Methods of myocardial protection and cardiopulmonary bypass (extracorporeal circulation) are two aspects of modern cardiovascular surgery that have greatly enhanced the safety and effectiveness of the surgical treatment of cardiovascular disease. However, despite its major beneficial impact on the care of patients with heart disease, cardioplegia may be associated with altered myocardial function and perfusion and episodic coronary artery spasm. In addition, extracorporeal circulation, under which most cardiovascular surgery is performed, is associated with altered vasomotor regulation and permeability in nearly all vascular beds. These changes in the microcirculation have been implicated in causing much of the morbidity of cardiac surgery including stroke, pulmonary failure and systemic inflammation. We have reviewed the microvascular changes that occur as a consequence of cardioplegia under conditions of extracorporeal circulation.
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