Acute regional myocardial ischemia and recovery after cardiopulmonary bypass: effects of intensity of antecedent ischemia.
Aortic cross-clamping with inadequate myocardial preservation has been shown to cause postoperative decreases in myocardial performance following coronary artery bypass graft surgery. We have demonstrated a mild decrement in myocardial beta-receptor function associated with cold cardioplegia in a normal animal model; in normal human hearts, however, response to beta-adrenergic inotropic stimulation was diminished significantly. Beta-receptor dysfunction also is associated with chronic myocardial ischemia that is associated with severe ischemic heart disease. Although the change in beta-receptor function with acute regional myocardial ischemia associated with severe ischemic heart disease is not understood fully, we found that the intensity of regional ischemia significantly affects functional recovery after cardiopulmonary bypass (CPB). Myocardial stunning does not appear to be significant in this dysfunction; however, alterations in beta-receptor density and function may play a critical role in post-CPB ventricular function.
Leone
B J
BJ
Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina 27710, USA.
Huggins
C P
CP
Johns
J
J
McRae
R L
RL
Smith
B
B
White
W
W
D000818:Animals; D002315:Cardiopulmonary Bypass; D004285:Dogs; D006324:Heart Arrest, Induced; D015428:Myocardial Reperfusion Injury / Q000503:physiopathology*; D011184:Postoperative Period; D011943:Receptors, Adrenergic, beta; D016276:Ventricular Function
D011943:Receptors, Adrenergic, beta