exposure because of the high potassium concentration. In addition, cardioplegia solutions with high sodium (>1.6 g/L) and low potassium (<0.8 g/L) concentrations increase vascular resistance and reduce endothelial damage [7,8].
The effect of dexmedetomidine on the inflammatory response in children undergoing repair of congenital heart disease: a randomized controlled clinical trial
Published in Egyptian Journal of Anaesthesia, 2020
Khaled A Abdelrahman, Shimaa A Hassan, Ahmed A Mohammed, Essam E Abdelhakeem, Sayed K. Abd-Elshafy, Ragaa H Salama, Esam M Abdalla
The routine strategy was performed by a non-pulsatile heart-lung machine (Stockert Centrifugal Pump S5 Console Roller pump 150- part No: 10–80-00, Ser No: 10E03400, Germany). Priming of the CPB circuit was done with mannitol, sodium bicarbonate, and packed red cells given to obtain a hematocrit of 22–26%. Heparin 400 IU/kg was given to the patient and once activated clotting time reached ≥450 seconds, CPB was initiated. The aorta was clamped and cold blood cardioplegia (15–20 ml/kg) was administered into the aortic root. The body (core) temperature was cooled to 30–32°C. The cardioplegia solution was repeated every 20 minutes. pH-stat blood gas strategy was used; partial pressure of carbon dioxide in arterial blood (PaCO2) was maintained between 35 and 45 mmHg. During CPB, mean systemic arterial pressure (MAP) was preserved between 30–60 mmHg, and anesthesia was conserved by sevoflurane 0.8–1.5%, fentanyl (1–2 mcg/kg/hr.) and cisatracurium (0.05 mg/kg per dose). Weaning from CPB was done at 37°C after completion of surgery. Ventilation was started, and patient hemodynamics and arterial blood gases were stabilized. Heparin was reversed by 1 mg protamine for every 100 IU heparin. The patients were transported to post-operative pediatric cardiac intensive care unit (PICU) post-surgery.
Related Knowledge Centers
- Ascending Aorta
- Asystole
- Brachiocephalic Artery
- Coronary Artery Disease
- Coronary Circulation
- Necrosis
- Perfusion
- Resting Potential
- Cardiopulmonary Bypass
- Cardiac Muscle