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via ATP-dependent Ca pumps, and the cell relaxes (diastole). However, the high potassium concentration of the cardioplegia extracellular prevents repolarization. The resting potential on ventricular myocardium is about −84 mV at an extracellular K concentration of 5.4 mmol/L. Raising the K concentration to 16.2 mmol/L raises the resting potential to −60 mV, a level at which muscle fibers are inexcitable to ordinary stimuli. When the resting potential approaches −50 mV, sodium channels are inactivated, resulting in a diastolic arrest of cardiac activity. Membrane inactivation gates, or
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156:. During this period of heart isolation, the heart is not receiving any blood flow, thus no oxygen for metabolism. As the cardioplegia solution distributes to the entire myocardium, the ECG will change and eventually asystole will ensue. Cardioplegia lowers the metabolic rate of the heart muscle, thereby preventing cell death during the ischemic period of time.
287:
suggested ‘’elective cardiac arrest’’, a technique already used for other purposes, in order to protect the heart from ischemia- since cardiac muscle is not working, oxygen demands should be low. In the 1960’s other groups introduced ice slur applied all over the heart’s surface. The rationale was to
291:
The next decades many investigators (Bretschneider, Kirch and others) came up with various solutions that could pause the heart without damaging cardiac muscle. In the same period, surgeons found out delivery roots for cardioplegia, other than the commonly used antegrade. Buckberg in North
America
185:
The use of two other cations, Na and Ca, also can be used to arrest the heart. By removing extracellular Na from perfusate, the heart will not beat because the action potential is dependent upon extracellular Na ions. However, the removal of Na does not alter the resting membrane potential of the
260:
Whilst there are several cardioplegic solutions commercially available; there are no clear advantages of one cardioplegic solution over another. Some cardioplegias, such as del Nido or
Histidine-Tryptophan-Ketoglutamate solutions, offer an advantage over blood and other crystalloid cardioplegia as
172:
of ventricular myocytes is about -90 mV. When extracellular cardioplegia displaces blood surrounding myocytes, the membrane voltage becomes less negative and the cell depolarizes more readily. The depolarization causes contraction, intracellular calcium is sequestered by the sarcoplasmic reticulum
101:
in the late 1800s. At that time Ringer and colleagues noticed that tap water had the ability to increase contractility of the heart, likely due to its high calcium content. Sydney Ringer also commented on the importance of potassium ion concentration on depressing intrinsic heart rhythm. Through a
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gates that tend to close. If partial depolarization is produced by a gradual process such as elevating the level of extracellular K, then the gates have ample time to close and thereby inactivate some of the Na channels. When the cell is partially depolarized, many of the Na channels are already
241:
The cold fluid (usually at 4 °C) ensures that the heart cools down to a temperature of around 15–20 °C, thus slowing down the metabolism of the heart and thereby preventing damage to the heart muscle. This is further augmented by the cardioplegia component which is high in potassium.
148:. This device, otherwise known as the heart-lung machine, takes over the functions of gas exchange by the lung and blood circulation by the heart. Subsequently, the heart is isolated from the rest of the blood circulation by means of an occlusive cross-clamp placed on the
190:. Conversely, increasing extracellular Ca concentration enhances contractile force. Elevating Ca concentration to a high enough level results in cardiac arrest in systole. This unfortunate irreversible event is referred to as "stone-heart" or rigor.
282:
Cardiac surgical cases were performed with the aid of a cardiopulmonary pump, without cardioplegia or other means of protecting the heart. High mortality rates due to cardiac injury though, made surgeons to look on how to protect the heart. In 1955
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coronary surgery where the surgery is done without the need of a cardiopulmonary bypass machine. Another is to use cross-clamp fibrillation whereby the heart fibrillates whilst on cardiopulmonary bypass in order to perform the distal anastomoses.
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Cardioplegic solution is the means by which the ischemic myocardium is protected from cell death. This is achieved by reducing myocardial metabolism through a reduction in cardiac work load and by the use of hypothermia.
97:
of the heart, or heart paralysis. One of the first physicians to use the term cardioplegia was Dr. Lam in 1957. However his work on the myocardial protection was preceded serendipitously by
89:"paralysis". Technically, this means arresting or stopping the heart so that surgical procedures can be done in a still and bloodless field. Most commonly, however, the word
238:, etc. is over, the cross-clamp is removed and the isolation of the heart is terminated, so normal blood supply to the heart is restored and the heart starts beating again.
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series of experiments performed on frog and canine hearts, reversible arrest was achieved with potassium ions with the consequence of ventricular fibrillation and observed
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Reynolds AC, Asopa S, Modi A, King N. HTK versus multidose cardioplegias for myocardial protection in adult cardiac surgery: A meta-analysis. J Card Surg. 2021 Feb 5.
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and
Menasche in Europe, introduced retrograde cardioplegia method, via a catheter inserted in Coronary Sinus and thus perfusing the heart in a retrograde fashion.
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Hypothermia is the other key component of most cardioplegic strategies. It is employed as another means to further lower myocardial metabolism during periods of
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511:"Intermittent Cross-Clamp Fibrillation Versus Cardioplegic Arrest During Coronary Surgery in 6,680 Patients: A Contemporary Review of an Historical Technique"
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cell. Likewise, removal of extracellular Ca results in a decreased contractile force, and eventual arrest in diastole. An example of a low low solution is
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223:). Blood is commonly added to this solution in varying amounts from 0 to 100%. Blood acts a buffer and also supplies nutrients to the heart during ischemia.
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Chemically, the high potassium concentration present in most cardioplegic solutions decreases the membrane resting potential of cardiac cells. The normal
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they only require one administration during short cardiac surgeries, compared to multiple doses required by blood and other crystalloid.
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Cold cardioplegia is given into the heart through the aortic root. Blood supply to the heart arises from the aortic root through
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inactivated, and only a fraction of these channels is available to conduct the inward Na current during phase 0 depolarization.
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on the distal aorta to limit systemic circulation), this is called antegrade cardioplegia. When introduced into the
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Gravlee G, Davis R, Utley J. Cardiopulonary Bypass
Principles and Practice. Williams & Williams Baltimore 1993.
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allows calculation that oxygen consumption will drop by 50% for every 10 °C reduction in temperature. This
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In coronary surgery, there are various alternatives to cardioplegia to perform the operation. One is
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The most common procedure for accomplishing asystole is infusing cold cardioplegic solution into the
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Ariyaratnam, Priyadharshanan; Cale, Alexander; Loubani, Mahmoud; Cowen, Michael E. (2019-12-01).
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219:. Cardioplegia in diastole ensures that the heart does not use up the valuable energy stores (
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effect combined with a chemical cardiac arrest can reduce myocardial oxygen consumption (MVO
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is a solution given to the heart during cardiac surgery, to minimize the damage caused by
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Intentional and temporary cessation of cardiac activity, primarily for cardiac surgery
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109:. These early experiments started nearly 50 years of work that has led to variety of
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Na gates, are voltage dependent. The less negative the membrane voltage, the more
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Kouchoukos, Nicholas; Blackstone, E. H.; Hanley, F. L.; Kirklin, J. K. (2013).
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decrease the temperature of the heart, thus to reduce oxygen demands further.
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Hans J. Geissler* and Uwe
Mehlhorn, Department of Cardiothoracic Surgery,
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Maintenance of therapeutic additives in effective concentrations
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141:, or heart muscle, from damage during the period of ischemia.
356:"Definition: Cardioplegia from Online Medical Dictionary"
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Immediate and sustained electromechanical quiescence
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123:Rapid and sustained homogeneous myocardial cooling
515:Journal of Cardiothoracic and Vascular Anesthesia
144:To achieve this, the patient is first placed on
116:The main goals of hypothermic cardioplegia are:
445:. 2nd Edition. Little, Brown and Company. 1995
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586:Kirklin/Barratt-Boyes Cardiac Surgery E-Book
93:refers to the solution used to bring about
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678:Cardiology diagnostic tests and procedures
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443:A Practical Approach to Cardiac Anesthesia
774:Transcatheter pulmonary valve replacement
613:at the U.S. National Library of Medicine
383:. 3rd Edition. W.B Saunders Company. 1993
226:Once the procedure on the heart vessels (
817:shunt from heart chamber to blood vessel
257:, it is called retrograde cardioplegia.
129:Periodic washout of metabolic inhibitors
917:shunt from blood vessel to blood vessel
347:
29:
1047:Valve-sparing aortic root replacement
786:enlargement of existing septal defect
458:. 3rd Edition. Mosby St. Louis 1993.
245:When solution is introduced into the
7:
781:production of septal defect in heart
417:"CV Physiology: Membrane Potentials"
311:
1636:Extracorporeal membrane oxygenation
325:Deep hypothermic circulatory arrest
48:
1631:Isolated organ perfusion technique
878:transposition of the great vessels
803:creation of septal defect in heart
488:Washington University in St. Louis
188:histidine-tryptophan-ketoglutarate
25:
1178:Cardiac resynchronization therapy
1402:
1401:
1694:Digital subtraction angiography
1185:Left atrial appendage occlusion
477:"Cardioplegia Delivery Systems"
393:"Cold Crystalloid Cardioplegia"
228:coronary artery bypass grafting
1719:Magnetic resonance angiography
230:) or inside the heart such as
1:
1790:Ankle–brachial pressure index
1307:Radionuclide ventriculography
1821:Thoracic surgical procedures
1600:Endovascular aneurysm repair
1292:Myocardial perfusion imaging
265:Alternatives to cardioplegia
137:. This process protects the
113:strategies available today.
69:while the heart is paused.
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899:for univentricular defect
589:(4th ed.). Elsevier.
527:10.1053/j.jvca.2019.07.126
482:September 4, 2006, at the
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1239:Implantable loop recorder
883:Arterial switch operation
673:Interventional cardiology
663:
85:meaning the "heart", and
49:
1760:Intravascular ultrasound
1714:Radionuclide angiography
1318:Coronary catheterization
808:Blalock–Hanlon procedure
769:Mitral valve replacement
752:Aortic valve replacement
615:Medical Subject Headings
1765:Carotid ultrasonography
1709:Fluorescein angiography
1314:Cardiac catheterization
1256:Electrophysiology study
1156:Radiofrequency ablation
1121:Alcohol septal ablation
278:History of Cardioplegia
236:congenital heart defect
1744:Impedance phlebography
1621:Cardiopulmonary bypass
1529:Ambulatory phlebectomy
1497:Carotid endarterectomy
1360:Impedance cardiography
982:Coronary artery bypass
567:Kouchoukos et al. 2013
320:Cardiopulmonary bypass
221:adenosine triphosphate
146:cardiopulmonary bypass
18:Cardioplegic solutions
1391:Transcutaneous pacing
1195:Heart transplantation
1116:Ventricular reduction
932:Blalock–Taussig shunt
441:Hensley F, Martin D.
404:University of Cologne
1699:Cerebral angiography
1460:Endovascular surgery
1365:Ballistocardiography
922:systemic circulation
199:Van 't Hoff equation
135:coronary circulation
1658:Seldinger technique
1653:First rib resection
1605:Open aortic surgery
1244:Cardiac stress test
1222:Electrocardiography
1161:Pacemaker insertion
908:Kawashima procedure
872:compound procedures
747:Aortic valve repair
720:Mitral valve repair
423:on 21 November 2016
81:combines the Greek
67:myocardial ischemia
1297:Cardiovascular MRI
1227:Vectorcardiography
1082:Pericardial window
1077:Pericardiocentesis
1018:Drug-eluting stent
847:Rastelli procedure
796:Balloon septostomy
398:2012-01-07 at the
381:Cardiac Anesthesia
330:Membrane potential
251:aortic cross-clamp
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1270:Angiocardiography
1216:Electrophysiology
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1146:Catheter ablation
1129:Conduction system
1054:LeCompte maneuver
1042:Bentall procedure
903:Norwood procedure
893:Senning procedure
888:Mustard procedure
791:Atrial septostomy
742:Valve replacement
596:978-1-4160-6391-9
521:(12): 3331–3339.
454:Berne R, Levy M.
335:Resting potential
234:or correction of
232:valve replacement
217:coronary arteries
170:resting potential
154:innominate artery
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16:(Redirected from
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1509:Carotid stenting
1469:Arterial disease
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1013:Bare-metal stent
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53:edit on Wikidata
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1101:Cardiomyoplasty
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1456:
1452:
1448:
1441:
1436:
1434:
1429:
1427:
1422:
1421:
1418:
1408:
1398:
1392:
1389:
1387:
1386:Cardioversion
1384:
1383:
1381:
1377:
1371:
1368:
1366:
1363:
1361:
1358:
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1349:
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1133:
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1126:
1125:
1122:
1119:
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1114:
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1109:
1107:
1106:Dor procedure
1104:
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1099:
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1085:
1083:
1080:
1078:
1075:
1072:
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1055:
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1036:
1033:
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1028:
1023:
1022:
1019:
1016:
1014:
1011:
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1003:
998:
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993:
990:
988:
985:
984:
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979:
976:
974:
971:
968:
964:
963:
961:
957:
949:
946:
945:
944:
941:to the right
940:
937:
933:
930:
929:
927:
923:
920:
915:
914:
909:
906:
904:
901:
900:
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870:
869:
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839:
836:
832:
829:
828:
827:
823:
820:
815:
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801:
797:
794:
792:
789:
788:
787:
784:
779:
778:
775:
772:
770:
767:
763:
762:Transcatheter
760:
758:
755:
754:
753:
750:
748:
745:
743:
740:
736:
733:
731:
728:
727:
726:
725:Valvuloplasty
723:
721:
718:
716:
713:
711:
708:
707:
705:
701:
697:
694:
690:
684:
681:
679:
676:
674:
671:
669:
666:
665:
662:
658:
654:
646:
641:
639:
634:
632:
627:
626:
623:
616:
612:
609:
608:
604:
598:
592:
588:
587:
581:
580:
576:
568:
563:
561:
557:
552:
548:
544:
540:
536:
532:
528:
524:
520:
516:
512:
505:
502:
496:
493:
489:
485:
481:
478:
473:
470:
464:
461:
457:
451:
448:
444:
438:
435:
422:
418:
411:
408:
405:
401:
397:
394:
389:
386:
382:
376:
373:
362:on 2007-12-09
361:
357:
351:
348:
341:
336:
333:
331:
328:
326:
323:
321:
318:
314:
309:
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304:
301:
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295:
293:
289:
286:
277:
275:
272:
264:
262:
258:
256:
252:
248:
243:
239:
237:
233:
229:
224:
222:
218:
213:
207:
200:
196:
191:
189:
183:
180:
176:
171:
166:
159:
157:
155:
151:
147:
142:
140:
136:
128:
125:
122:
119:
118:
117:
114:
112:
108:
105:
100:
99:Sydney Ringer
96:
92:
88:
84:
80:
72:
70:
68:
64:
54:
45:
42:
40:
36:
31:
19:
1795:Toe pressure
1626:Cardioplegia
1625:
1174:implantation
1168:implantation
1151:Cryoablation
992:Off-pump CAB
802:
785:
710:Valve repair
700:Heart valves
611:Cardioplegia
585:
518:
514:
504:
495:
472:
463:
455:
450:
442:
437:
425:. Retrieved
421:the original
410:
388:
380:
375:
364:. Retrieved
360:the original
350:
290:
285:D.G. Melrose
281:
268:
259:
244:
240:
225:
214:
192:
184:
178:
174:
167:
163:
143:
132:
115:
91:cardioplegia
90:
86:
82:
79:cardioplegia
78:
76:
63:Cardioplegia
62:
61:
33:Cardioplegia
1739:Portography
1704:Aortography
1686:Angiography
1572:Arteriotomy
1487:Atherectomy
1482:Angioplasty
1328:Cardiac PET
1071:Pericardium
1035:Atherectomy
973:Angioplasty
715:Valvulotomy
247:aortic root
1810:Categories
1785:Angioscopy
1753:Ultrasound
1731:Venography
1591:dissection
1577:Phlebotomy
1323:Cardiac CT
1190:Cardiotomy
1095:Myocardium
863:Sano shunt
653:procedures
651:Tests and
486:hosted on
456:Physiology
427:8 November
379:Kaplan J
366:2008-06-19
342:References
212:) by 97%.
160:Physiology
139:myocardium
104:myocardial
703:and septa
551:199540471
535:1053-0770
490:, website
249:(with an
111:perfusion
77:The word
1554:Arterial
1504:Stenting
1455:Vascular
1407:Category
1140:minimaze
1136:Cox maze
543:31401206
480:Archived
396:Archived
296:See also
271:off-pump
195:ischemia
107:necrosis
95:asystole
73:Overview
39:ICD-9-CM
692:Surgery
577:Sources
415:Aaron.
310: (
308:B05XA16
1560:access
1558:venous
1379:Pacing
987:MIDCAB
978:Bypass
928:shunt
822:atrium
735:mitral
730:aortic
617:(MeSH)
593:
549:
541:
533:
197:. The
87:plegia
83:cardio
1614:Other
1336:sound
1208:Tests
1166:S-ICD
1063:Other
997:TECAB
842:aorta
657:heart
547:S2CID
51:[
44:39.63
1556:and
1457:and
1138:and
876:for
591:ISBN
539:PMID
531:ISSN
429:2016
1285:TEE
1280:TTE
1172:ICD
967:CHD
939:SVC
924:to
856:to
840:to
824:to
523:doi
313:WHO
1812::
1589:/
943:PA
559:^
545:.
537:.
529:.
519:33
517:.
513:.
205:10
1593::
1439:e
1432:t
1425:v
1316:/
1142:)
980:/
644:e
637:t
630:v
599:.
553:.
525::
431:.
369:.
316:)
210:2
203:Q
179:h
175:h
55:]
20:)
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