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The role of cardioplegia induction temperature and amino acid enrichment in neonatal myocardial protection  Michael T Kronon, MD, Bradley S Allen, MD,

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Presentation on theme: "The role of cardioplegia induction temperature and amino acid enrichment in neonatal myocardial protection  Michael T Kronon, MD, Bradley S Allen, MD,"— Presentation transcript:

1 The role of cardioplegia induction temperature and amino acid enrichment in neonatal myocardial protection  Michael T Kronon, MD, Bradley S Allen, MD, Kirk S Bolling, MD, Shaikh Rahman, PhD, Tingrong Wang, MD, Hersh S Maniar, BS, Sunil M Prasad, BS, Michel N Ilbawi, MD  The Annals of Thoracic Surgery  Volume 70, Issue 3, Pages (September 2000) DOI: /S (00)

2 Fig 1 Warm versus cold cardioplegic induction: recovery of left ventricular systolic function in hypoxic hearts undergoing reoxygenation on cardiopulmonary bypass without ischemia or 70 minutes of cardioplegic arrest with an aspartate/glutamate (Asp/Glu) -enriched cardioplegic induction. Contractility is measured by the end-systolic elastance (EES) and expressed as a percentage of control (baseline) values. ∗p < The Annals of Thoracic Surgery  , DOI: ( /S (00) )

3 Fig 2 Warm versus cold cardioplegic induction: postbypass left ventricular diastolic compliance in hypoxic hearts undergoing reoxygenation on cardiopulmonary bypass without ischemia or 70 minutes of cardioplegic arrest with an aspartate/glutamate (Asp/Glu) -enriched cardioplegic induction. Compliance is measured by the end-diastolic pressure-volume relationship and expressed as a percentage of stiffness compared with control (baseline) values. Note that there is a marked increase in diastolic stiffness in hypoxic hearts given a cold induction, whereas warm induction allowed for cellular repair of the hypoxia–reoxygenation injury, resulting in a diastolic compliance that is not statistically different from nonhypoxic (normal) hearts undergoing cardioplegic arrest. ∗p < The Annals of Thoracic Surgery  , DOI: ( /S (00) )

4 Fig 3 Amino acids and their mechanism of action: recovery of left ventricular systolic function in hypoxic hearts receiving a warm cardioplegic induction (with or without aspartate/glutamate [Asp/Glu]) as measured by end-systolic elastance (EES) and expressed as percentage of control (baseline). Nitroglycerin (NTG) was added in one group of piglets not receiving aspartate/glutamate. ∗p < The Annals of Thoracic Surgery  , DOI: ( /S (00) )

5 Fig 4 Amino acids and their mechanism of action: postbypass left ventricular diastolic compliance in hypoxic hearts receiving a warm cardioplegic induction (with or without aspartate/glutamate [Asp/Glu]) as measured by the end-diastolic pressure-volume relationship and expressed as percentage of stiffness compared with control (baseline). Nitroglycerin (NTG) was added in one group of piglets not receiving aspartate/glutamate. ∗p < The Annals of Thoracic Surgery  , DOI: ( /S (00) )

6 Fig 5 Warm versus cold cardioplegic induction: coronary vascular resistance (CVR) during each cardioplegic infusion in hypoxic and nonhypoxic hearts given an aspartate/glutamate-enriched cold induction. Note that there is a marked rise in coronary vascular resistance when cold induction is used in hypoxic hearts, implying a derangement in vascular function. ∗p < The Annals of Thoracic Surgery  , DOI: ( /S (00) )

7 Fig 6 Warm versus cold cardioplegic induction: coronary vascular resistance (CVR) during each cardioplegic infusion in hypoxic and nonhypoxic hearts given an aspartate/glutamate-enriched warm induction. Note that there is no difference in coronary vascular resistance in hearts given a warm induction, indicating preservation of vascular function despite a hypoxic stress. ∗p = not significant. The Annals of Thoracic Surgery  , DOI: ( /S (00) )

8 Fig 7 Amino acids and their mechanism of action: coronary vascular resistance (CVR) measured during cardioplegic induction in hypoxic piglets receiving a warm induction with or without aspartate/glutamate (Asp/Glu) -enrichment. Nitroglycerin (NTG) was added in one group of piglets not receiving aspartate/glutamate. ∗p < versus all groups; ∗∗p < versus no NTG. The Annals of Thoracic Surgery  , DOI: ( /S (00) )


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