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This chapter reviews the rationale for the use of cardioplegia, techniques of administration, components of different cardioplegia solutions and applications of cardioplegia in different surgical interventions. Myocardial damage can be detected by electrocardiography, echocardiography, radioactive imaging studies and cardiac magnetic resonance imaging. The clinical manifestations of myocardial damage may present as low cardiac output syndrome due to impaired myocardial contractility, dysrhythmias, decreased ventricular compliance or segmental myocardial wall motion abnormalities. The goal of myocardial protection with cardioplegia is to prevent myocardial injury during the periods of intentional ischemia that are required to perform cardiac operations. Cardioplegia delivery systems generally comprise an infusion system with in-line pressure monitors, a cardioplegic heat exchanger for cold and warm perfusion, and cannulae for antegrade and retrograde delivery. Crystalloid cardioplegia solutions are usually delivered at 4°C, cold blood solutions at 10-16°C and warm blood solutions at 37°C.
In this chapter the impact of congenital heart disease and its surgical treatment on the neonatal brain will be discussed. Babies may have congenital cardiac disease as an isolated malformation or may have a heart defect as part of a larger spectrum of abnormalities, which may in turn be associated with a syndrome. In addition, these babies are often profoundly ill, presenting to medical attention on the verge of cardiac arrest with severe hypoxia, hypotension, or both. The treatment of the condition usually involves a trip to the catheterization laboratory or operating room (or both). We therefore have great potential for neurological morbidity, with a combination of possible underlying abnormality of the brain, preoperative, perioperative, and postoperative insults all conspiring to injure the cardiac surgery patient's brain. Despite these problems, the majority of babies do extremely well following heart surgery in the newborn period, although it is important to recognize that many of them will have a subtle neurological deficit if they are compared to the normal population. These are evidenced as cognitive and intellectual impairment, behavioral difficulties, speech delays, etc.. The incidence of major neurological insult postoperatively as manifest by seizures, stroke, coma, or choreo-athetoid movements has fallen to around 2–11% in the current era.
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