Cardioplegia

Principles and Problems
  • Hans Jürgen Bretschneider
  • Martha Maria Gebhard
  • Claus Jürgen Preusse
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 34)

Abstract

Interruption of the coronary circulation with ensuing depletion of cardiac oxygen reserves and shift from aerobic to anaerobic energy gain leads to disturbances of contractile function, to acidosis and changes in electrolyte and water distribution between intracellular and extracellular compartments, and thereby to disturbances of basic electrophysiologic processes, to structural alterations, and, finally, to organ death. Irreversible damage to the left ventricular myocardial muscle occurs much more rapidly than in the right ventricle, the atria, and the central and peripheral conductive system. In considering partial or complete reversibility of an ischemic stress by reperfusion and reoxygenation, three phases of global ischemia can be defined using the terminology originally applied to functional changes in the brain under global ischemia {1}:

The first phase of undisturbed function or latency period is identical with the duration of myocardial aerobic energy supply from the oxygen reserves available at the time of coronary circulatory arrest, oxyhemoglobin, oxymyoglobin, and physically dissolved oxygen, which total about 1–2 ml/ 100g left ventricular myocardium. Depending on the level of myocardial performance and O2 demand prior to ischemia, these reserves last for no more than 1–20 s under normothermic conditions.

Keywords

Creatine Phosphate Global Ischemia Left Ventricular Myocardium Cardioplegic Solution Revival Time 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Bretschneider HJ: Überlebenszeit und Wiederbelebungszeit des Herzens bei Normo-und Hypothermie. Verh Dtsch Ges Kreislaufforsch 30: 11–34, 1964.PubMedGoogle Scholar
  2. 2.
    Bretschneider HJ, Gebhard MM, Preusse CJ: Reviewing the pros and cons of myocardial preservation within cardiac surgery. In: Longmore DB (ed) Towards safer cardiac surgery. Lancaster: MTP, 1981, pp 21–53.CrossRefGoogle Scholar
  3. 3.
    Bretschneider HJ, Heilige G: Pathophysiologie der Ventrikelkontraktion-Kontraktilität, Inotropie, Suffizienzgrad und Arbeitsökonomie des Herzens. Verh Dtsch Ges Kreislaufforsch 42: 14–30, 1976.PubMedCrossRefGoogle Scholar
  4. 4.
    Hearse DJ, Braimbridge MV, Jynge P: Protection of the ischemic myocardium: cardioplegia. New York: Raven, 1981.Google Scholar
  5. 5.
    Noble D: The initiation of the heart beat. Oxford: Clarendon, 1979.Google Scholar
  6. 6.
    Buckberg GD, Brazie JR, Nelson RL, Goldstein SM, McConnell DH, Cooper N: Studies on the effects of hypothermia on regional myocardial blood flow and metabolism during cardiopulmonary bypass. I. The adequately perfused beating, fibrillating, and arrested heart. J Thorac Cardiovasc Surg 73: 87–94, 1977.PubMedGoogle Scholar
  7. 7.
    Chance B, Sies H, Boveries A: Hydroperoxide metabolism in mammalian organs. Physiol Rev 59: 527–605, 1979.PubMedGoogle Scholar
  8. 8.
    Hütter JF, Schweickhardt C, Piper HM, Spieckerman PG: Inhibition of fatty acid oxidation and decrease of oxygen consumption of working rat heart by 4-bromocrotonic acid. J Mol Cell Cardiol 16: 105–108, 1984.PubMedCrossRefGoogle Scholar
  9. 9.
    Neely JR, Morgan HE: Relationship between carbohydrate and lipid metabolism and the energy balance of the heart muscle. Annu Rev Physiol 36: 413–459, 1974.PubMedCrossRefGoogle Scholar
  10. 10.
    Kübler W, Spieckermann PG: Regulation of glycolysis in the ischemic and the anoxic myocardium. J Mol Cell Cardiol 1: 351–377, 1970.PubMedCrossRefGoogle Scholar
  11. 11.
    Roos A, Boron WF: Intracellular pH. Physiol Rev 61: 296–434, 1981.PubMedGoogle Scholar
  12. 12.
    Preusse CJ, Gebhard MM, Bretschneider HJ: Myocardial “equilibration processes” and myocardial energy turnover during initiation of artificial cardiac arrest with cardioplegic solution. Thorac Cardiovasc Surg 29: 71–76, 1981.PubMedCrossRefGoogle Scholar
  13. 13.
    Kallerhoff M, Hölscher M, Kläss G, Heimchen U, Bretschneider HJ: Influence of different kidney-protective solutions on metabolism and energetics of ischemic kidneys. Pflügers Arch 382: R15, 1982.Google Scholar
  14. 14.
    Schnabel PhA, Gebhard MM, Preusse CJ, Richter J, Schwartz P, Spieckermann B, Bretschneider HJ: Protektion der Ultrastruktur im ischämischen Myokard durch die kardioplegische Lösung HTK nach Bretschneider bei 25°C. Verh Anat Ges 77: 605–608, 1983.Google Scholar
  15. 15.
    Schulte HD, Preusse CJ, Groschopp C, Bircks W, Bretschneider HJ: Crystalloid cardioplegia: experience with the Bretschneider solution. In: Engelman RM, Levitsky S (eds) A textbook of clinical cardioplegia. Mt Kisco NY: Futura, 1982.Google Scholar
  16. 16.
    Bretschneider HJ, Gebhard MM, Gersing W, Preusse CJ: Problems of myocardial protection under view of the heterogeneity of the affected tissues and the different vulnerability of subcellular structures. In: Caldarera CM, Harris P (eds) Advances in studies on heart metabolism. Bologna: CLUEB, 1982.Google Scholar
  17. 17.
    Gebhard MM, Bretschneider HJ, Gersing E, Preusse CJ, Schnabel PhA, Ulbricht LJ: Calcium-free cardioplegia-pro. Europ Heart J 4 (Suppl. H): 151–160, 1983.CrossRefGoogle Scholar
  18. 18.
    Gercken G, Bischoff H, Trotz M: Myokardprotektion durch eine Carnosin-gepufferte kardioplegische Lösung. Drug Res 30: 2140–2143, 1980.Google Scholar
  19. 19.
    Bretschneider HJ, Gebhard MM, Gersing E, Preusse CJ, Schnabel PhA: Recent advances for myocardial protection. In: Kaplitt MJ, Borman JB (eds) Concepts and controversies in cardiovascular surgery. Norwalk, Connecticut: Appleton-Century-Crofts, 1983.Google Scholar

Copyright information

© Springer Science+Business Media Dordrecht 1984

Authors and Affiliations

  • Hans Jürgen Bretschneider
  • Martha Maria Gebhard
  • Claus Jürgen Preusse

There are no affiliations available

Personalised recommendations