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Ann Thorac Surg 1981;32:536-545
© 1981 The Society of Thoracic Surgeons

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Articles

Limitations of Potassium Cardioplegia during Cardiac Ischemic Arrest: A Phosphorus 31 Nuclear Magnetic Resonance Study

From the Department of Physiology and Biophysics, Harvard Medical School, Boston, MA, and the Cardio-Vascular Surgical Department and INSERM U-127, Hôpital Lariboisière, Paris, France

^* Address reprint requests to Dr. Menasche, Service de Chirurgie Cardio-Vasculaire, Hôpital Lariboisière, 2, rue Ambroise Paré, 75475 Paris, France

Cold K⁺ cardioplegia is commonly used to preserve the myocardium during surgical ischemia. Since the K⁺-induced membrane depolarization could cause a Ca²⁺-mediated breakdown of adenosine triphosphate, this study compared the influence of different electrolytes on high-energy phosphate metabolism during cardioplegic arrest and subsequent recovery of mechanical function. An isolated working heart was subjected to hypothermic ischemia for one hour. Metabolic studies were assessed on phosphorus 31 nuclear magnetic resonance (NMR). Results show that (1) K⁺ cardioplegia is harmful when the Ca²⁺ content is equal to 2 mEq/L; (2) deleterious effects of K⁺ are markedly reduced by lowering the Ca²⁺ content; (3) the most adequate preservation is provided by a Mg²⁺-rich–Ca²⁺-poor perfusate; (4) this protection is not enhanced by addition of K⁺. Finally, ³¹P NMR appears particularly appropriate for evaluating myocardial protection techniques since it allows noninvasive serial monitoring of high-energy phosphate content and subsequent correlation with functional recovery after ischemia.

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