A Textbook of Cardioplegia for Difficult Clinical Problems [antikvár]

Preface This book, A Textbook of Cardioplegia for Difficult Clinical Problems, is jointly edited by Richard M. Engelman and Sidney Levitsky, both well-known cardiac surgeons with a long experience in clinical as well as experimental studies of myocardial protection. Some of the topics now incorporated in these chapters were presented and discussed at the International Conference on Cardioplegia held in Oxford, England, in August, 1990. The textbook is truly international, including 28 chapters from different parts of the world. It covers all types of cardiac problems, including both infants and adults, transplantation and arrhythmias. As the title Difficult Clinical Problems indicates, several chapters focus especially upon acute problems where myocardial substrate is either severely impaired or an infarction has already occurred. There are chapters on acute myocardial infarction, PTCA failure, acute ventricular septal defect, and acute mitral insufficiency from papillary muscle rupture after infarction. All of these represent a far greater challenge to myocardial preservation than an elective uncomplicated coronary bypass. For example, for well over a decade, operative mortality for mitral valve replacement for mitral insufficiency from rupture of a papillary muscle after myocardial infarction remained at a prohibitively high level, ranging from 40% to 80%. As the hemodynamic problem, acute mitral insufficiency, was predominantly a mechanical one, it seems strongly probable that the high mortality was due to inadequate myocardial protection. The 1989 report by Panos of an operative mortality of only 11% with such patients with continuous cold blood cardioplegia supports the thesis that customary techniques of cardioplegia are usually adequate for routine cases but may not be with severe acute myocardial ischemia. The chapters vary widely in scope and content, ranging from experimental studies of new drugs or experimental techniques such as intermittent coronary sinus occlusion to a description of standard techniques by widely recognized surgeons with vast experience with complex problems such as ruptured ventricular septum or reoperations for coronary bypass. When one reads different chapters, the wide variation in methods of myocardial preservation is impressive, almost astonishing. This reflects, to some extent, the evolving nature of the field, but particularly indicates that the usual indices of effective myocardial preservation, such as immediate cardiac function, myocardial infarction, or death, are very crude ones. The chapter by Khuri is a refreshing example to the contrary, discussing data from continuous myocardial pH measurements, a technique not available to the vast majority of investigators. Detailed data are not given, but their studies found that an infusion of 10-20 mL iii