Myocardial Protection

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Abstract

The concept of myocardial protection in congenital heart surgery has dramatically evolved over the last two decades. Pediatric clinical practice has largely been extrapolated from experiences with adult myocardial protection. These practice patterns did not account for the inherent anatomic and physiologic differences between adult and immature myocardium that can make immature myocardium more (reduced free radical scavenging, increased calcium sensitivity) or less (preference to glucose, high glycogen stores and low 5′ nucleotidase activity) susceptible to ischemia. Neonatal hearts are also equally or more susceptible to global ischemia when exposed to chronic volume and pressure overloading and chronic hypoxia. This chapter will discuss the physiology of neonatal and immature myocardium and summarize the most current research done in pediatric myocardial protection over the last 20 years regarding different cardioplegia solutions and additives, temperature and cardiopulmonary bypass strategy and reperfusion techniques.

Keywords

Myocardial protection Cardiopulmonary bypass Cardioplegia Congenital heart surgery Perfusion technique 
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Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  1. 1.Department of Pediatric Cardiothoracic SurgeryUniversity of Utah and Primary Children’s Medical CenterSalt Lake CityUSA
  2. 2.Division of Pediatric Cardiothoracic SurgeryThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA

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