L-arginine, prostaglandin, and white cell filtration equally improve myocardial protection in stressed neonatal hearts Michael T. Kronon, MD, Bradley.

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Presentation transcript:

L-arginine, prostaglandin, and white cell filtration equally improve myocardial protection in stressed neonatal hearts 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 665-673 (October 1999) DOI: 10.1016/S0022-5223(99)70012-7 Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 1 Postbypass LV contractile function (hypoxic-ischemic hearts). 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 aspartate-glutamate blood cardioplegic solution is unable to fully resuscitate the heart. In contrast, cardioplegic solution enriched with L-arginine, PGE 1, or passed through a WBC filter is able to fully resuscitate the hypoxic myocardium, resulting in complete return of systolic function. *P < 0.001 (mean ± standard error). The Journal of Thoracic and Cardiovascular Surgery 1999 118, 665-673DOI: (10.1016/S0022-5223(99)70012-7) 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 to control (baseline). Note: There is a marked increase in diastolic stiffness in hearts given blood cardioplegic solution alone. Conversely, enriching the cardioplegic solution with L-arginine, PGE1, or pumping it through a WBC filter allowed for cellular repair of the hypoxic ischemia injury, improving diastolic compliance. *P < 0.001 (mean ± standard error). The Journal of Thoracic and Cardiovascular Surgery 1999 118, 665-673DOI: (10.1016/S0022-5223(99)70012-7) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 3 Postbypass overall myocardial function (hypoxic-ischemic hearts). Recovery of overall myocardial function as measured by preload recruitable stroke work (PRSW) and expressed as a percentage of control (baseline). *P < 0.001 (mean ± standard error). The Journal of Thoracic and Cardiovascular Surgery 1999 118, 665-673DOI: (10.1016/S0022-5223(99)70012-7) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 4 Coronary vascular resistance (CVR) measured during cardioplegic infusions once the flow and cardioplegic pressures were stable. Note: Because a WBC filter does not cause vasodilation, the lower CVR in groups 2 to 4 must be due to preservation of vascular function and not vasodilation. This also implies that L-arginine and PGE1 prevent vascular damage primarily by inhibition of a WBC-mediated injury. *P < 0.001 (mean ± standard error). The Journal of Thoracic and Cardiovascular Surgery 1999 118, 665-673DOI: (10.1016/S0022-5223(99)70012-7) Copyright © 1999 Mosby, Inc. Terms and Conditions