Already have an account? Get multiple benefits of using own account!
Login in your account..!
Remember me
Don't have an account? Create your account in less than a minutes,
Forgot password? how can I recover my password now!
Enter right registered email to receive password!
Myocardial Protection : To a great extent, the result of cardiac surgery depends on how well the myocardium is protected during cardio pulmonary bypass. Temporary depression of myocardium (stunning) or myocardial necrosis resulting in low cardiac output may occur after bypass. Sub endocardial layer is particularly vulnerable to injury. A still heart, free of blood is essential for accurate intra cardiac repair. In the earlier era, fibrillatoiy arrest or ischaemic arrest by cross clamping the aorta was used to facilitate open-heart surgery. These days, diastolic arrest of the heart is achieved by administration of cold cardioplegic solution, proximal to aortic clamp. When there is aortic regurgitation, aorta is opened and direct coronary ostial cannulation is required for giving cardioplegia. When there are multiple blocks in coronary arteries, ante grade cardioplegia will not ensure uniform distribution of the solution. Such cases will need retrograde cardioplegia administered through a coronary sinus cannula. Special retrograde cardioplegia cannulae are available with balloons, which will fill up at the time of cardioplegia. The coronaiy sinus can be cannulated blindly through a purse string on the right atrium. The coronary sinus pressure should be kept below 30 mm of Hg at the time of cardioplegia. The cardioplegic solution could be cold asanguinous (clear) or with blood. The commonly used one is St. Thomas solution that essentially contains 20 .meq of potassium cooled down to 4°C. Cardioplegia is usually supplimented with topical cold saline or ice slush. Cardioplegia may be cold or warm. At times patients are operated at normothermia with warm blood cardioplegia. If the patient has recent
myocardial infarction or when the ejection fraction is low, it is good to give warm blood (hotshot) just before releasing aortic clamp, to reduce reperfusion injury. The cardioplegic solution is slightly hyper osmolar and buffered with sodium bicarbonate or THAM. Amino acids like Glutamate and Aspartate added to the solution reduces reperfusion injury. Adenosine adds to further protection. To reduce the injury due to oxygen free radicals, super oxide dismutase (SOD) and dimethyl sulphoxide (DMSO) can be added to the cardioplegic solution.
transport systerms
EXAMPLES OF NATURAL SELECTION - 1 . INDUSTRIAL MELANISM - First studied by Fischer & Ford (1845) on pepperd moth (Biston betularia) of two types : grey moth (B.
Question 1 Describe the external features of the heart. Add a note on circulation of blood within the heart Question 2 Discuss the major joints of thorax and pelvis Quest
Q. What are the major components of the cytoskeleton? The cytoskeleton is a network of very small filaments and tubules distributed throughout the cytoplasm of eukaryotic cells
Q. To what substance is the acidic flavor of fermented milk due? Some bacteria ferment milk lactose by lactic fermentation producing lactic acid this product is responsible for
Bleeding on Probing (BOP) BOP when elicited (notated in patient record as BOP +) after the insertion of a probe into the sulcus with light pressure i.e. 25 N has been shown to
First Stage of Invagination The large endodermal cells that are remaining in the vegetal plate move laterally towards the centre of the plate and fill the gap in the vegetal
what are the excretory organs of birds
How are the antibodies against the Rh factor formed? Anti-Rh antibodies are made by humoral immune response. When an Rh- individual makes contact with the Rh factor this is rec
What proportion of children with Down syndrome do you expect when women with down syndrome have children with men who have 46 chromosomes? Justify answer
Get guaranteed satisfaction & time on delivery in every assignment order you paid with us! We ensure premium quality solution document along with free turntin report!
whatsapp: +91-977-207-8620
Phone: +91-977-207-8620
Email: [email protected]
All rights reserved! Copyrights ©2019-2020 ExpertsMind IT Educational Pvt Ltd