| Objective This prospective study was designed to evaluate the myocardial protection during on-pump beating-heart intracardiac procedures compared with traditional cardioplegia-arrested heart technique in Lhasa. Methods 52 patients with congenital heart disease undergoing cardiac operations were enrolled into the study. Of them, 40 patients were randomly subjected into Group BH and Group AH. 20 patients in Group BH were performed intracardiac procedures with on-pump beating heart technique. In Group AH, other 20 cases were operated on arrested-heart by cardioplegia perfusion. 12 patients received ligation of PDA through thoracotomy as the control (group NB). Perioperative plasma cTnT, ET-1 and CGRP were measured dynamically. Myocardial tissues were sampled from right atrium at the start and the end of CPB respectively for ultrastructure observation. Results 1. There was no significant change of plasma cTnT, ET-1 and CGRP in Group NB, which were significantly elevated in Group BH and Group AH. 2. Plasma cTnT and ET-1 during and after CPB in patients with pulmonary hypertension were higher than those in patients without pulmonary hypertension. 3. In Group BH, the plasma cTnT, ET-1 during and after CPB were much lower than those in Group AH, but plasma CGRP was higher. 4. Compared with Group AH, the myocardialultrastructure changes after operation were mild. Conclusion Intracardiac procedures performed on plateau would cause severe myocardial injury, which would be much worse in patients with severe pulmonary hypertension. The results suggested that the myocardial protection effects of on-pump beating heart technique are superior to that of traditional cardioplegia-arrested heart on Plateau, less disturbance to endothelium during CPB might be one of the mechanisms.
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