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Prophylactic and Therapeutic Use of Digitalis in Open-Heart Operations

Prophylactic and Therapeutic Use of Digitalis in Open-Heart Operations Abstract Physicians have long debated the advisability of giving digitalis as a prophylaxis against cardiac failure which may occur in connection with the stress of general surgical operations. While there is agreement as to its benefits for the failing heart, in the nonfailing heart it has often been considered not only useless but even harmful. The problem has recently been brought into sharper focus by the widespread use of cardiotomy for correction of intracardiac defects, especially when such physical trauma to the myocardium is accompanied by the metabolic insult of induced cardiac arrest. We have recently demonstrated the beneficial effects of digitalis in experimental animals subjected to periods of induced cardiac arrest.6 With 30 minutes of potassium cardioplegia in dogs, there is profound depression of ventricular function.15 The digitalized canine heart arrested with potassium citrate is subsequently able to perform more than 19.5 grammeters stroke work in response to References 1. Bailey, C. P., in discussion on Kittle, C. F., and Crockett, J. E.11 2. Black, H., in discussion on Kittle, C. F., and Crockett, J. E.11 3. Bloodwell, R. D.; Goldberg, L. I.; Braunwald, E.; Gilbert, J. W.; Ross, J. A., and Morrow, A. G.: Myocardial Contractility in Man: The Acute Effects of Digitalis, Sympathomimetic Amines, and Anoxic Cardiac Arrest, presented at the Fundamental Forum of the American College of Surgeons, Atlantic City, N.J., Sept., 1959. 4. Boniface, K. J.; Brodie, O. J., and Walton, R. P.: Resistance Strain Gauge Arches for Direct Measurement of Heart Contractile Force in Animals , Proc. Soc. Exper. Biol. & Med. 84:263, 1953. 5. Burack, B.; Schwedel, J. B., and Young, D.: The Role of Digitalis in Mitral Valvuloplasty , Am. Heart J. 54:863, 1957. 6. Cooper, T.; Willman, V. L.; Zafiracopoulos, P., and Hanlon, C. R.: Effect of Prophylactic Digitalization on Myocardial Function After Elective Cardiac Arrest, Ann. Surg., to be published. 7. Cotton, M. DeV., and Stopp, P. F.: Action of Digitalis on the Nonfailing Heart of the Dog , Am. J. Physiol. 192:114, 1958. 8. Dock, W., and Tainter, M. L.: The Circulatory Changes After Full Therapeutic Doses of Digitalis, with a Critical Discussion of Views on Cardiac Output , J. Clin. Invest. 8:467, 1930. 9. Eddleman, E. E., Jr.; Willis, K.; Greve, M. J., and Heyer, H. E.: The Effect of Digitoxin on the Apparent Stroke Volume, Posteroanterior Cardiac Diameter, and the Cardiac Cycle in Normal Subjects as Studied by the Electrokymograph , Am. Heart J. 41:161, 1951. 10. Harvey, R. M.; Feirer, M. I.; Cathcart, R. T.; Richards, D. W., Jr., and Cournand, A.: Some Effects of Digoxin upon the Heart and Circulation in Man , Am. J. Med. 7:439, 1949. 11. Kittle, C. F., and Crockett, J. E.: The Etiology and Prevention of Atrial Fibrillation After Mitral Valvotomy , J. Thoracic Surg. 38:353, 1959. 12. LeVeen, H. H.; Schatman, B., and Falk, G.: Cardiac Arrest Produced by Massive Transfusions , Surg. Gynec. & Obst. 109:4:502, 1959. 13. Spencer, F. C., in discussion on Boyd, A. D.; Tremblay, R. C.; Spencer, F. C., and Bahnson, H. T.: Estimation of Cardiac Output Soon After Intracardiac Surgery with Cardiopulmonary Bypass , Ann. Surg. 150:613, 1959. 14. Stewart, H. J., and Cohn, A. E.: Studies on the Effect of the Action of Digitalis on the Output of Blood from the Heart , J. Clin. Invest. 8:917, 1932. 15. Willman, V. L.; Cooper, T.; Zafiracopoulos, P., and Hanlon, C. R.: Depression of Ventricular Function Following Elective Cardiac Arrest with Potassium Citrate , Surgery 46:792, 1959. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png A.M.A. Archives Surgery American Medical Association

Prophylactic and Therapeutic Use of Digitalis in Open-Heart Operations

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Publisher
American Medical Association
Copyright
Copyright © 1960 American Medical Association. All Rights Reserved.
ISSN
0096-6908
DOI
10.1001/archsurg.1960.01290220152019
Publisher site
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Abstract

Abstract Physicians have long debated the advisability of giving digitalis as a prophylaxis against cardiac failure which may occur in connection with the stress of general surgical operations. While there is agreement as to its benefits for the failing heart, in the nonfailing heart it has often been considered not only useless but even harmful. The problem has recently been brought into sharper focus by the widespread use of cardiotomy for correction of intracardiac defects, especially when such physical trauma to the myocardium is accompanied by the metabolic insult of induced cardiac arrest. We have recently demonstrated the beneficial effects of digitalis in experimental animals subjected to periods of induced cardiac arrest.6 With 30 minutes of potassium cardioplegia in dogs, there is profound depression of ventricular function.15 The digitalized canine heart arrested with potassium citrate is subsequently able to perform more than 19.5 grammeters stroke work in response to References 1. Bailey, C. P., in discussion on Kittle, C. F., and Crockett, J. E.11 2. Black, H., in discussion on Kittle, C. F., and Crockett, J. E.11 3. Bloodwell, R. D.; Goldberg, L. I.; Braunwald, E.; Gilbert, J. W.; Ross, J. A., and Morrow, A. G.: Myocardial Contractility in Man: The Acute Effects of Digitalis, Sympathomimetic Amines, and Anoxic Cardiac Arrest, presented at the Fundamental Forum of the American College of Surgeons, Atlantic City, N.J., Sept., 1959. 4. Boniface, K. J.; Brodie, O. J., and Walton, R. P.: Resistance Strain Gauge Arches for Direct Measurement of Heart Contractile Force in Animals , Proc. Soc. Exper. Biol. & Med. 84:263, 1953. 5. Burack, B.; Schwedel, J. B., and Young, D.: The Role of Digitalis in Mitral Valvuloplasty , Am. Heart J. 54:863, 1957. 6. Cooper, T.; Willman, V. L.; Zafiracopoulos, P., and Hanlon, C. R.: Effect of Prophylactic Digitalization on Myocardial Function After Elective Cardiac Arrest, Ann. Surg., to be published. 7. Cotton, M. DeV., and Stopp, P. F.: Action of Digitalis on the Nonfailing Heart of the Dog , Am. J. Physiol. 192:114, 1958. 8. Dock, W., and Tainter, M. L.: The Circulatory Changes After Full Therapeutic Doses of Digitalis, with a Critical Discussion of Views on Cardiac Output , J. Clin. Invest. 8:467, 1930. 9. Eddleman, E. E., Jr.; Willis, K.; Greve, M. J., and Heyer, H. E.: The Effect of Digitoxin on the Apparent Stroke Volume, Posteroanterior Cardiac Diameter, and the Cardiac Cycle in Normal Subjects as Studied by the Electrokymograph , Am. Heart J. 41:161, 1951. 10. Harvey, R. M.; Feirer, M. I.; Cathcart, R. T.; Richards, D. W., Jr., and Cournand, A.: Some Effects of Digoxin upon the Heart and Circulation in Man , Am. J. Med. 7:439, 1949. 11. Kittle, C. F., and Crockett, J. E.: The Etiology and Prevention of Atrial Fibrillation After Mitral Valvotomy , J. Thoracic Surg. 38:353, 1959. 12. LeVeen, H. H.; Schatman, B., and Falk, G.: Cardiac Arrest Produced by Massive Transfusions , Surg. Gynec. & Obst. 109:4:502, 1959. 13. Spencer, F. C., in discussion on Boyd, A. D.; Tremblay, R. C.; Spencer, F. C., and Bahnson, H. T.: Estimation of Cardiac Output Soon After Intracardiac Surgery with Cardiopulmonary Bypass , Ann. Surg. 150:613, 1959. 14. Stewart, H. J., and Cohn, A. E.: Studies on the Effect of the Action of Digitalis on the Output of Blood from the Heart , J. Clin. Invest. 8:917, 1932. 15. Willman, V. L.; Cooper, T.; Zafiracopoulos, P., and Hanlon, C. R.: Depression of Ventricular Function Following Elective Cardiac Arrest with Potassium Citrate , Surgery 46:792, 1959.

Journal

A.M.A. Archives SurgeryAmerican Medical Association

Published: May 1, 1960

References

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