[Myocardial metabolism and functional capacity in various types of cardiac reperfusion]

Myocardial metabolism and function were studied in 128 patients operated on under extracorporeal circulation for acquired heart diseases. Three groups of patients with different types of cardiac reperfusion were analyzed. Controlled (one- and two-stage) reperfusion was carried out with hyperosmotic unified solution 7 minutes before the beginning of blood recirculation and with perfusate after restoration of blood circulation. Reperfusion was spontaneous with perfusate alone in the control group. It was shown that the use of controlled reperfusion permit the negative action of oxygen and thermal shocks on the cold anoxed myocardium to be largely overcome. This is manifested by rather rapid reorganization of myocardial cells to the aerobic pathway, by inhibited activation of free oxygen radicals, by normalization of fluid-and-electrolyte balance, etc. Two-stage reperfusion was most effective in preventing myocardial metabolic disorders, as evidenced by more rare defibrillation to restore cardiac rhythm and less catecholamine uptake than those with one-stage and especially spontaneous reperfusion. With the latter, myocardial metabolic and functional disturbances were more severe and could be corrected only by the end of an operation.