Luna OP, Serrano VX, González CO, Santibañez EF

Language: Spanish
References: 125
Page: 112-128
PDF size: 333.83 Kb.

ABSTRACT

Ventricular dysfunction following cardiac surgery occurs commonly in patients undergoing cardiopulmonary bypass resulting from a number of factors which can be categorized in: preexisting left ventricular dysfunction, intraoperative factors, type of surgery, cardiopulmonary bypass and pathophysiological factors related to ischemia and reperfusion injuries, this ventricular dysfunction that is a reversible injury is known as “stunned myocardium”. This article discusses the causes and mechanism of this ventricular dysfunction, like: calcium homeostasis, excitation-contraction coupling in stunned myocardium, systolic and diastolic dysfunction and postcardioplegia dysfunction. Management of the patient with perioperative ventricular dysfunction requires rapid confirmation of the diagnosis to establish an adequate treatment with pharmacologic intervention like: betaadrenergic receptor agonist, phosphodiesterase III inhibitor, thyroid hormone, combined therapy, glucose-insulin-potassium infusion. This article also reviews the roll of calcium and calcium sensitizers and arginine vasopressin, calcium antagonists, adenosine, prostaciclin, angiotensin converting enzyme inhibitors, ATP-dependent potassium channel openers, sodium-hydrogen exchange inhibitors and magnesium sulfate. When ventricular dysfunction results in the low output syndrome, the selection of an appropriate therapeutic regimen is a crucial element for weaning patients from cardiopulmonary bypass and obtain better outcome.

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