HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Bradley S. Allen Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Allen, B. S. Search for Related Content PubMed PubMed Citation Articles by Allen, B. S. Related Collections Myocardial protection

J Thorac Cardiovasc Surg 2004;128:11-13
© 2004 The American Association for Thoracic Surgery

Editorial

Pediatric myocardial protection: Where do we stand?

^a Department of Cardiothoracic and Vascular Surgery, The University of Texas at Houston, Memorial Hermann Children's Hospital, Houston, Tex, USA

Received for publication March 9, 2004; accepted for publication March 22, 2004.

^* Address for reprints: Bradley S. Allen, MD, Professor of Cardiothoracic and Vascular Surgery, Chief, Pediatric Cardiac Surgery, The University of Texas at Houston, 6431 Fannin St, MSB 1.214, Houston, TX 77030, USA
Bradley.Allen@uth.tmc.edu

The first 300 words of the full text of this article appear below.

See related article on page 67.

 

The objectives of every cardiac operation, whether adult or pediatric, are technical success and absence of iatrogenic injury from inadequate myocardial protection. To obtain the best results, the surgeon should select a method of protection only after learning how the cardioplegic method was developed, as well as how to benefit from its advantages, and how to avoid inappropriate use by recognizing the disadvantages. The choice for protection is similar to the selection of a structural technique for surgical repair of an underlying cardiac lesion. Failure of either modality is unacceptable, because both are equally important if the patient is to receive the full benefit from the surgical correction. Improved myocardial protection is not a phase of surgical development; it is intrinsic to the repair of congenital cardiac defects.

Despite major advances in the technical aspects of surgical repair, pediatric myocardial protective techniques remain relatively unchanged. Moreover, there are currently few articles in the major journals on pediatric myocardial protection. This would imply that current techniques provide optimal and complete preservation of the pediatric heart and that there is little need for further research to improve protection methods. However, pediatric patients continue to need mechanical assist devices, as well as prolonged inotropic support or an open chest despite a "technically perfect repair." Moreover, perioperative myocardial damage with low cardiac output remains the most common cause of morbidity and death after repair of congenital lesions.^1-3 Cardiac damage from inadequate myocardial protection can prolong hospital stay and result in delayed myocardial fibrosis, leading to cardiac dysfunction months to years later.¹ Protection of the immature heart is further complicated by a reduced response to inotropic agents relative to the adult heart.^2-4 Thus preservation of myocardial function in immature hearts assumes even greater importance, because a perioperative insult . . . [Full Text of this Article]

This article has been cited by other articles:

				J. D. O'Brien, S. E. Howlett, H. J. Burton, S. B. O'Blenes, D. S. Litz, and C. L. H. Friesen Pediatric cardioplegia strategy results in enhanced calcium metabolism and lower serum troponin T. Ann. Thorac. Surg., May 1, 2009; 87(5): 1517 - 1523. [Abstract] [Full Text] [PDF]

				W. Luo, B. Li, R. Chen, R. Huang, and G. Lin Effect of ischemic postconditioning in adult valve replacement Eur. J. Cardiothorac. Surg., February 1, 2008; 33(2): 203 - 208. [Abstract] [Full Text] [PDF]

				P. Modi, S. M. Suleiman, B. C. Reeves, A. Pawade, A. J. Parry, G. D. Angelini, and M. Caputo Changes in myocardial free amino acids during pediatric cardiac surgery: a randomised controlled trial of three cardioplegic techniques. Eur. J. Cardiothorac. Surg., July 1, 2006; 30(1): 41 - 48. [Abstract] [Full Text] [PDF]

				H. J. Geissler and U. Mehlhorn Cold crystalloid cardioplegia MMCTS, January 9, 2006; 2006(0109): 1040. [Abstract] [Full Text] [PDF]

				C. Schlensak Myocardial protection in congenital heart surgery MMCTS, November 29, 2005; 2005(1129): 729. [Abstract] [Full Text] [PDF]