Protection of the pediatric myocardium. Differential susceptibility to ischemic injury of the neonatal rat heart.

Myocardial protection during pediatric cardiac operations has been suggested to be less successful than in adult hearts. In the present study we have compared the resistance of adult, infant, and neonatal rat hearts to various periods of ischemic arrest with normothermic (37 degrees C) crystalloid cardioplegia. Isolated hearts with intraventricular balloons, from adult (50 to 60 days of age, heart weight 865 +/- 13 mg), infant (20 to 25 days of age, heart weight 251 +/- 3 mg), and neonatal rats (3 to 5 days of age, heart weight 40 +/- 1 mg) were subjected to 10, 20, 30, 40, 50, 60, 80, and 100 minutes of ischemia (n = 6 hearts for each time point and for each age group). St. Thomas' Hospital cardioplegic solution was infused at the onset of the period of arrest. With increasing durations of ischemia there was a declining postischemic recovery of function. Up to 40 minutes of ischemia there was no significant difference between the three age groups in postischemic recovery of left ventricular developed pressure: 40.3% +/- 4.4%, 45.4% +/- 6.5%, and 44.4% +/- 2.2% of preischemic control for adult, infant, and neonatal hearts, respectively. Beyond 40 minutes adult and infant hearts showed an identical deterioration with effectively no recovery beyond 60 minutes of ischemia. By contrast, neonatal hearts were much more resistant to ischemia. After 100 minutes of ischemia the mean recovery of left ventricular developed pressure was 20.9% +/- 1.1%, whereas in infant and adult hearts the values were 0.6% +/- 0.3% after 80 minutes of ischemia and 0% after 100 minutes, respectively. Analysis of creatine kinase leakage also indicated that with ischemic durations in excess of 40 minutes, the neonatal heart was far more resistant to ischemia, and creatine kinase leakage per gram dry weight was much less than in infant or adult rats. Analysis of the rates of recovery during reperfusion again revealed differences between neonatal hearts and hearts from the other two age groups. We conclude that in the normal rat the neonatal heart has a greater inherent tolerance to ischemia than that of the infant or adult rat.