Perioperatives myokardiales Monitoring von bypassoperierten Patienten

Abstract Background   Microdialysis allows the biochemical analysis of interstitial fluids. We investigated the dynamic changes of myocardial metabolism from patients with ischemic heart disease and with low left ventricular ejection fraction (EF <50%). Methods   In 30 patients undergoing coronary artery bypass grafting, a microdialysis catheter was inserted in the left heart in an area of abnormal ventricular contraction. A second catheter was placed in the normal tissue of the right ventricle. Microdialysis measurements were performed in the perioperative course. Results   During CBP both ventricles showed signs of poor tissue oxygenation. The glucose-lactate ratio (GLQ) as a marker of nutritional disorder of the right ventricle had significantly better values at this point. Glycerol was significantly higher in the left myocardium. The postoperatively increased lactate-pyruvate ratio of three patients was associated with acute myocardial infarction. Conclusions   Conclusions GLQ and glycerol values as markers of anaerobic metabolism and cell membrane desintregity, respectively, showed signs of rising in both ventricles during cardioplegic arrest, but were significantly higher in the left ventricle due to underlying ischemic coronary disease. Myocardial microdialysis is an useful tool in rapid intraoperative detection of ischemia.