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Purines and Myocardial Protection: An Overview

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Purines and Myocardial Protection

Part of the book series: Developments in Cardiovascular Medicine ((DICM,volume 181))

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Abstract

Although the morbidity and mortality associated with coronary artery bypass graft (CABG) surgery in uncomplicated cases is currently low, recent studies suggest that morbidity and mortality are increasing as the demographic profile of these patients changes. Patients presenting for CABG surgery are now older and sicker. Most of these patients are being sustained on multiple medical therapies such as β-adrenergic receptor and calcium channel blockers, and have had one or more angioplasties. Recent estimates conclude that the number of angioplasties performed exceeds the number of CABG operations per year. Coronary artery restenosis occurs in a large number of patients after angioplasty procedure. It has been shown that there is a strong causal relationship between myocardial ischemia before cardiopulmonary bypass surgery and the outcome of surgery. Myocardial ischemia occurring prior to bypass doubles or triples the risk of subsequent myocardial infarction. Indicators of perioperative ischemia include electrocardiographic determination of ST segment depression; increases in left ventricular end-diastolic pressure and segmental wall motion, wall thickening abnormalities and release of purines and enzymes. Indeed, purine in plasm has been used as a sensitive index of ischemia (1,2). Both segmental shortening and wall thickening abnormalities provide the most sensitive clinical measure of ischemia.

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Authors and Affiliations

  1. Division of Cardiothoracic Surgery, Department of Surgery, Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia, USA

    Anwar-Saad A. Abd-Elfattah, Jian-Hua Guo, El-Mostafa El-Guessab, Shin-Ping Gao & Yang Gu

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  1. Anwar-Saad A. Abd-Elfattah
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  2. Jian-Hua Guo
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  3. El-Mostafa El-Guessab
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  4. Shin-Ping Gao
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  5. Yang Gu
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Editors and Affiliations

  1. Cardiothoracic Division, Department of Surgery, Box 890532, MCV Station, Richmond, VA, 23298-0532, USA

    Anwar-Saad A. Abd-Elfattah MS, Ph.D.

  2. Department of Surgery, Medical College of Virginia, Richmond, Virginia, 23298-0532, USA

    Andrew S. Wechsler M.D.

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© 1996 Kluwer Academic Publishers

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Abd-Elfattah, AS.A., Guo, JH., El-Guessab, EM., Gao, SP., Gu, Y. (1996). Purines and Myocardial Protection: An Overview. In: Abd-Elfattah, AS.A., Wechsler, A.S. (eds) Purines and Myocardial Protection. Developments in Cardiovascular Medicine, vol 181. Springer, Boston, MA. https://doi.org/10.1007/978-1-4613-0455-5_8

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