A textbook of clinical cardioplegia [antikvár]

Preface "The heart . . . moves of itself and does not stop unless for ever." Leonardo DaVinci Dell'Anatómia, Fogli B In June 1980, an International Symposium on Cardioplegia, organized by St. Thomas' Hospital and the Royal Postgraduate Medical School, was held at the Royal Society in London. The papers presented at that meeting constitute the substance of this book. It was particularly fitting that the Symposium be organized by St. Thomas' Hospital, since it was at that institution that Mr. Dennis Melrose and his colleagues first applied, in 1955, clinical potassium-induced cardioplegia during open-heart surgery. The obvious advantage of a quiet, bloodless operative field accompanied by a flaccid myocardium and avoidance of air emboli resulted in widespread acceptance as pioneering surgeons struggled to learn the techniques of cardiac surgery. As is often the case with many clinical advances, urgent patient needs outstripped basic research knowledge and understanding of this new powerful tool called "cardioplegia." When some of these patients exhibited late myocardial necrosis, the technique was abandoned without substantial evidence to verify that the injury was caused by hyperkalemia rather than warm ischemia. Over the ensuing twenty-five years, a few brave souls, particularly in the research laboratories of Rodewald and Bretschneider in Germany, persisted in evaluating and developing techniques for administering cardioplegia. General interest was reactivated in the early 1970s following the work of Gay and Ebert on potassium-induced iso-osmotic cardioplegia. Thus, it seemed appropriate to ask Drs. Gay and Ebert to write the Introduction to this book. The editors wish to thank our secretaries, Ruthann Hanoman and Ann O'Hanlon, who typed and organized the many pages of manuscripts and illustrations and Martha Hess who contributed the cover illustration. In addition, we wish to thank our clinical associates, Drs. John H. Rousou, Paul A. Thomas, Jr., and Norman A. Silverman, for their understanding and gracious assumption of additional clinical responsibilities as this edition was brought to fruition. Finally, Dr. Engelman would like to take this opportunity to thank Dr. Frank C. Spencer, Chairman of the Department of Surgery at New York University, who fostered an inquiring mind and directed attention to the significance of laboratory investigation in clinical pursuits; and Dr. Levitsky would like to extend his appreciation to Dr. Lloyd M. Nyhus, Head of the Department of Surgery at the University of Illinois Medical Center, for providing the environment that supported a decade of research in intraoperative protection of the myocardium. Richard Engelman Sidney Levitsky