Subendocardial myocardial necrosis: a preventable lesion.
Left ventricular subendocardial hemorrhagic necrosis, a lesion entirely different from conventional myocardial infarction, has been an important cause of serious morbidity and mortality in open heart surgery, particularly aortic valve replacement. An established experimental model in which this lesion could be consistently produced in calves, was utilized to examine the protective role of hypothermia and/or Solumedrol infusion. Solumedrol infusion and systemic hypothermia were not sufficiently effective in protecting the myocardium against 40 minutes of left coronary artery occlusion during total cardiopulmonary bypass. Profound continuous irrigation of the pericardial cavity with 4 degrees centigrade Ringers lactate solution, with or without Solumedrol infusion, under similar circumstances yielded excellent results, both in terms of myocardial performance and preservation. This experiment has encouraged the clinical use of this technique in our institution.
D000818:Animals; D000831:Animals, Newborn; D006348:Cardiac Surgical Procedures; D002417:Cattle; D004195:Disease Models, Animal; D006349:Heart Valve Diseases / Q000601:surgery; D007036:Hypothermia, Induced; D007263:Infusions, Parenteral; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D009203:Myocardial Infarction / Q000517:prevention & control*; D009336:Necrosis; D012770:Shock, Cardiogenic / Q000517:prevention & control
D008775:Methylprednisolone