Evaluation of intraoperative myocardial metabolism in infants when repairing congenital heart diseases under extracorporeal circulation

Some features of myocardial metabolism were studied in 40 CHD infants operated under extracorporeal circulation with the use of crystalloid pharmacological/ chemical cardioplegia (FCC) (11 patients), blood cardioplegia (14 patients) and "Custodiol" solution (15 patients). A complex evaluation of intraoperative content of glucose, lactate, pyruvate, free fatty acids (FFA), inorganic phosphor (IP) in arterial blood and coronary sinus blood samples was carried out. It was found out that dynamics of biochemical parameters under study when comparing the values of arterial and venous (coronary sinus) blood was of a unidirectional nature. Statistical differences of these parameters in patients with acyanotic and blue heart diseases were not observed. Despite the use of cardiac protection techniques, glucose utilization and some symptoms of myocardium hypoxia because of lactate and pyruvate in the coronary sinus blood, alongside a simultaneous increase of these media in arterial blood, were revealed. While analyzing the production/extraction of energy media, the metabolic pathways in the myocardium were found to switch at different stages of CHD repair. Intraoperative and reperfusion disturbances of cardiac metabolism in the form of hypoergosis and lactacidosis can be considered as risk factors of cardiac insufficiency in the early postoperative period.