Sunil P Malhotra, MD, Stephan Thelitz, MD, R. Kirk Riemer, PhD, V

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Fetal myocardial protection is markedly improved by reduced cardioplegic calcium content Sunil P Malhotra, MD, Stephan Thelitz, MD, R.Kirk Riemer, PhD, V.Mohan Reddy, MD, Sam Suleman, BS, Frank L Hanley, MD The Annals of Thoracic Surgery Volume 75, Issue 6, Pages 1937-1941 (June 2003) DOI: 10.1016/S0003-4975(03)00032-8

Fig 1 Diagram of the isolated biventricular fetal heart preparation. Orientation for Langendorff (solid arrows) and working heart (dashed arrows) perfusion modes illustrated. (IVC = inferior vena cava; LA = left atrium; LV = left ventricle; PA = pulmonary artery; RA = right atrium; RV = right ventricle; SVC = superior vena cava.) The Annals of Thoracic Surgery 2003 75, 1937-1941DOI: (10.1016/S0003-4975(03)00032-8)

Fig 2 Ventricular systolic function measured by end-systolic elastance (ESE). Percent recovery represents the ratio of postarrest ESE to prearrest ESE. Hypocalcemic cardioplegia improves preservation of right ventricular (RV) and left ventricular (LV) systolic function. Systolic function is significantly diminished following hypercalcemic arrest. (□ = normal [Ca]; ▧ = low [Ca]; ■ = high [Ca].) The Annals of Thoracic Surgery 2003 75, 1937-1941DOI: (10.1016/S0003-4975(03)00032-8)

Fig 3 Ventricular diastolic stiffness expressed as a percentage of postarrest stiffness compared with prearrest values. Left ventricular (LV) diastolic dysfunction following normocalcemic cardioplegic arrest is attenuated by the use of hypocalcemic cardioplegia. Increased right ventricular (RV) stiffness is unaffected by the use of low-calcium cardioplegia. Hypercalcemic cardioplegia markedly increases postarrest stiffness of both ventricles. (□ = normal [Ca]; ▧ = low [Ca]; ■ = high [Ca].) The Annals of Thoracic Surgery 2003 75, 1937-1941DOI: (10.1016/S0003-4975(03)00032-8)

Fig 4 Recovery of myocardial contractility as measured by preload recruitable stroke work (PRSW) and expressed as a percentage of baseline PRSW. Hypocalcemic cardioplegia provided excellent preservation of contractile function (> 90%) of both ventricles. This compared with only 75% recovery when normocalcemic cardioplegia was used. Hypercalcemic arrest resulted in global impairment of myocardial function. (□ = normal [Ca]; ▧ = low [Ca]; ■ = high [Ca].) (LV = left ventricular; RV = right ventricular.) The Annals of Thoracic Surgery 2003 75, 1937-1941DOI: (10.1016/S0003-4975(03)00032-8)

Fig 5 Myocardial water content determinations. Hypercalcemic arrest caused the greatest degree of myocardial edema with water content of 88% ± 1.1% (p = 0.004). Low calcium cardioplegia resulted in the lowest myocardial water content of the three groups (79.1% ± 1.8%, p = 0.0006). The Annals of Thoracic Surgery 2003 75, 1937-1941DOI: (10.1016/S0003-4975(03)00032-8)