Myocardial protection in congenital heart surgery.

Modern pediatric cardiac surgery prides itself by performing primary surgical repair of cardiac anomalies. As a consequence, the majority of cases are nowadays performed in neonates and young infants. For the repair of intracardiac malformations the aorta is crossclamped and the heart is arrested (i.e. subjected to ischemia). Cardioplegic solution is administered routinely to arrest the contractile apparatus, decrease energy consumption and thereby increase ischemia tolerance. It is usually combined with hypothermia as another method to extend ischemia tolerance. In pediatric cardiac surgery several different cardioplegic solutions and strategies are currently used. For myocardial protection during crossclamp time either blood or crystalloid solution is administered into the aortic root or retrogradely into the coronary sinus, intermittently or as a single shot. The final concept for myocardial protection is highly dependent on the individual surgeon and his personal preference. There is currently no evidence in favor of one or the other technique. Thus, pediatric protection is currently experience-based.