Amaç: Çalışmanın amacı, koroner arter cerrahisi geçirecek, diabetik ve düşük kalp debili (EF 40) olguların, akut normovolemik hemodilüsyon uygulamasına kardiyak yanıtlarının transözefageal ekokardiyografik yöntemle değerlendirilmesidirGereç ve Yöntem: Hastalara TÖE 4 gruba ayrıldılar: Grup 1ANH (n: 15): Ejeksiyon fraksiyonu > % 40, ANH uygulanacak grup. Grup 1K (n: 15): Kontrol grubu, Ejeksiyon fraksiyonu > % 40, ANH uygulanmayacak grup. Grup 2ANH (n: 15): Ejeksiyon fraksiyonu
Objective: The aim of this study is to evaluate the cardiac responses to acute normovolemic hemodilution (ANH) in diabetic patients with normal (EF > 40) or low (EF <= 40%) cardiac output undergoing coronary artery surgery with transoesophageal echocardiography. Material and Method: The patients were divided into four groups based on TEE findings: Group 1ANH (n: 15): Patients with ejection fraction>%40 who will undergo ANH. Grup 1C (n: 15): Patients with ejection fraction> %40 who will not undergo ANH .Grup 2ANH (n: 15): Patients with ejection fraction<=40 % who will undergo ANH. Grup 2C (n: 15): Control group. Patients with ejection fraction <=40% who will not undergo ANH. The TEE measurements were obtained before ANH and 30 minutes after the application. Using 2D echocardiography systolic (left ventricle end diastolic area (LVEDA), left ventricle end- systolic area (LVESA), fractional area difference (FAD), stroke volume (SV), cardiac index (CI) and diastolic functions; early mitral inflow velocity (Em Vmax), atrial contraction (Am Vmax), ratio (E/A) and deceleration time (DT), isovolumetric relaxation time (IVRT). Results: Hemodynamic and TEE data in Group 1K and Group 1ANH were not different baseline values. However, LVEDA was significantly higher in Group 2ANH after ANH, according to those at the beginning in Group 2ANH (p<0.01). LVESA was not different in these groups. EmVmax. also did not change, but AmVmax. was significantly increased and E/A ratio was significantly decreased in Group 2ANH after ANH, compared to baseline values in Group 2ANH. (p<0.001). Conclusion: In summary, application of moderate degrees of acute normovolemic hemodilution in diabetic patients with normal or low EF was well tolerated without deteriorating left ventricular functions. However, in the presence of atrial fibrillation in diabetic patients with low ejection fractions undergoing cardiac surgery, ANH should be performed carefully, because of the risk of increasing the AmVmax. with ANH.
1. Pliskow B, Li JKJ, O'Hara D, Kaya M. A novel approach to modeling acute normovolemic hemodilution. Computers in Biology and Medicine 2016;68;155-64. https://doi.org/10.1016/j.compbiomed.2015.11.003
2. Jamnicki M, Kocian R, van der Linden P, Zaugg M, Spahn DR. Acute normovolemic hemodilution: physiology, limitations, and clinical use. J Cardiothorac Vasc Anesth 2003;17:747-54. https://doi.org/10.1053/j.jvca.2003.09.018
3. Ickx BE, Rigolet M, Van Der Linden PJ. Cardiovascular and metabolic response to acute normovolemic anemia. Effects of anesthesia. Anesthesiol 2000;93:1011- 16. doi: 1017-1021.
4. Licker M, Ellenberger C, Sierra J, Christenson J, Diaper J, Morel D. Cardiovascular response to acute normovolemic hemodilution in patients with coronary artery diseases: Assessment with transesophageal echocardiography. Crit Care Med 2005;33(3):591-7. Issn Print: 0090-3493
5. Grundy SM, Benjamin IJ, Burke GL, Chait A, Eckel RH, Howard BV, et al. Diabetes and cardiovascular disease: a statement for healthcare professionals from the American Heart Association. Circulation 1997;100(10):1134-46. https://doi.org/10.1161/01.CIR.100.10.1134
6. Juutilainen A, Lehto S, Rönnemaa T, Pyörälä K, Laakso M. Type 2 diabetes as a "coronary heart disease equivalent": an 18-year prospective populationbased study in Finnish subjects. Diabetes Care 2005;28(12):2901-7. https://doi.org/10.2337/diacare.28.12.2901
7. Sağcan A, Çelik PK, Payzın S ve ark. Tip II Diyabetiklerde Koroner Bypass'yn Kalbin Diyastolik ve Sistolik Parametreleri Üzerine Etkisi. Turkish J Thorac Cardiovasc Surg 2001;9:128-32.
8. Ceyhan K, Kadi H, Koç F, Celik A, Oztürk A, Onalan O. Longitudinal left ventricular function in normotensive prediabetics: a tissue Doppler and strain/strain rate echocardiography study. J Am Soc Echocardiogr 2012;25(3):349-56. https://doi.org/10.1016/j.echo.2011.11.018
9. Taşoğlu İ, İmren VY, Yener A. Impact of intraoperative transesophageal echocardiography on surgical decisions in the cardiovascular operating room. İntraoperatif transözofajiyal ekokardiyografinin ameliyat odasında kardiyovasküler cerrahi kararlarına etkisi. Türk Kardiyol Dern Arş - Arch Turk Soc Cardiol 2012;40(3):242- 50. https://doi.org/10.5543/tkda.2012.75725
10. Eltzschig HK, Rosenberger P, Löffler M et al. Impact of intraoperative transesophageal echocardiography on surgical decisions in 12,566 patients undergoing cardiac surgery. Ann Thorac Surg 2008;85:845-53. https://doi.org/10.1016/j.athoracsur.2007.11.015
11. De Mey N, Couture P, Laflamme M, Denault AY, Perrault LP, Deschamps A, et al. Intraoperative changes in regional wall motion: Can Postoperative Coronary Artery Bypass Graft Failure Be Predicted? J Cardiothorac Vasc Anesth 2012;26(3):371-5. https://doi.org/10.1053/j.jvca.2012.02.005
12. Sliem H and Nasr G. Left ventricular structure and function in prediabetic adults:Relationship with insulin resistance. J Cardiovascular Disease Research 2011;2(1):23-8. https://doi.org/10.4103/0975-3583.78583
13. Nagueh SF, Smiseth OA, Appleton CP, Byrd BF, Dokainish H, Edvardsen T, et al. Recommendations for the evaluation of left centricular diastolic function by echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2016;29(4):277-314. https://doi.org/10.1016/j.echo.2016.01.011
14. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015;28:1- 39. https://doi.org/10.1016/j.echo.2014.10.003
15. Ferreira RG, Brandon M, Esper SA, Swaminathan M. Quantative and semiquantative echocardiography: Ventricular and valvular physiology. Perioperative transesophageal echocardiography. A companion to Kaplan's Cardiac Anesthesia. Edited by Reich DL and Fisher GW. Elsevier Saunders., Philadelphia, printed in Chine, print no: 9, Section 1. p: 90-105, 2013.