Full Description
In open heart surgery, protection of the myocardium against injury by ischemia-reperfusion is an issue of utmost clinical interest. The knowledge on the causal mechanisms of myocardial injury in ischemia-reperfusion has greatly progressed in recent years, both to clinical and experimental research. This book provides a critical and comprehensive overview on the current discussion of myocardial protection in cardiac experimental research and surgery. Leading groups from Europe, the U.S. and Japan have contributed reviews of their special fields.
On the basic science side, major topics discussed are the mechanisms of stunning and lethal reperfusion injury, the role of the endothelium and leukocyte activation in postischemic myocardial dysfunction, and the differences between the adult and neonatal myocardium. On the clinical side, the major concepts and procedures for cardioplegic myocardial protection, their rationales, application and respective merits are discussed. In a third part of the book, possible approaches for the monitoring of myocardial injury during ischemia and reperfusion are evaluated, with particular attention to their intraoperative use.
This book brings together the scientific discussions on ischemia-reperfusion in experimental cardiology and cardiac surgery, a task needed for a long time. It is of general interest for clinicians as well as research workers and students in the cardiac field.
Contents
ONE: Pathophysiology of ischemia and reperfusion.- 1. Moderate ischemic injury and myocardial stunning.- 2. Severe ischemic injury and the oxygen paradox.- 3. Role of leukocytes in reperfusion injury.- 4. Ischemia of the neonatal heart.- TWO: Concepts of cardioplegia.- 5. Cardioplegia with an intracellular formulation.- 6. Cardioplegia with an extracellular formulation.- 7. Blood cardioplegic strategies during adult cardiac operations.- THREE: Clinical application of cardioplegia.- 8. High volume perfusion.- 9. Intermittent coronary perfusion.- 10. Retrograde perfusion.- 11. Cardiac arrest by ventricular fibrillation.- 12. Myocardial preservation in the immature heart.- FOUR: Evaluation of cardioplegic methodology.- 13. High-energy phosphates and their catabolites.- 14. Lactate monitoring during and after cardiopulmonary bypass: an approach implicating a perioperative measure for cardiac energy metabolism.- 15. Myocardial tissue pH in the assessment of the extent of myocardial ischemia and the adequacy of myocardial protection.- 16. Morphology of the acute and chronic ischemic myocardium in man.- 17. Muscle birefringence.- 18. How to measure cardiac energy expenditure.- 19. Cardioplegia and cardiac function.
