M. Şah TOPÇUOĞLU, Acar TOKCAN, Hafize YALINIZ, Handan ZEREN, Tümer ULUS, Bülent KISACIKOĞLU, Hakan POYRAZOĞLU

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"Diltiazem" eklenmiş soğuk kan ve ılık kan kardiyoplejisinin miyokard korunmasına etkileri (Klinik çalışma)

AMAÇ:Bu çalışmada soğuk kan kardiyoplejisinin indüksiyon dozuna eklenen "diltiazem"in ve (indüksiyon dozuna diltiazem eklenmiş) ılık kan kardiyoplejisinin açık kalp ameliyatı yapılan hastalarda miyokardiyal reperfüzyon hasarına etkilerinin olup olmadığı biyokimyasal ve morfolojik olarak araştırılmıştır. YÖNTEM : Koroner bypass ameliyatı uygulanan 30 hasta, uygulanan kardiyopleji metoduna göre, üç grupta incelendi: Grup I: soğuk kan kardiyoplejisi uygulanan 10 hastadan, Grup II: soğuk kan kardiyoplejisininin indiksiyon dozuna 150 $mu$g/kg diltiazem eklenmiş 10 hastadan ve Grup III: indiksiyon dozuna 150 $mu$g/kg diltiazem eklenmiş ılık kan kardiyoplejisi uygulanan 10 hastadan oluşmaktadır. Miyokardiyal hücre hasarının araştırılmasında postoperatif 3-96. saatlerde serum CK-MB seviyeleri ve "cross clamp"ın 20.dakikasında ve reperfüzyonun 30.dakikasında sol ventrikül ön yüzünden alınan miyokard örneklerinde ültrastrüktürel değişiklikler kullanılmıştır. SONUÇLAR: Grup l'e göre Grup II ve Grup II'de serum CK-MB değerleri normal seviyelere daha erken dönmüş ultrastrüktürel değişiklikler daha hafif olmuştur. YORUM: Serum CK-MB seviyeleri ve ultrastrüktürel bulgulara dayanarak; soğuk kan kardiyoplejisinin indüksiyon dozuna eklenen diltiazem'in ve (indütsiyon dozuna diltiazem eklenmiş) ılık kan kardiyopejinin açık kalp cerrahisinin global iskemi ve reperfüzyon dönemlerinde myokard hasarının oluşumunun önlemesinde etkili oldukları sonucuna varılmıştır.

The effect of cold and tepid blood cardioplegia with supplementation of "Diltiazem" on myocardial protection: Clinical study

PURPOSE: The effects of diltiazem in the cold blood cardioplegia and tepid blood cardioplegia with diltiazem are biochemically and morphologically evaluated. METHOD: 30 patient undergoing coronary by-pass surgery were randomly dividede into three groups. Group I was consisted of 10 patients with cold blood cardioplegia applied. Group II was consisted of 10 patients whom added 150 microgr/kg diltiazem to induction of cold blood cardioplegia, and group III was consisted of 10 patients whom added diltiazem (150 microgr /kg) to induction of tepid blood cardioplegia. The CK-MB blood leves in 3rd 96rd hours postoperatively and ultrastructural variations in myocard speciements taken from the anterior surface of left ventricule at 20th minute following "cross clamp" and 30th minute following reperfusion were used to assess the myocardial cell injury. RESULTS : In Group II and Group III serum CK-MB levels and ultrastructural findings are better then Group I. CONCLUSION: We concluded that cold and tepid blood cardioplegia with diltiazem added to induction, are effective methods in preventing from myocardial injury occurred during global ischemia and reperfusion periods in open heart surgery, due to CK-MB blood levels and ultrastructural findings.
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  • 1. Baue AA, Geha AS, Hammond GL, et al: Glenn's Thoracic and Cardiovascular Surgery, Connecticut-Appleton-Lange; 1991 :p 1417.
  • 2. Braunwald E, Kloner RA: The stunned myocardium;' prolonged postischemic ventricular dysfunction. Circulation 1982; 66:1146.
  • 3. Byersdof F, Qkamoto F, Buekberg GD, etaj: Studies on prolonged acute regional,ischemia. II. J Thbrac Cardiovasc Surg 1989; 98:224.
  • 4. Chitwood WR, Hill RC, Sink JD et al: diastolic ventricular properites in patients during coronary revascularization. J Thorac Cardiovasc Surg 1983; 85:595-602.
  • 5. Digerness SB, Tracy WG, Andrews NF, et al: Reversal of myocardial ischemic contracture and the relatinship to functional recovery and tissue calcium. Circulation 1983; 68:11-34.
  • 6. Hearse DJ, Humphrey SM, Nayler WG, et al: Ultrastructural damage associated with oxygenation of the arioxic myocardium. J Moll Cell Cardiol 1975; 7:815-820.
  • 7. Ledingham SJM: Intraoperative myocardial protection in KayPH (ed) Butterworth Heinemann, Techniques in extracorporeal circulation 3 rd Ed .Oxford, 1992; 144-156.
  • 8. Patel B, Kloner RA, Przyklenk K, Braunwald E: Postischemic myocardial "stunning" A clinical reluetant fenamenon. Ann Int Med 1988; 108-626.
  • 9. Sabiston DC, Spencer FC: Surgery of The Chest. WB Sauhders Comp. Philadelphia, 1990, 1635.
  • 10. Dişçigil B, Gürcün U, Badak i, Boğa M ve ark. Miyokard korunmasında tepid, kan kardiyoplejisi kullanımı ve sol ventrikül fonksiyonları üzerine etkisi. TGKDCD 1999; 7:426-9.
  • 11. Rosenkraanz ER, Okamato F, Buckberg GD: The safety of prolonged aoritc clamping with blood cardioplegia. II. Glutamate enrichment in energy depleted heart. J Thorac Cardiovacs Surg 1984; 88:402-10.
  • 12. Fremes SE, Cristakis GT, Weisel RD, Michle DAG, et al: A clinical trial of blood and crystaloid cardioplegia. J Throac Cardivasc Surg 1984; 88: 726-741.
  • 13. Barner HB: Blood cardioplegia, a review and comparison with cryskloid cardioplegia. Ann Thorac Surg 1991; 52: 1354-67.
  • 14. Pichon H, Chocron S, Alwan K, Tukin G, et al: Cristaloid versus cold blood cardioplegia and cardiac troponin relase. Circulation 1997; 96: 316-20.
  • 15. Fiore AC, Chwartz MT, Nevtt R, Vieth PJ, et al: intermittent antegrade tepid versus cold blood cardioplegia in elective myocardiol revascurization. Ann Thorac Surg 1998; 65:1559-64.
  • 16. Lichtenstein SV, Ashe KA, El Dalati H, et al: Warm heart surgery. J Thorac Cardiovasc Surg 1991; 101:269-74.
  • 17. Deyiri E, Borman JB, Mein G, et al: Lukewarm blood cardioplegia. Heart Surgery 1995; 95:321-30.
  • 18. Hayashida N, Weisel RD, Shirai T, et al: Tepid antegrad and retrograd cardioplegia. Ann Thorac Surg 1995; 59:723-9.
  • 19. Chorcron S, Kaili D, Yan Y, et al: intermediate lukewarm (20 degress C) antegrade intermittent blood cardiyoplegia compared with cold and warm blood cardiyoplegia. J Thorac Cardiovasc Surg 2000; 119(3):610-16.
  • 20. Ferrari R.Ceconi C.Curella S,et al: Myocardial damage during ischemia and reperfusion. European Heart Journal 1993; 14(Suppl):25-30.
  • 21. Schaper J: Morphological changes in the human heart caused by global ischemia during open herat surgery. In Roberts"AJ (ed), Myocardial protection in cardiac surgery. Basel NewYork 1976;53-69.
  • 22. Guamieri G, Flamigni F, Calderera CM: Role of oxygen in the cellular damage induced by reoxygenation of hypoxic heart. J Mol Cell Cardiol 1980; 12:797-808.
  • 23. Hammond B, Hess ML: The oxygen free radical system: Potential mediator of myocardial injury. Am Coll Cardial 1985; 6:215.
  • 24. Me Cord JM: Superoxide radical : A likely link between reperfusion injury and inflamation. Ad Free Radical Biol Med 1986; 2:325.
  • 25. Gânote CE, Nayler WG: Contraeture and the calcium paradox. J Mol Cell Cardiol 1985; 17:733-45.
  • 26. Ganotte CE, Seabre-Gomes R: Nayler WG, Jennings RB: Irreversbl myokardial injury in anoxic perfused rat hearts. Am J Pathol 1975; 80:419-450.
  • 27. Hazer CD: Calcium and stunned myocardium. J Cardiac Surgery 1993; 8:329.
  • 28. Sato H, Hori M, Kitakeze M, et al: Calcium overload during reperfision disrupts network structure microtublue in the cannine stunned myokardium. Heart and Vessels 1982; 8:52.
  • 29. Shen AC, Jennings RB: Myocardial calcium and magnesium in acute ischemic injury. Am J Pathol 1972; 67:417!
  • 30. Folette DM, Fey K, Bucberg GD: Reducing postishemic damage by temporay modification of reperfusate calcium, potasium, PH and osmolarity. J Thorac Cardiovasc Surg 1981; 82:221.
  • 31. Follette DM, Fey K, Livesay J, et al: Reducing reperfusion injury with hypocalcemic, hypercalemic.alkalotic blood during reoxygenation. Surg Forum 1978; 29: 284.
  • 32. Hearse DJ, Garlick PB, Humprey SM: Ischemic contracture of the myocardium: Mechanisms and preventions. Am J Cardiol 1977; 39:986.
  • 33. Hearse DJ, O'Brian K and Brainbirdge MV: Protection of mycardium during ischemic arrest: Dose response curves for procaine and lidnocaine in cardioplegic solutions. J Thorac Cardiovasc Surg 1981; 81:873.
  • 34. Lowe JE, Kleinman LA, Reimer KA. Effects of cardioplegia produced b calcium flux inhibition. Surg Forum 1977; 28: 279.
  • 35. Robb-Nicholson C, Currie WD, Wachster AS. Effects of verapamil on myocardiol tolerance to ischemic arrest, comparision to potassium arrest circulation 1978; 58: Supl 1:119.
  • 36. Magee PG, Flaherty JT, Bixter TJ, et al. Effects of myocardial protection with nifedipine and potasium. Circulation 1979; 60. Suppl 1, 151.
  • 37. Yörükoğlu Y, Akkoç Ö, Çiçek S, ve ark: Kalp cerrahisinde diltiazemin reperfüzyon hasarına etkisi (Deneysel araştırma). GATA Bülteni 1994; 36: 15-20.
  • 38. Lathrop AD, Pnd Valle-Aguilera JR MD.PnD et al: Comparative electropysiologic and coronary hemodynamic effects of Diltiazem, Nisoldipine and Verapamil on myocardial tissue. Cardiol 1982; 49:613-620.
  • 39. Clark RE, Christlieb IY, Ferguson TB et al: The first American clinical trial of Nifedipine in cardioplegia. A report of the first 12 month expedierce. J Thorac Cardiovasc Surgery 1981; 82:848-859.
  • 40. Shaper J, Hehrlein F, Schlepper M, Thiedemann KU: Ultrastructural alterations during ischemia and reparfusion in human hearts during cardiac surgery. J Med Cell Cardiol 1977; 9:175.
  • 41. Ferrans VJ: Morfological methods for evaluation of myocardiol proltection. Ann Thorac Surg 1975; 20:11.
  • 42. Martin AM Jr, Hackel DB: An electron microscobic study of the progression of myocardial ischemia in the dog after hemorhagic shock 1996; L al Invest 15; 243.
  • 43. Flameng W, Borgers M, Deenen W, Stalpaert G.Ultrastructural and crystoloid correlates of myocardiol protection by cardiac hypotermia in mon. J Thorac Cardiovasc Surg 1980; 79:413-424.
  • 44. Çatalyürek H, Oto Ö, Hazan E, Medir K, ve ark. Soğuk kan kardiyoplejisi tekniğinde hot shot sıcak uygulaması: Her zaman gerekli mi? GKDC Der 1998; 6: 457-464.
  • 45. Christakis GT, Fremes SE, Weisel RD et al: Diltiazem cardioplegia a balance of risk and benefit. J Thorac Cardiovasc Surg 1986; 91:647-661.
  • 46. Weintein GS, Rao PS, Tyras D. Reduction of myocardial injury with verapamil before aortic cross-, clamping. Ann Thorac Surg 1990; 49: 419.
  • 47. Aral A, Eren T, Özberak H: Aortik kross klemp öncesi uygulanan diltiazem ile myokardial hasarlanmanın azaltılması. Medical Network Kardiyoloji. 1995; 1:32-35.
  • 48. Vouhe PR, Helias J, Robert P: Myocardial protection through cold cardioplegia with potassium or dilitazem. Experimental evidence that diltiazem provides beter protection even when coronary blood flow is impaired by critical stenosis. Circulation 1982; 65: 1078-1085.
  • 49. Opie LH, Toit EF: Postischemic stunning : The two-phase model for the role of calcium as pathogen. J Cardiovascular Pharmacology 1992; 20 (Supp 1.5):1.
  • 50. 50. Mullen JC, Khan N, Weisel RD: Atrial activity during cardioplegia and postoperative arrhythmias. J Throrac Cardiovasc Surg 1987; 94:558-565.
  • 51. 51. Barrier HB, Swartz MT, Devine JE, Williams GA, Janosik D: Diltiazem as an odjunct to cold blood potasium cardioplagia. A clinical assesment of dose and postoperative randomization. Ann Thorac Surg 1987; 43: 191-197.
  • 52. Guyton RA, Dosey LM, Colgan TK, Hatcher CR. Calicum channel blocage as an adjunt to heterogenous delivery of cardioplegia. Ann Thorac Surg 1983; 36: 626.
  • 53. Borner HB, Jellinec U, Standeven JW, Menz LJ, Hahn JW. Cold-blood-dilatiazem cardioplegia. Ann Thorac Surg 1982; 33:55-63.
  • 54. Şaban M, Özbek C, Andaç H, Kestelli M, ve ark: Miyokard korumada diltizemli soğuk kan kardiloplejisinin hemodinamik ve metabolik etkenleri. Türkiyenin Çeşitli Merkezlerinde Diltizem ile Yapılan Çalışmalar (Mustafa Nevzat İlaç Sanayi AŞ) 1995, 107-130.
  • 55. Baltarlı A, Türköz R, Şirin H ve ark. Potasyomlu soğuk kan kardiyoplejisine diltiazem eklenmesinin miyokard korunması üzerine etkileri. Türk Kardiyoloji Derneği Arşivi 1996;24:102-6
  • 56. Ashraf M, Masahiko Onda PhD, Benedict John B, MD, et al: Prevention of Calcium paradox-related myocardial cell injury with diltiazem, a calsium channel blocking agent. Am Cardiol 1982; 49:1675-1681.
  • 57. Standeven JW, Jellinek M, Menz LJ, et al: Cold blood pottassium diltiazem cardioplegia. J Thorac Cardiovasc Surg 1984; 87:201-202.
  • 58. Balderman SC, Chan AK, Gage AA: Verapamil cardioplegia; Improved myocardial preservation during global ischemia. Thoracic Cardiovasc Surg 1984; 88:57-66.
  • 59. Clark RE, Chrislieb IY, Spratt JA: Myocardial preservation with nifedipine. A comparative study at normothermic. Ann Thorac Cardiovasc Surg 1981; 31:3-19.
  • 60. Magovern GJ, Dixon CM, Burkholder JA: Improved myocardial protection with nifedipine and potassium based cardoplegia. J Thoracic Cardiovasc Surg 1981; 82: 239-244.
  • 61. Boe JL, Dixon CM, Sahert TA, Magovern GJ. The control of myocardial Ca++ sequestation with nifedipine cardioplegia. J Thorac Cardiovasc Surg 1982; 84:152.
  • 62. Standeven JW, Jellinek M, Menz LJ, et al: Cold blood pottasium diltiazem cardioplegia. J Thorac Cardiovasc Surg 1984; 87:201-212.
  • 63. Yamamoto F, Monning AS, Crome R, et al: Calcium antagonists and myocardial protection: a comparative study of the functional , metabolic and electrical consequences of verapamil and nifedipine as additives to the St. Thomas cardioplegic solution. Thorac Cardiovas Surgeon 1985; 33:354-359.
  • 64. Teoh KH, Mickle DAG, Weisel RD, et al: Improving mjyocardial metabolic and functional recovery after cardiyoplegic arrest. J Thorac Cardiyovaasc Surg. 1988; 95:788-98.
  • 65. Teoh KH, Mickle DAG, Weisel RD, et al: Decreased postoperative miyocardial fatty acid oxidation. J Surg Res 1988; 44: 36-44.
  • 66. See YP, Weisel RD, Mickle DAG, et al: Prolonged hypotermic cardiac storage for transplantation: the effect on miyocardial metabolism and mitochondrial function. J Thorac Cardiyovasc Surg 1992- 104- 817-24.
  • 67. McMurchie EJ, Raison JK, Cairncross KD: Temperature induced phase changes in membranes of heart: a contrast between the thermal response of poikilotherms and homeotherms. Comp Biochem Physiol 1973; 44:1017-26.
  • 68. Aoki M, Kawata H, Mayer JE: Coronary andolhollal injury by cold crystalloid cardlyoplefllo solution In neonatal lambs. Circulation 1992; 86: 346-51.
  • 69. Hearse DJ, Stewart DA, Bralmbridge MV, el al: Cellular protection during miyocardial Ischemia: the development and characterization of a procedure for the induction of reversible ischemic arrest. Circulation 1976; 54:193-202.
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  • ISSN: 0250-5150
  • Yayın Aralığı: 4
  • Yayıncı: Tülay Candan
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