Can myocardial stunning contribute to myocardial infarction during coronary artery bypass surgery?
Myocardial stunning commonly occurs after cardiopulmonary bypass (CPB). Myocardial stunning can be cardioprotective under some conditions, but in other situations may actually contribute to myocardial infarction (MI). Vascular endothelial stunning may be one of the mechanisms by which myocardial stunning can cause MI. It has been found that 15 minutes of reversible ischemia is enough to cause elevations in vascular resistance and impairment of vasodilator responsiveness. However, no correlation between contractile dysfunction and microvascular stunning has been observed. Transduction defects (increased oxygen extraction and consumption despite normal regional oxygen blood flow and delivery) may be another mechanism by which stunning predisposes to MI, indicating uncoupling of substrate utilization from energy production. In addition, abnormalities in wall motion, oxygen free radical toxicity, hypotension, use of inotropic agents (leading to increased oxygen consumption, high heart rates, and arrhythmias) increase the risk of cellular necrosis. Following CPB, flow limitations due to diffuse atherosclerosis in some areas may result in poor contractility, and newly grafted areas have a high probability of becoming ischemic and stunned. These areas are likely to contribute to MI.
Jain
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Department of Anesthesia, University of California, San Francisco 94121.
D009202:Cardiomyopathies / Q000503:physiopathology*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003331:Coronary Vessels / Q000503:physiopathology; D006801:Humans; D009200:Myocardial Contraction; D009203:Myocardial Infarction / Q000209:etiology*