Michael T. Kronon, MD, Bradley S

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Presentation transcript:

Dose dependency of l-arginine in neonatal myocardial protection: The nitric oxide paradox Michael T. Kronon, MD, Bradley S. Allen, MD, Ari Halldorsson, MD, Shaikh Rahman, PhD, Tingrong Wang, MD, Michel Ilbawi, MD The Journal of Thoracic and Cardiovascular Surgery Volume 118, Issue 4, Pages 655-664 (October 1999) DOI: 10.1016/S0022-5223(99)70011-5 Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 1 Recovery of LV systolic function as measured by end-systolic elastance (EES) and expressed as percentage of control (baseline). Note: Exposing the heart to hypoxia and ischemia produces such a severe stress that unmodified aspartate-glutamate blood cardioplegic solution is unable to fully resuscitate the heart. In contrast, cardioplegic solution enriched with a 4 mmol/L concentration of L-arginine is able to fully resuscitate the hypoxic myocardium, resulting in complete return of systolic function. Conversely, these beneficial effects were negated if the L-arginine concentration was increased to 10 mmol/L. *P < .001 (mean ± standard error). The Journal of Thoracic and Cardiovascular Surgery 1999 118, 655-664DOI: (10.1016/S0022-5223(99)70011-5) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 2 Postbypass LV diastolic compliance as measured by the end-diastolic pressure volume relationship and expressed as percentage of stiffness compared with control (baseline). Note: There is a marked increase in diastolic stiffness in hearts given unmodified blood cardioplegic solution. Conversely, enriching the cardioplegic solution with a 4 mmol/L concentration of L-arginine allowed for cellular repair of the hypoxic-ischemia injury, improving diastolic compliance. This beneficial effect was lost if the dose of L-arginine was increased to 10 mmol/L. *P < .001 (mean ± standard error). BCP, Blood cardioplegic solution. The Journal of Thoracic and Cardiovascular Surgery 1999 118, 655-664DOI: (10.1016/S0022-5223(99)70011-5) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 3 Recovery of overall myocardial function as measured by preload recruitable stroke work (PRSW) and expressed as percentage of control (baseline). *P < .001 (mean ± standard error). The Journal of Thoracic and Cardiovascular Surgery 1999 118, 655-664DOI: (10.1016/S0022-5223(99)70011-5) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 4 Coronary vascular resistance (CVR) measured during cardioplegic infusion once the flow and cardioplegic pressures were stable. *P < .001 (mean ± standard error). The Journal of Thoracic and Cardiovascular Surgery 1999 118, 655-664DOI: (10.1016/S0022-5223(99)70011-5) Copyright © 1999 Mosby, Inc. Terms and Conditions