Experimental and clinical study of crystalloid cardioplegic solution in neonatal period and early infancy. Effects of calcium and prostacyclin analogue.

The effects of calcium and a prostacyclin (PGI2) analogue in the glucose-insulin-potassium (GIK) cardioplegic solution for the neonatal period and early infancy were evaluated. The assessment was based mainly on semiquantitative scoring of mitochondrial damage and intracellular edema in postreperfusion biopsies. Experimentally, 45 isolated perfused newborn rabbit hearts (age, 0-2 days) underwent 2 hours of global ischemia at 15 degrees C with a single dose of GIK cardioplegic solution and were subsequently assigned to three groups: Group 1 hearts (n = 15) were infused with basic GIK cardioplegic solution alone (no added calcium, but measured at 0.1-0.2 mM/l); Group 2 hearts (n = 15) received GIK cardioplegic solution with calcium (1.2 mM); and Group 3 hearts (n = 15) received GIK cardioplegic solution with calcium and a PGI2 analogue (OP-41483, 300 micrograms/l). Group 3 hearts showed significantly lower mitochondrial damage and intracellular edema scores than did Group 1 and Group 2 hearts (p less than 0.05). Hemodynamic measurement (aortic flow and coronary flow) results after reperfusion were also better in Group 3 hearts than in the hearts of the other two groups (p less than 0.05). In the clinical study with 18 infants who were less than 3 months old, the same three cardioplegic solutions were used. Group 2 (n = 6) and Group 3 (n = 5) infants showed significantly lower mitochondrial damage scores than did Group 1 (n = 7) infants. Group 3 infants also showed significantly lower intracellular edema scores than did Group 1 and Group 2 infants.(ABSTRACT TRUNCATED AT 250 WORDS)