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Ann Thorac Surg 1986;41:22-26
© 1986 The Society of Thoracic Surgeons
From the First Department of Surgery, Osaka University Medical School, Osaka, Japan
Accepted for publication April 10, 1985.
* Address reprint requests to Dr. Matsuda, First Department of Surgery, Osaka University Medical School, 1-1-50 Fukushima, Fukushima-ku, Osaka 553, Japan
Twenty-eight patients with chronic aortic valve disease and left ventricular (LV) hypertrophy who underwent aortic valve replacement were studied. Angiographically obtained LV mass ranged from 113 to 580 gm (average, 292 gm). In 14 patients, the LV mass per square meter of body surface area was 200 gm or more. Cold glucose-insulin-K+ cardioplegic solution was infused to obtain a myocardial temperature of less than 15°C. The initial dose of cardioplegic solution was increased to as much as 25 mL per kilogram of body weight when LV hypertrophy was severe. The initial dose was standardized by LV mass and ranged from 1.0 to 3.6 ml/gm (average, 2.7 ml/gm). Postoperative peak levels of the myocardial-specific isoenzyme of creatine phosphokinase (CPK-MB) showed no significant relationship to aortic cross-clamp time, but were related significantly to LV mass (r = 0.457, p < 0.02). The initial dose of cardioplegic solution per LV mass and the peak CPK-MB had an inverse relationship (r = –0.753, p < 0.001). Also, peak CPK-MB was significantly lower in those patients with an initial dose of cardioplegic solution per LV mass of 2.5 ml/gm or more regardless of the size of the LV mass (300 gm or more and less than 300 gm) in spite of no significant difference in myocardial temperature. These results indicate that the dose determination of cardioplegic solution by LV mass seems desirable for patients with chronic aortic valve disease and LV hypertrophy even when myocardial temperature is monitored.
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