Calcium and cardioplegia. The optimal calcium content for the St. Thomas' Hospital cardioplegic solution.

The relationship between the calcium content of the St. Thomas' Hospital cardioplegic solution and the degree of tissue protection it affords has been characterized by means of an isolated working rat heart preparation subjected to normothermic ischemic arrest. With a 3 minute period of preischemic infusion of solutions containing calcium chloride concentrations of 0, 0.6, 1.0, 1.1, 1.2, 1.3, 1.4, and 2.4 mmol/L and 35 minutes of normothermic ischemic arrest, postischemic creatine kinase leakage was 562.3 +/- 26.7, 64.8 +/- 12.1, 63.3 +/- 9.9, 37.5 +/- 5.4, 33.4 +/- 3.1, 41.2 +/- 4.1, 58.6 +/- 7.4, and 65.7 +/- 9.1 IU/15 min/gm dry weight, respectively. The postischemic recovery of aortic flow was 0%, 29.2% +/- 6.8%, 29.0% +/- 3.3%, 45.8% +/- 4.9%, 55.5% +/- 1.4%, 38.5% +/- 2.7%, 27.8% +/- 8.6%, and 19.5 +/- 7.1%, respectively. The results indicate optimal protection with a calcium concentration of 1.2 mmol/L and a rapid decline in protection with even small changes in concentration either side of the optimum. The hazard of total absence of calcium was confirmed by the induction of the calcium paradox. This study shows that under normothermic conditions a calcium concentration of 1.2 mmol/L is optimal for the St. Thomas' Hospital solution. This study reinforces the importance of undertaking dose-response studies for all components of all cardioplegic solutions.