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James T. Diehl
Elliot Kaplan
Arthur R. Dresdale
Douglas D. Payne
Richard J. Cleveland
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Ann Thorac Surg 1989;48:829-834
© 1989 The Society of Thoracic Surgeons

Articles

Effects of atrial cardioplegia on the ischemic right ventricle after acute coronary artery occlusion and reperfusion

James T. Diehl, MD*, Elliot Kaplan, MD, Arthur R. Dresdale, MD, Andreas Kreis, MD, Marvin A. Konstam, MD, Ian M. Ross, CCP, Raymond J. Connolly, PhD, Natesa G. Pandian, MD, Mark Aronovitz, BA, Douglas D. Payne, MD, Richard J. Cleveland, MD

Division of Cardiotholacic Surgery and Cardiology, New England Medical Center Hospitals and Tufts University School of Medicine, Boston, Massachusetts, USA

Accepted for publication August 28, 1989.

* Address reprint requests to Dr Diehl, Division of Cardiothoracic Surgery, New England Medical Center, 750 Washington St. Boston, MA 02111.

Right atrial cardioplegia has been advocated as a simple method of delivering retrograde cardioplegia. Passive disteition of the right heart inherent with right atrial cardioplegia has been shown to impair right ventricular function in a canine model of global ischemia. This study was designed to compare right ventricular performance after right atrial cardioplegia administered intermittently (n = 5) and continuously (n = 5) with coronary sinus retrograde cardioplegia (n = 9) and aortic root cardioplegia (n = 8) in a canine model of acute right ventricular ischemia and reperfusion. Right ventricular performance was assessed using the load-independent relationship of end-systolic pressure versus dimension (myorardial fiber length). Right ventricular performance was well preserved after reperfusion in those dogs protected with intermittent right atrial cardioplegia (95% of control). Results with continuous right atrial cardioplegia (66% of control) and coronary sinus retrograde cardioplegia (40% of control) demonstrated diminished postreperfusion right ventricular performance. Right ventricular performance in the group protected with aortic root cardioplegia was significantly impaired after reperfusion when compared with all retrograde groups (34% of control, p < 0.05). In this model, postreperfusion right ventricular performance was preserved in the right atrial cardioplegia groups despite passive ventricular distention. All methods of retrograde cardioplegia resulted in superior preservation of right ventricular performance when compared with standard aortic root cardioplegia.




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C. Haan, H. L. Lazar, S. Bernard, S. Rivers, J. Zallnick, and R. J. Shemin
Superiority of retrograde cardioplegia after acute coronary occlusion
Ann. Thorac. Surg., March 1, 1991; 51(3): 408 - 412.
[Abstract] [PDF]


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