title: Effects of antegrade versus integrated blood cardioplegia on left ventricular function evaluated by echocardiographic real-time 3-dimensional speckle tracking.
abstract: OBJECTIVE
  The objective of this study was to evaluate left ventricular free wall and interventricular septal function by 2-dimensional transthoracic echocardiography and live/real-time 3-dimensional transthoracic speckle tracking echocardiography before and after on-pump cardiac surgery and to assess the effect of mode of cardioplegia delivery.
  
  
  METHODS
  A total of 22 patients were studied 1 day before and 4 to 5 days after surgery. Cold blood cardioplegia was delivered by intermittent antegrade infusion or by the integrated method. The latter includes a combination of intermittent antegrade and retrograde cardioplegia with a terminal warm amino acid-enriched reperfusion.
  
  
  RESULTS
  The overall group displayed significant deterioration of septal function after surgery by 2-dimensional transthoracic echocardiography, as assessed by wall motion score index, yet subgroup analysis by 3-dimensional transthoracic speckle tracking echocardiography permitted distinction of outcomes achieved by antegrade or integrated delivery methods. Analysis after surgery showed that only the antegrade group displayed statistically significant deterioration in the strain parameters of some of the segments of the septum and free wall when strain was measured in the free wall and septum in the longitudinal, circumferential, and radial modes of deformation (P < .05). In contrast, only the integrated group displayed significant improvement in global radial, circumferential, and longitudinal strain (P < .05).
  
  
  CONCLUSIONS
  These findings by 3-dimensional transthoracic speckle tracking echocardiography indicate that integrated cardioplegia offers superior myocardial protection of the left ventricular free wall and septum compared with the antegrade mode of cardioplegia delivery.
authors.affiliation: Department of Community Medicine, University of Alabama, Birmingham, Ala.
authors.forename: Maneesha
authors.initials: M
authors.lastname: Bhaya
authors.affiliation: Department of Community Medicine, University of Alabama, Birmingham, Ala.
authors.forename: Selvin
authors.initials: S
authors.lastname: Sudhakar
authors.affiliation: Department of Community Medicine, University of Alabama, Birmingham, Ala.
authors.forename: Kamel
authors.initials: K
authors.lastname: Sadat
authors.affiliation: Department of Community Medicine, SSR Medical College, Belle Rive, Mauritius.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Beniwal
authors.affiliation: Department of Community Medicine, University of Alabama, Birmingham, Ala.
authors.forename: Deepak
authors.initials: D
authors.lastname: Joshi
authors.affiliation: Department of Community Medicine, University of Alabama, Birmingham, Ala.
authors.forename: James F
authors.initials: JF
authors.lastname: George
authors.affiliation: Department of Community Medicine, University of Alabama, Birmingham, Ala.
authors.forename: Navin C
authors.initials: NC
authors.lastname: Nanda
authors.affiliation: Department of Cardiothoracic Surgery, University of California Los Angeles Medical Center, Los Angeles, Calif. Electronic address: gbuckberg@mednet.ucla.edu.
authors.forename: Gerald D
authors.initials: GD
authors.lastname: Buckberg
authors.affiliation: Department of Community Medicine, University of Alabama, Birmingham, Ala.
authors.forename: Constantine L
authors.initials: CL
authors.lastname: Athanasuleas
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D002314:Cardioplegic Solutions / Q000008:administration & dosage* / Q000009:adverse effects; D002315:Cardiopulmonary Bypass; D003080:Cold Temperature; D019560:Echocardiography, Three-Dimensional; D005260:Female; D006324:Heart Arrest, Induced / Q000009:adverse effects / Q000379:methods*; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D015428:Myocardial Reperfusion Injury / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D016277:Ventricular Function, Left; D054088:Ventricular Septum / Q000000981:diagnostic imaging* / Q000503:physiopathology
chemical_list: D002314:Cardioplegic Solutions