Blood Lactate, Pyruvate and Lactate-Pyruvate Ratios in Congenital Heart Disease

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Abstract
THE equilibrium (Equation 1, below) which exists between lactic acid and pyruvic acid is, in the presence of normal lactic dehydrogenase (LDH) activity, dependent upon the ratio of oxidized (DPN) to reduced (DPNH2) diphosphopyridine nucleotide (that is, NAD and NADH, oxidized and reduced nicotinamide-adenine dinucleotide, respectively, according to recent nomenclature), and so is controlled, through electron-transfer systems, by molecular oxygen. In the presence of decreased amounts of molecular oxygen the normal DPN:DPNH2 ratio cannot be maintained, and Equation 1 shifts to the right, with a consequent accumulation of lactic acid. For this reason the ratio between lactate . . .