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J Thorac Cardiovasc Surg 2000;119:1102-1109
© 2000 The American Association for Thoracic Surgery

SURGERY FOR CONGENITAL HEART DISEASE

EFFECTS OF RETROGRADE CARDIOPLEGIA ON MYOCARDIAL PERFUSION AND ENERGY METABOLISM IN IMMATURE PORCINE MYOCARDIUM

From the Institute for Biodiagnostics, National Research Council of Canada^a; Medical Systems, General Electronic,^b Milwaukee, Wis; and the Department of Cardiovascular Surgery, University of Manitoba, Winnipeg,^c Manitoba, Canada.

This work was supported by the Medical Research Council of Canada (grant 9609OP-348-BME-CDAA-26321) and the Heart and Stroke Foundation of Manitoba.

Address for reprints: Ganghong Tian, 435 Ellice Ave, Winnipeg, Manitoba, Canada, R3B 1Y6 (E-mail: tian{at}ibd.nrc.ca ).

Objectives: Retrograde cardioplegia has been widely used for the protection of adult hearts during cardiac operations. Its efficacy to protect immature myocardium is still unclear. This study was designed to assess the effects of retrograde cardioplegia on myocardial perfusion and energy metabolism in immature hearts.
Methods: Piglet hearts were divided into 3 groups. Hearts in group 1 were used to assess myocardial perfusion of retrograde cardioplegia by means of magnetic resonance imaging. Hearts in groups 2 and 3 were used to assess the effects of retrograde cardioplegia on myocardial energy metabolism by use of phosphorus 31 magnetic resonance spectroscopy.
Results: Magnetic resonance images showed that perfusion with retrograde cardioplegic solution was heterogeneous. A perfusion defect was noted during retrograde cardioplegia in the right ventricular wall and in a portion of the posterior wall of the left ventricle in 4 of 6 hearts. Phosphorus 31 spectra showed that at the end of 45-minute retrograde cardioplegia, myocardial intracellular pH was 6.83 ± 0.17 and phosphocreatine was 53.5% ± 27% of its prearrest value. The adenosine triphosphate level, however, remained normal throughout the retrograde cardioplegia period. Last, the hearts subjected to retrograde cardioplegia or antegrade cardioplegia showed similar and complete metabolic and functional recovery during reperfusion.
Conclusions: Retrograde cardioplegia provides heterogeneous perfusion. Its ability to protect the right ventricular myocardium is poor and varies between individuals. Myocardial perfusion provided by retrograde cardioplegia is slightly less than that needed to sustain normal myocardial energy metabolism under normothermic conditions.

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