Intravenous Metabolic Support with GIK (Glucose-Insulin-Potassium) and Amino

Rolf Svedjeholm

Myocardial preservation in cardiac surgery has evolved rapidly during the last decades. Some authors of this book have made major contributions to this development. A variety of methods to protect the heart are available and complex procedures can be safely performed. Inappropriate prote...

Ischemic Preconditioning - from Bench to Bedside

Torsten Doenst and Heinrich Taegtmeyer

Traditional ways to improve ischemia tolerance in patients with obstructive coronary artery disease include pharmacological and mechanical interventions. Recently, ischemic preconditioning has emerged as a third modality. Observations in the laboratory have developed into a strategy for ...

Mechanoelectric Transduction/Feedback: Physiology and Pathophysiology

Max J. Lab

Cardiac “mechanotransduction” involves various physiological and biophysical phenomena in which mechanical energy is transduced to changes in function of cardiac myocytes and of the whole heart. In this chapter different manifestations of mechanotransduction are reviewed, with special emphasis on th...

Mechanotransduction of the Endocrine Heart Paracrine and Intracellular Regulation of B-Type Natriuretic Peptide Synthesis

Sampsa Pikkarainen, Heikki Tokola and Heikki Ruskoaho

Cardiac overload initiates a process, which aims to maintain and adapt cardiovascular system to altered hemodynamics. In adults, myocardial mass increases mainly due to enlargement of individual myocytes (for reviews, see refs. 1,2). Cardiac pressure overload in conditions such as aortic steno...

Metabolic and Antioxidant Support with Amino Acids

Oleg I. Pisarenko

Hypothermic hyperkalemic cardiople- giais is currently the preferred method of myocardial preservation for the performance of cardiac operations. At present research efforts of many laboratories focus on approaches to enhanced myocardial protection by various pharmacological agents. Duri...

Metabolic Support for the Heart During Ischemia and Reperfusion: Role of Amino Acids

Heinrich Taegtmeyer and Torsten Doenst

In reviewing amino acid metabolism of the heart during ischemia and reperfusion it is important to address a few principles of energy substrate metabolism first. The healthy human heart has a very high rate of energy turnover. Like all living cells, cardiac myocytes need the energy captu...

Methods to Reduce Ischemia/Reperfusion InjuryPICSO

Günter Steurer, Katharina Palisek and Werner Mohl

Enormous advances in surgical, pharmacological, and interventional techniques resulting in early restoration of infarct artery patency significantly improved outcome in patients with acute coronary syndromes.¹ However, time-consuming preparations in patients with acute myocard...

Myocardial Protection Strategies in Routine Coronary and Valve Operations

Kiyozo Morita and Michio Yoshitake

The goal of every cardiac operation must be a technically perfect anatomic result contributing to functional improvement that requires adequate visualization in a quiet, bloodless operative field without postoperative deterioration in cardiac function. The essential prerequisite for a...

Natural History of the Human Coronary Atherosclerotic Plaque and Related Forms of Myocardial Injuries

Giorgio Baroldi, Malcolm Silver

The first need was to reconstruct the natural history of the morphology of the coronary atherosclerotic plaque seen in humans with and without CHD. Since different arterial vessels have dissimilar hemodynamics, wall structure and nervous control, each artery has to be studied independently becaus...

OPCAB Surgery in High Risk-Patients

Gengarr Apoo and Raymond Cartier

The advent of cardiopulmonary bypass (CPB) circulation in the past half century has revolutionized the field of cardiac surgery. Although CPB has been associated with very low morbidity, its side-effects can be detrimental. The purported advantages of “off-pump” coronary surgery are potentially m...

Origin of Mechanotransduction: Stretch-Activated Ion Channels

Clive M. Baumgarten

Stretch-activated ion channels (SAC) serve as cardiac mechanotransducers. Mechanical stretch of intact tissue, isolated myocytes, or membrane patches rapidly elicits the open ing of poorly selective cation, K+, and Cl- SAC. Several voltage- and ligand-gated channels also are mechanosensitive. SAC...

Plastic Cast Study of Coronary Vessels

Giorgio Baroldi, Malcolm Silver

Coronary heart disease (CHD) becomes epidemic in any society that transforms itself from an agricultural one to an industrial-technological system with an associated behavioural alteration in the populace’s diet, stress and consumerism. Despite risk factors prevention and many new therapeutic app...

Potential Benefit of OPCAB Surgery

Marzia Leache and Raymond Cartier

Since the introduction of the extra-corporeal circulation (ECC) in the late fifties, its use has been seen as a necessary evil to perform surgery on the heart. The systemic inflamma tory reaction generated under cardiopulmonary bypass (CPB) is thought to be responsible for the so-called “reperfus...

Principles of Stabilization and Hemodynamics in OPCAB Surgery

Raymond Cartier

Stabilization of the myocardium during coronary grafting remains a major task in OPCAB surgery. In the early beginning, only the anterior territory of the heart was targeted and acceptable rudimentary stabilization was achieved with myocardial stay sutures, pharmacological manipulation, and an ad...

Protection Strategies for Heart Transplantation

Juergen Martin, Armin Geiger and Friedhelm Beyersdorf

Safe procurement and effective preservation are fundamental features in heart transplantation. The preservation technique might influence the rate of early graft failure as well as the incidence of graft vasculopathy.^1,2

Data from the Registry of the International Society ...

Regional Differences and Variability in Left Ventricular Wall Motion

Werner Heimisch

In our understanding of the mechanical performance of the heart as a pump we mostly rely on the famous studies of Otto Frank¹ and Ernest Starling² whose observations have been widely accepted for a century. Thus, the clinical therapeutic regimens contain volume s...

Retrograde Cardioplegia in Infants and Children

Steven R. Gundry

The coronary venous connections to the capillary bed of the heart have been described for nearly 100 years,¹ yet it was not until the 1940s that clinical application of this concept to treat heart disease was employed by Beck.² Since that time surgeons have intermit...

Revisiting Dogma Related to Coronary Artery Disease

Baroldi, Giorgio, Malcolm Silver

Science evolves as a continuous turnover of hypotheses that require constant review/ revision. It is time to reconsider each single caryatid which sustains the present conceptual temple dealing with the etiopathogenesis of CHD. Readers will recognize that most, if not all, current etiopathogenic ...

Second Messenger Systems Involved in Heart Mechanotransduction

Hiroshi Hasegawa, Hiroyuki Takano, Yunzeng Zou, Hiroshi Akazawa and Issei Komuro

Mechanical stress can be considered one of the major stimuli that evoke hypertrophic responses including reprogramming of gene expression in cardiac myocytes. Therefore, it is important to understand how mechanical loading is sensed by cardiomyocytes and converted into intracellular biomechanical si...

Sodium-Proton Exchange Inhibition as a Novel Strategy for Myocardial Protection

Willem Flameng and Wolfgang Scholz

Ongoing developments in cardiac surgery, like surgery on the beating, warm heart in minimal invasive coronary bypass grafting, the increasing incidence of cardiac surgery in the elderly as well as in neonates and the increasing number of complex interventions, imply a continuous request ...

Structure and Function of the Cardiac Lymphatic System

Hubert Schad

The physiology of the lymphatic system lives like Cinderella at the side of her attractive sisters the physiology of the heart and of the circulation. Lymphatic vessels, however, have been observed in classical antiquity. Hippocrates (460-377 B.C.) reported vessels draining "white blo...

Surgical Techniques for Warm Blood Cardioplegia

Syed T. Raza and Tomas A. Salerno

Hypothermic techniques of  myocardial preservation (crystalloid or blood cardioplegia) have been utilized in recent years and represent an important development in cardiac surgery. It can be stated that results of cardiac surgery are largely due to precision in surgical te...

Sutureless Coronary Artery Bypass Grafting: Experimental and Clinical Progress

Kenton J. Zehr

The vision of vascular surgery became clearer in 1902, when Alexis Carrel described his triangulation technique for suturing blood vessels together.1 He experimented with vessels of many sizes and thickness. Suturing was able to accommodate these discrepancies, and the technique allowed for paten...

Systematic OPCAB Surgery for Multivessel Disease With the CoroNeo Cor-Vasc Device

Raymond Cartier

Introduced in the mid-1960s for single vessel, OPCAB surgery is currently applicable to multivessel disease.1-4 The advent of mechanical stabilizers has been, without any doubt, a giant leap in the evolution of this technique. Needless to say that 40 years of collective experience with the corona...

Tables and References for the Etiopathogenesis of Coronary Heart Disease

Baroldi, Giorgio, Malcolm Silver

Complete tables and references for the Etiopathogenesis of Coronary Heart Disease.