Anesthesiology and Intensive Care

 In 1956, Lillehei and his colleagues proposed the technique of retrograde infusion of cardioplegic solutions directly into the coronary sinus. Many practitioners have found this method to be as effective as antegrade infusion , though it often results in less perfusion of the right ventricle (especially its midsection) and right atrium. To address this issue, retrograde infusion can be administered through the right atrium and right ventricle instead. Retrograde coronary sinus infusion is particularly beneficial in cases with acute high-grade coronary artery stenoses or obstructions.

Technique of Antegrade Cardioplegia antegrade cardioplegia, cardioplegia technique, myocardial protection, cardiac surgery, heart surgery, cardiopulmonary bypass, aortic root perfusion, potassium cardioplegia, surgical myocardial preservation After establishing cardiopulmonary bypass (CPB) with the perfusate at 32°C—ensuring that ventricular fibrillation does not occur—a catheter is inserted into the aortic root through a previously placed purse-string stitch, attached to the cardioplegia line, and de-aired. Optionally, the pressure line of the catheter can be connected to a strain gauge for continuous monitoring of aortic root pressure. The aorta is clamped once the aortic root catheter is in place and certainly before the heart has cooled enough from whole-body perfusion to become arrhythmic or develop ventricular fibrillation .

Principles of Cardioplegic Solutions keywords:Cardioplegia, cardioplegic solution, myocardial protection, heart surgery, cardiac arrest, myocardial ischemia, reperfusion Energy conservation during myocardial ischemia can be achieved by inducing chemical arrest through two primary mechanisms: Preventing the conduction of the myocardial action potential by inhibiting the fast sodium current can be achieved through one or more of the following methods : a . Extracellular hyperkalemia  b . Sodium channel blockers (e.g., lidocaine)  c . KATP channel openers (e.g., adenosine) Preventing myocyte contraction by inhibiting calcium activation of myofilaments can be accomplished through one or more of the following approaches : a . Reducing extracellular calcium to zero  b . Using L-type calcium channel blockers (e.g., magnesium )  c . Directly inhibiting myofilaments with agents such as 2,3-butanedione monoxime (BDM) Cold Cardioplegia There are two types of solutions used...