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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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145:. 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.
276:
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
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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
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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
249:
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
161:
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
90:
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
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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.
137:. 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
179:. 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.
271:
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.
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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
78:"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
227:, 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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500:"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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212:). 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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208:. 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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98:. 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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130:, or heart muscle, from damage during the period of ischemia.
345:"Definition: Cardioplegia from Online Medical Dictionary"
109:
Immediate and sustained electromechanical quiescence
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112:Rapid and sustained homogeneous myocardial cooling
504:Journal of Cardiothoracic and Vascular Anesthesia
133:To achieve this, the patient is first placed on
105:The main goals of hypothermic cardioplegia are:
434:. 2nd Edition. Little, Brown and Company. 1995
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575:Kirklin/Barratt-Boyes Cardiac Surgery E-Book
82:refers to the solution used to bring about
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667:Cardiology diagnostic tests and procedures
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432:A Practical Approach to Cardiac Anesthesia
763:Transcatheter pulmonary valve replacement
602:at the U.S. National Library of Medicine
372:. 3rd Edition. W.B Saunders Company. 1993
215:Once the procedure on the heart vessels (
806:shunt from heart chamber to blood vessel
246:, it is called retrograde cardioplegia.
118:Periodic washout of metabolic inhibitors
906:shunt from blood vessel to blood vessel
336:
18:
1036:Valve-sparing aortic root replacement
775:enlargement of existing septal defect
447:. 3rd Edition. Mosby St. Louis 1993.
234:When solution is introduced into the
7:
770:production of septal defect in heart
406:"CV Physiology: Membrane Potentials"
300:
1625:Extracorporeal membrane oxygenation
314:Deep hypothermic circulatory arrest
37:
1620:Isolated organ perfusion technique
867:transposition of the great vessels
792:creation of septal defect in heart
477:Washington University in St. Louis
177:histidine-tryptophan-ketoglutarate
14:
1167:Cardiac resynchronization therapy
1391:
1390:
1683:Digital subtraction angiography
1174:Left atrial appendage occlusion
466:"Cardioplegia Delivery Systems"
382:"Cold Crystalloid Cardioplegia"
217:coronary artery bypass grafting
1708:Magnetic resonance angiography
219:) or inside the heart such as
1:
1779:Ankle–brachial pressure index
1296:Radionuclide ventriculography
1810:Thoracic surgical procedures
1589:Endovascular aneurysm repair
1281:Myocardial perfusion imaging
254:Alternatives to cardioplegia
126:. This process protects the
102:strategies available today.
58:while the heart is paused.
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888:for univentricular defect
578:(4th ed.). Elsevier.
516:10.1053/j.jvca.2019.07.126
471:September 4, 2006, at the
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1228:Implantable loop recorder
872:Arterial switch operation
662:Interventional cardiology
652:
74:meaning the "heart", and
38:
1749:Intravascular ultrasound
1703:Radionuclide angiography
1307:Coronary catheterization
797:Blalock–Hanlon procedure
758:Mitral valve replacement
741:Aortic valve replacement
604:Medical Subject Headings
1754:Carotid ultrasonography
1698:Fluorescein angiography
1303:Cardiac catheterization
1245:Electrophysiology study
1145:Radiofrequency ablation
1110:Alcohol septal ablation
267:History of Cardioplegia
225:congenital heart defect
1733:Impedance phlebography
1610:Cardiopulmonary bypass
1518:Ambulatory phlebectomy
1486:Carotid endarterectomy
1349:Impedance cardiography
971:Coronary artery bypass
556:Kouchoukos et al. 2013
309:Cardiopulmonary bypass
210:adenosine triphosphate
135:cardiopulmonary bypass
1380:Transcutaneous pacing
1184:Heart transplantation
1105:Ventricular reduction
921:Blalock–Taussig shunt
430:Hensley F, Martin D.
393:University of Cologne
1688:Cerebral angiography
1449:Endovascular surgery
1354:Ballistocardiography
911:systemic circulation
188:Van 't Hoff equation
124:coronary circulation
1647:Seldinger technique
1642:First rib resection
1594:Open aortic surgery
1233:Cardiac stress test
1211:Electrocardiography
1150:Pacemaker insertion
897:Kawashima procedure
861:compound procedures
736:Aortic valve repair
709:Mitral valve repair
412:on 21 November 2016
70:combines the Greek
56:myocardial ischemia
1286:Cardiovascular MRI
1216:Vectorcardiography
1071:Pericardial window
1066:Pericardiocentesis
1007:Drug-eluting stent
836:Rastelli procedure
785:Balloon septostomy
387:2012-01-07 at the
370:Cardiac Anesthesia
319:Membrane potential
240:aortic cross-clamp
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1135:Catheter ablation
1118:Conduction system
1043:LeCompte maneuver
1031:Bentall procedure
892:Norwood procedure
882:Senning procedure
877:Mustard procedure
780:Atrial septostomy
731:Valve replacement
585:978-1-4160-6391-9
510:(12): 3331–3339.
443:Berne R, Levy M.
324:Resting potential
223:or correction of
221:valve replacement
206:coronary arteries
159:resting potential
143:innominate artery
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141:proximal to the
42:edit on Wikidata
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1375:Cardioversion
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930:to the right
929:
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751:Transcatheter
749:
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743:
742:
739:
737:
734:
732:
729:
725:
722:
720:
717:
716:
715:
714:Valvuloplasty
712:
710:
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700:
697:
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690:
686:
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673:
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581:
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546:
541:
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365:
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351:on 2007-12-09
350:
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97:
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88:Sydney Ringer
85:
81:
77:
73:
69:
61:
59:
57:
53:
43:
34:
31:
29:
25:
20:
1784:Toe pressure
1615:Cardioplegia
1614:
1163:implantation
1157:implantation
1140:Cryoablation
981:Off-pump CAB
791:
774:
699:Valve repair
689:Heart valves
600:Cardioplegia
574:
507:
503:
493:
484:
461:
452:
444:
439:
431:
426:
414:. Retrieved
410:the original
399:
377:
369:
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353:. Retrieved
349:the original
339:
279:
274:D.G. Melrose
270:
257:
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233:
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132:
121:
104:
80:cardioplegia
79:
75:
71:
68:cardioplegia
67:
65:
52:Cardioplegia
51:
50:
22:Cardioplegia
1728:Portography
1693:Aortography
1675:Angiography
1561:Arteriotomy
1476:Atherectomy
1471:Angioplasty
1317:Cardiac PET
1060:Pericardium
1024:Atherectomy
962:Angioplasty
704:Valvulotomy
236:aortic root
1799:Categories
1774:Angioscopy
1742:Ultrasound
1720:Venography
1580:dissection
1566:Phlebotomy
1312:Cardiac CT
1179:Cardiotomy
1084:Myocardium
852:Sano shunt
642:procedures
640:Tests and
475:hosted on
445:Physiology
416:8 November
368:Kaplan J
355:2008-06-19
331:References
201:) by 97%.
149:Physiology
128:myocardium
93:myocardial
692:and septa
540:199540471
524:1053-0770
479:, website
238:(with an
100:perfusion
66:The word
1543:Arterial
1493:Stenting
1444:Vascular
1396:Category
1129:minimaze
1125:Cox maze
532:31401206
469:Archived
385:Archived
285:See also
260:off-pump
184:ischemia
96:necrosis
84:asystole
62:Overview
28:ICD-9-CM
681:Surgery
566:Sources
404:Aaron.
299: (
297:B05XA16
1549:access
1547:venous
1368:Pacing
976:MIDCAB
967:Bypass
917:shunt
811:atrium
724:mitral
719:aortic
606:(MeSH)
582:
538:
530:
522:
186:. The
76:plegia
72:cardio
1603:Other
1325:sound
1197:Tests
1155:S-ICD
1052:Other
986:TECAB
831:aorta
646:heart
536:S2CID
40:[
33:39.63
1545:and
1446:and
1127:and
865:for
580:ISBN
528:PMID
520:ISSN
418:2016
1274:TEE
1269:TTE
1161:ICD
956:CHD
928:SVC
913:to
845:to
829:to
813:to
512:doi
302:WHO
1801::
1578:/
932:PA
548:^
534:.
526:.
518:.
508:33
506:.
502:.
194:10
1582::
1428:e
1421:t
1414:v
1305:/
1131:)
969:/
633:e
626:t
619:v
588:.
542:.
514::
420:.
358:.
305:)
199:2
192:Q
168:h
164:h
44:]
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