lock Open Access lock Peer-Reviewed




New delivery system for pediatric blood cardioplegia

Pedro R SalernoI; Magaly Santos ArraesI; Marcelo B JateneI; Fábio B JanteneI; Paulo ChaccurII; Jarbas J DinkhuysenII; Camilo Abdulmassih NetoII; Antoninho S ArnoniIII; Paulo P PaulistaIII; Adib D JateneI; Luiz Carlos Bento de SouzaI

DOI: 10.1590/S0102-76381995000300006


The purpose of this study is to present a simple Delivery System of Blood Cardioplegia for myocardial preservation during congenital cardiac operation. We prospectively analysed 71 patients (pts) with 10/12 kg of body mean weight, 34 were female and mean age was 2/1 years. From the arterial line, passing through a mini heat exchanger, blood at 8 C is aspirated to a 50 cc syringe, which is conected to a 10 cc syringe with a KCL + decimal solución using 2 stopcocks. The mixture originates a cold blood with 15 mEq/l of KCL + that is infused into the aortic root, according to the pts weight (10 cc/kg). In all pts cardiac arrest was obtained. The mean extracorporeal circulation time and crossclamping was 87.2 and 60.7 min. All pts recovered sinus rhythm with good ventricular function. Thirteen patients died, 6 with respiratory failure, 3 with low cardiac output, 2 with dysrhythmias, 1 with renal failure and 1 with hematologic disorder; the other 58 patients left the hospital with no complications. In conclusion, this method showed good results with efficient myocardial preservation and low morbi-mortality.


O objetivo do presente estudo é apresentar um sistema de cardioplegia sangüínea para cirurgia de cardiopatia congênita. Foram analisados, prospectivamente, 71 pacientes com 10.12 kg em média, 34 eram do sexo feminino e a idade média foi de 2,1 anos. Da linha arterial, passando por um trocador de calor, aspiramos para uma seringa de 50 cc sangue a 8ºc, a qual é conectada a outra seringa de 10 cc com uma solução decimal de potássio, através de duas torneirinhas. A mistura da solução decimal (3 ml) com 47 ml de sangue a 8o C origina uma solução de sangue com 15 meq/1 de potássio. Esta solução é infundida na raiz da aorta, de acordo com o peso do paciente (10 cc/kg). Em todos obtivemos parada cardioplégica. O tempo médio de extracorpórea foi de 87,2 minutos e de pinçamento aórtico, de 60,7 minutos. Treze pacientes evoluíram para óbito, 6 por falência miocárdica, 3 por síndrome de baixo débito, 2 com arritmia, 1 com falência renal e 1 com coagulopatia. Os 58 demais pacientes receberam alta hospitalar sem complicações. Em conclusão, este método mostrou ser eficiente na preservação miocárdica e com baixa morbi-mortalidade.
Full text available only in portuguese PDF format.


1. AOKI, M.; NOMURA, F.; MAYER, J. E. - Interactions between preischemic hypothermia and cardioplegic solutions in the neonatal lamb heart. J. Thoracic. Cardiovasc. Surg., 107: 822-828, 1994.

2. BARNER, H. B. - Blood cardioplegia: a review and comparison with crystalloid cardioplegia. Ann. Thoracic. Surg., 52: 1354-1367. 1991.

3. BERS, D. M.; PHILIPSON, K. D.; LANGER, G. A. - Cardiac contractility and sarcolemmal calcium binding in several cardiac muscle preparations. Am. J. Physiol., 240: H576-H583, 1981. [MedLine]

4. BUCKBERG, G. D.; BRAZIER. J. R.; NELSON, R. L. - Studies of the effects of hypothermia on regional myocardial blood flow and metabolism during cardiopulmonary bypass. J. Thoracic. Cardiovasc. Surg., 73: 87-94, 1977.

5. BULL, C; COOPER, J.; STARK, J. - Cardioplegic protection of the child's heart. J. Thorac. Cardiovasc. Surg., 88: 287-293, 1984. [MedLine]

6. CASTANEDA, A. R.; MAYER Jr., J. E.; JONAS, R. A.; LOCK, J. E.; WESSEL, D. L.; HICHEY, P. - The neonate with critical congenital heart disease: a surgical challenge. J. Thorac. Cardiovasc. Surg., 98: 869-875, 1989. [MedLine]

7. DENNY, T. L.; HAGGERTY, S. P.; BOLEY, T. M.; CURTIS, J. J. - Lack of cardioplegia uniformity in clinical myocardial preservation. Ann. Thorac. Surg., 57: 648-651, 1994. [MedLine]

8. DRINKWATER, D. C.& LAKS, H. - Pediatric cardioplegic techniques. Semin. Thorac. Cardiovasc. Surg., 5: 168-175, 1993. [MedLine]

9. DRINKWATER, D. C; CUSHEN, C. K.; LAKS, H.; BUCKBERG, G. D. - The use of combined antegraderetrograde infusion of blood cardioplegic solution in pediatric patients undergoing heart operations. J. Thorac. Cardiovasc. Surg., 104: 1349-1355, 1992. [MedLine]

10. ESPOSITO, G.; KEETON, B. B.; SUTHERLAND, G. R.; MONRO, J. L; MANNERS, J. M. - Open heart surgery in the first 24 hours of life. Ped. Cardiol., 10: 33-36, 1989.

11. GEORGE, B. L.; NAKANISSHI, T.; NISHIOKA, K.; JARMAKANI, J. M. - Effect of verapamil on mechanical function of the neonatal rabbit heart. Ped. Res., 15: 463, 1981 (Resumo).

12. HEINLE, J. S.; LODGE, A. J.; MAULT, J. R.; WHITAKER, E. G.; UNGERLEIDER, R. M. - Myocardial function is normal after rapid cooling of the in vivo neonatal heart. Ann. Thorac. Surg., 57: 326-333, 1994.

13. HOSSEINZADEH, T.; TCHERVENKOV, C; QUANTZ, M.; CHIU R. C. J. - Adverse effect of prearrest hypothermia in immature hearts: rate versus duration of cooling. Ann. Thorac. Surg., 53: 464-471, 1992. [MedLine]

14. JARMAKANI, J. M.; NAGATOMO, T.; LANGER, G. A. - The effect of calcium and high energy phosphate compounds on myocardial contracture in the newborn and adult rabbit. J. Mol. Cell. Cardiol. 10: 1017-1023, 1978.

15. JULIA, P. L.; BUCKBERG, G. D.; ACAR, C. - Studies of controlled reperfusion after ischemia. XXI Reperfusate Composition: superiority of blood cardioplegia over crystalloid cardioplegia in limiting reperfusion damage importance of endogenous oxygen free radical scavengers in red blood cells. J. Thorac. Cardiovasc. Surg., 101: 303-313, 1991. [MedLine]

16. KOHMAN, L. J. & VEIT, L. J. - Single-dose versus multidoses cardioplegia in neonatal hearts. J. Thorac. Cardiovasc. Surg., 107: 1512-1518, 1994. [MedLine]

17. LAKS, H. - Advances in the repair of complex congenital heart disease. Ped. Ann. 11: 926-931, 1982.

18. NISHIOTA, K.; NAKANISHI, T.; GEOORGE, B. L; JARMAKANI, J. M. - The effect of calcium on the inotrophy of catecholamine and paired electrical stimulation in the newborn and adult myocardium. J. Mol. Cell Cardiol., 13: 511-520, 1981. [MedLine]

19. PEARL, J. M.; LAKS, H.; DRINKWATER, D. C.; MENESHIAN, A.; SUN, B.; GATES, R. N.; CHANG, P. - Normocalcemic blood or crystalloid cardioplegia provides better protection than does low-calcium cardioplegia. J. Cardiovasc. Surg., 105: 201-206, 1993.

20. REEVES, R. B. & MALAN, A. - Model studies of intracellular acid-base temperature responses in ectotherms. Respir. Physiol., 28: 49-57, 1970.

21. ROSS, B. A.; SEIDEL, C. L; GARSON, A.; McNAMARA, D. - Verapamil effect on vascular smoth muscle: variation in immature and mature animals. Ped. Cardiol., 5: 252, 1984. (Resumo).

22. SHUN - TIM, D.; TCHERVENKOV, C. I.; LOUGH, J. O.; CHIU, R. C. J. - Newborn myocardial protection after prolonged prearrest cooling: a calcium overlood phenomenon? Ann. Thorac. Surg., 57: 311-318, 1994. [MedLine]

23. VINTEN - JOHANSEN, J.; EDGERTON, T. A.; HANSEN, K. J. - Surgical revascularization of acute (1 hour) coronary occlusion: blood versus crystalloid cardioplegia. Ann. Thorac. Surg., 42: 247-254, 1986. [MedLine]

24. YEE, E. S. & EBERT, P. A. - Effect of ischemia on ventricular function, compliance and edema in immature and adult canine hearts. Surg. Forum, 30: 250-252, 1979. [MedLine]

CCBY All scientific articles published at are licensed under a Creative Commons license


All rights reserved 2017 / © 2021 Brazilian Society of Cardiovascular Surgery DEVELOPMENT BY