Iatrogenic myocardial edema with potassium cardioplegia

Foglia, Robert P.; Steed, David L.; Follette, David M.; DeLand, Edward Charles

doi:10.1016/s0022-5223(19)38129-2

Cited by 101 publications

(17 citation statements)

References 8 publications

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“…58 The dilution decreases O 2 content and oncotic pressure, a factor known to promote myocardial edema. 78 During cold blood cardioplegia, the hydric balance is hardly negligible. When the cardioplegia is aspirated in the cardiotomy reservoir, the positive hydric balance increases after each cardioplegia injection, and the final result is a decrease in hemoglobin level.…”

Section: Rationale For Warm Cardioplegiamentioning

confidence: 99%

“…It is noteworthy that the advantages ascribed to pediatric warm surgery are similar to those for warm adult surgery. 45,[76][77][78][79][80][81][82][83][84][85][86][87][88][89][90][91] Some facts are important to stress: normothermia is used for the treatment of all types of cardiopathy, including total pulmonary anomalous venous return, interruption of the aortic arch, and Norwood or Sano procedures; once surgeons decided to move to normothermia, they never decided to shift back to hypothermia; the same technique and microplegia solution were used in all patients, with the only variable factor being the interval between injections, which was center-dependent and varied from 10 to 25 min; in this large group of patients, no postoperative neurological deficit including seizure activity, delirium, or significant motor dysfunction could be ascribed to normothermia. Finally, normothermia is not a point of no return.…”

Section: Evolution Of the Incidence Of Pediatric Warm Surgery In Europementioning

confidence: 99%

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Warm Pediatric Cardiac Surgery: European Experience

Durandy

2010

Asian Cardiovasc Thorac Ann

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Cold pediatric cardiac surgery has been a dogma for 50 years. However, the beneficial effects of cold perfusion are counterbalanced by the drawbacks of hypothermia. Thus, we propose a major paradigm shift from hypothermic surgery to warm perfusion and intermittent warm blood cardioplegia. This approach gives satisfactory results even with prolonged aortic crossclamp times. The major advantages are reduced time to extubation and shorter intensive care unit stay. Warm pediatric surgery is an anecdotal phenomenon no more; over 10,000 procedures have been carried out in Europe. All types of cardiopathy have been treated, including arterial switch, total pulmonary anomalous venous return, interruption of the aortic arch, and hypoplastic left heart syndrome. Once surgeons decide to shift from hypothermia to normothermia, they never decide to shift back to hypothermia. This fact is evidence of the satisfactory clinical outcome obtained with this technique. The technique and the composition of microplegia is identical in all European centers, the only variable factor being the interval between microplegia injections, which varies from 10 to 25 min. We hope that the increasing interest in pediatric warm surgery will hearten new candidates.

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Section: Rationale For Warm Cardioplegiamentioning

confidence: 99%

Section: Evolution Of the Incidence Of Pediatric Warm Surgery In Europementioning

confidence: 99%

Warm Pediatric Cardiac Surgery: European Experience

Durandy

2010

Asian Cardiovasc Thorac Ann

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“…Iatrogenic myocardial edema has been shown to occur with potassium cardioplegia. 16 The opportunity of the heart to beat on circulatory support is also important as myocardial contraction supports myocardial lymphatic function, resulting in minimal myocardial edema, associated with less impairment of left ventricular performance. 17 Thus, allowing the heart to beat between periods of ischemic fibrillatory arrest can theoretically lessen myocardial edema.…”

Section: Discussionmentioning

confidence: 99%

Coronary Artery Bypass Surgery without Cardioplegia: Early Results

Wong

Vendargon

Lim

2000

Asian Cardiovasc Thorac Ann

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From November 1996 to April 1999 patients underwent isolated noncardioplegic coronary artery bypass grafting at a new center. There were 123 (35%) patients aged over 60 years, 48 (14%) were female, 70 (20%) had a left ventricular ejection fraction below 0.3. Coronary artery bypass graft surgery was performed using hypothermic intermittent ischemic fibrillatory arrest of the heart. The left internal mammary artery was used in 97% of cases. Mean grafts per patient was 3.5. Sixty-three patients (18%) underwent 65 coronary endarterectomies. The overall operative mortality rate was 2.3% (8/348). Follow-up was 97% complete. Mean follow-up was 14.9 ± 8 months (range, 1 to 30 months). Freedom from angina was 98.3% at 6 months, 97% at 12 months, and 97% at 24 months. The overall survival was 96.7% at 6 months, 95.8% at 12 months, and 94.4% at 24 months. It was concluded that this method of myocardial protection for isolated coronary artery bypass graft surgery provided excellent operating conditions in this group of patients.

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“…[32]. Hemodilution in particular can take too long to reverse to study the process of edema resolution [16]. Furthermore, ischemia directly impacts cardiac function, masking the potential effects of myocardial edema.…”

Section: Acute Myocardial Edema Induced By Coronary Sinus Hypertensiomentioning

confidence: 99%

AWARD ARTICLE: Microcirculatory Society Award for Excellence in Lymphatic ResearchTime Course of Myocardial Interstitial Edema Resolution and Associated Left Ventricular Dysfunction

et al. 2012

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Please cite this paper as: Dongaonkar RM, Stewart RH, Quick CM, Uray KL, Cox CS, Laine GA. Time course of myocardial interstitial edema resolution and associated left ventricular dysfunction. Microcirculation 19: 714–722, 2012. Abstract Objective: Although the causal relationship between acute myocardial edema and cardiac dysfunction has been established, resolution of myocardial edema and subsequent recovery of cardiac function have not been established. The time to resolve myocardial edema and the degree that cardiac function is depressed after edema resolves are not known. We therefore characterized temporal changes in cardiac function as acute myocardial edema formed and resolved. Methods: Acute myocardial edema was induced in the canine model by elevating coronary sinus pressure for three hours. Myocardial water content and cardiac function were determined before and during coronary sinus pressure elevation, and after coronary sinus pressure restoration. Results: Although no change in systolic properties was detected, accumulation of water in myocardial interstitium was associated with increased diastolic stiffness. When coronary sinus pressure was relieved, myocardial edema resolved within 180 minutes. Diastolic stiffness, however, remained significantly elevated compared with baseline values, and cardiac function remained compromised. Conclusions: The present work suggests that the cardiac dysfunction caused by the formation of myocardial edema may persist after myocardial edema resolves. With the advent of new imaging techniques to quantify myocardial edema, this insight provides a new avenue for research to detect and treat a significant cause of cardiac dysfunction.

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Iatrogenic myocardial edema with potassium cardioplegia

Cited by 101 publications

References 8 publications

Warm Pediatric Cardiac Surgery: European Experience

Warm Pediatric Cardiac Surgery: European Experience

Coronary Artery Bypass Surgery without Cardioplegia: Early Results

AWARD ARTICLE: Microcirculatory Society Award for Excellence in Lymphatic ResearchTime Course of Myocardial Interstitial Edema Resolution and Associated Left Ventricular Dysfunction

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