Induced fibrillation is equally effective as crystalloid cardioplegia in the protection of fetal myocardial function

Malhotra, Samir; Thelitz, Stephan; Riemer, R. Kirk; Reddy, V. Mohan; Suleman, Sam; Hanley, Frank L.

doi:10.1016/s0022-5223(02)73245-5

Cited by 15 publications

(14 citation statements)

References 14 publications

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“…Our in vivo findings share some similarities with previous studies in the ex vivo fetal sheep heart, where biventricular PRSW was assessed as an index of contractility after various methods of cardiac arrest 20. In these studies by Malhotra et al , neither RV nor LV PRSW recovered to pre-arrest baseline values with fibrillatory or normocalcaemic cardioplegic arrest 20.…”

Section: Discussionsupporting

confidence: 88%

“…In these studies by Malhotra et al , neither RV nor LV PRSW recovered to pre-arrest baseline values with fibrillatory or normocalcaemic cardioplegic arrest 20. Of note, the findings from these in vitro models were generated using single axis sonomicrometry, providing pressure-dimension relationship data as opposed to pressure-volume relationship data.…”

Section: Discussionmentioning

confidence: 97%

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Myocardial function after fetal cardiac bypass in an ovine model

Duffy

Petrucci

Baker

et al. 2011

The Journal of Thoracic and Cardiovascular Surgery

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Objective Fetal cardiac surgery may improve the prognosis of certain complex congenital heart defects that have significant associated mortality and morbidity in utero or after birth. An important step in translating fetal cardiac surgery is identifying potential mechanisms leading to myocardial dysfunction following bypass. The hypothesis was that fetal cardiac bypass results in myocardial dysfunction, possibly due to perturbation of calcium cycling and contractile proteins. Methods Mid-term sheep fetuses (n=6) underwent 30 minutes of cardiac bypass and 120 minutes of monitoring after bypass. Sonomicrometry and pressure catheters inserted in left (LV) and right ventricles (RV) measured myocardial function. Cardiac contractile and calcium cycling proteins, along with calpain, were analyzed by immunoblot. Results Preload recruitable stroke work (slope of the regression line) was reduced at 120 min after bypass (RV – baseline vs. 120 min after bypass, 38.6±6.8 vs. 20.4±4.8 (P=.01); LV – 37±7.3 vs. 20.6±3.9 (P=.01). Tau (msec), a measure of diastolic relaxation, was elevated in both ventricles (RV – baseline vs. 120 min after bypass, 32.7±4.5 vs. 67.8±9.4 (P<.01); LV – 26.1±3.2 vs. 63.2±11.2 (P=.01). Cardiac output was lower and end-diastolic pressures were higher in the RV, but not the LV, after bypass compared with baseline. RV troponin I was degraded by elevated calpain activity and protein levels of sarco(endo)plasmic reticulum calcium ATPase (SERCA2a) were reduced in both ventricles. Conclusions Fetal cardiac bypass was associated with myocardial dysfunction and disruption of calcium cycling and contractile proteins. Minimizing myocardial dysfunction after cardiac bypass is important for successful fetal surgery to repair complex congenital heart defects.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 97%

Myocardial function after fetal cardiac bypass in an ovine model

Duffy

Petrucci

Baker

et al. 2011

The Journal of Thoracic and Cardiovascular Surgery

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“…55 Calcium-handling properties of the fetal myocardium differ from the more mature state, and recent studies have started to define strategies for myocardial protection during fetal open heart surgery. 51,52 …”

Section: Fetal Cardiac Function and The Fetal Stress Responsementioning

confidence: 99%

Current Status of Fetal Cardiac Intervention

2010

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“…It is possible to obtain PV loops using conductance catheters in vivo in experimental animal models [85,86] and ex vivo using isolated heart preparations [87,88] and together with the use of fiber-optic oxygen probe it was possible to assess PVA-MVO2 relationship in mouse hearts [89,90]. This technique may become a valuable tool in studying fetal heart function and metabolism in the future.…”

Section: Pressure-volume (Pv) Loops Derived Indicesmentioning

confidence: 99%

The Fetal Cardiac Function

Acharya¹,

Räsänen²,

Kiserud³

et al. 2006

CCR

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Despite significant progress in the prenatal diagnosis of congenital heart disease and the postnatal management, the prenatal evaluation of fetal heart function remains difficult. The unique characteristics of the fetal circulation have a significant impact on its cardiac function. Commonly used physiological concepts about the function of the heart can be misleading when applied to the intrauterine situation. Most noninvasive parameters of cardiac function are not validated in the fetus. In addition, unlike structural defects that can be easily confirmed after delivery, functional hemodynamic abnormalities diagnosed in utero cannot be verified postnatally with certainty as the neonatal circulation defers considerably from the fetal circulation. This review attempts to describe commonly used methods of assessment of fetal cardiac function, their physiological basis and, their utility in clinical practice. THE FETAL CARDIAC FUNCTIONThe heart's main function is to deliver sufficient oxygenated blood to meet the metabolic requirements of the tissues [1]. The overall cardiac performance reflects the interaction of the heart, blood volume and blood vessels. The unique characteristics of the fetal circulation [2] have a significant impact on its cardiac function and distribution of cardiac output. The fetal circulation differs considerably from the adult and neonatal circulation. The placenta, a large extracorporal organ designed for disposal at birth, performs the functions of many organ systems in utero. Human placenta receives about 30% of the combined cardiac output [3,4] and the total peripheral resistance in the fetus is mainly determined by the placental-vascular resistance [5]. The placental volume blood flow normalized for fetal weight decreases with advancing gestation after 25 weeks [6].Both sides of the fetal heart under normal conditions have similar pressures [7] and work in parallel, and the fetal heart rate is much faster than the adult. As a result the weight-indexed combined cardiac output is higher in the fetus and the outputs of the left and right ventricles can be different. Right ventricular dominance develops towards term, and the output of the right ventricle constitutes about 60% of the combined cardiac output [8]. The parallel disposition of two ventricular pumps confers the aortic isthmus (Fig. 1), i.e. the vascular segment located between the origin of the left subclavian artery and the junction of the aorta with the ductus arteriosus, a special function of maintaining communication and balance between two parallel arterial outlets [9].The pulmonary circulation has a high vascular resistance and is sensitive to the changes in arterial pH and partial Fig. (1). Color Doppler image of fetal aorta demonstrating the isthmic area (arrow) and typical pulsed-wave (inverted) Doppler velocity waveforms (lower panel) obtained at the aortic isthmus in a near term fetus. A brief small reverse component during early diastole (arrow-head) is normal in late gestation.pressure of oxygen (PO 2 ) and carbon di...

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Induced fibrillation is equally effective as crystalloid cardioplegia in the protection of fetal myocardial function

Cited by 15 publications

References 14 publications

Myocardial function after fetal cardiac bypass in an ovine model

Myocardial function after fetal cardiac bypass in an ovine model

Current Status of Fetal Cardiac Intervention

The Fetal Cardiac Function

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