Warm continuous antegrade blood cardioplegia: applications in congenital heart disease.
Continuous warm blood cardioplegia is utilized by many surgeons as their method of choice for myocardial protection during operations for acquired heart disease.


OBJECTIVE
this study was performed to determine the feasibility and safety of this method for intracardiac procedures through the right atrium and in particular, total cavopulmonary connection.


METHODS
procedures included closure of an atrial septal defect (23), atrial septectomy (2) and total cavopulmonary connection (4). Antegrade blood cardioplegia was delivered continuously for an average of 27 +/- 21 minutes at an average flow of 130 +/- 60 cc/min to maintain the aortic root pressure between 60 and 80 mmHg (mean 74 +/- 5 mmHg). Perfusion with regular blood commenced in the last 2 to 8 minutes and complete de-airing procedure was performed on the beating heart before removal of the aortic cross-clamp.


RESULTS
all patients resumed sinus rhythm and all but one had normal cardiac output postoperatively. In one patient after cavopulmonary connection the inferior vena-cava to pulmonary-artery connection was taken down because of increased pulmonary vascular resistance resulting in low output state. All patients made an uneventful recovery without neurological complications.


CONCLUSIONS
this initial experience suggests that normothermic aerobic arrest can be used safely in the repair of congenital defects and may provide superior myocardial protection for complex procedures such as the Fontan procedure.
Elami
A
A
Department of Cardiothoracic Surgery, Hebrew University-Hadassah Medical School, Jerusalem, Israel.
Milgalter
E
E
Merin
G
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D001769:Blood; D002648:Child; D002675:Child, Preschool; D005069:Evaluation Studies as Topic; D006324:Heart Arrest, Induced / Q000379:methods*; D018610:Heart Bypass, Right; D006330:Heart Defects, Congenital / Q000601:surgery*; D006344:Heart Septal Defects, Atrial / Q000601:surgery; D006346:Heart Septum / Q000601:surgery; D006801:Humans; D007223:Infant; D008875:Middle Aged; D013696:Temperature; D014188:Transposition of Great Vessels / Q000601:surgery