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The Journal of Thoracic and Cardiovascular Surgery, Vol 96, 700-710, Copyright © 1988 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
T Fujiwara, T Kurtts, W Anderson, J Heinle and JE Mayer Jr
To investigate the susceptibility of cyanotic neonatal myocardium to
ischemia and the effectiveness of cardioplegia for protection, we induced
cyanosis in 2- to 5-day-old lambs (n = 16) by connecting the left atrial
appendage to the main pulmonary artery with a 4 mm polytetrafluoroethylene
graft, which produced an arterial oxygen tension of 34.1 +/- 1.2 torr.
Seven to 10 days after creation of the model, isolated perfused hearts from
cyanotic animals were subjected to 2 hours of ischemia with topical cooling
or crystalloid cardioplegia (K = 30 mEq/L) for myocardial protection (both
at 15 degrees C). Identical studies were performed on hearts from 16
normoxemic neonatal lambs 5 to 14 days old. The overall effect of cyanosis
was to produce a significant impairment in recovery of maximum developed
pressure (p less than 0.05) after ischemia. The overall effect of
cardioplegia was to produce a significant improvement in recovery of
maximum developed pressure, developed pressure at V10 (the balloon volume
to produce an end-diastolic pressure of 10 mm Hg during the preischemic
period), and peak rate of pressure rise at V10 (p less than 0.05). The
protective effect of cardioplegia was more prominent in cyanotic hearts
than in normoxemic hearts for recovery of maximum of peak rate of pressure
rise and peak rate of pressure rise at V10 (p less than 0.05).
End-diastolic pressure at V10 and the diastolic stiffness constant at 10
and 20 mm Hg were all significantly higher after ischemia in the cyanotic
hearts than in the normoxemic hearts (p less than 0.05). We conclude that
in neonatal hearts cyanosis may increase the vulnerability to ischemia and
cardioplegia appears to enhance the recovery of systolic but not diastolic
function in these hearts.
ARTICLES
Myocardial protection in cyanotic neonatal lambs
Department of Cardiac Surgery, Children's Hospital, Boston, Mass. 02115.
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