Seckin Tuncer, Ahmet Akkoca, Murat Cenk Celen, Nizamettin Dalkilic

Abdominal I skemi-Reperfu zyon Sonrası Papiller Kas Aksiyon Potansiyelinde Meydana Gelen Değişiklikler

Abdominal aort anevrizması (AAA) yüksek prevalansa sahiptir ve cerrahi tedavi hala birçok nedenden ötürü en iyi seçenek olarak görülmektedir. Cerrahi tedavi abdominal kan akımının bir süreliğine kesilmesine neden olmakta ve iskemi-reperfüzyon (I/R) olarak adlandırılan bu durum farklı organlarda hasar meydana getirerek sekonder komplikasyonlara yol açmaktadır. Post-operatif komplikasyonlar arasında kardiyak olanlar en yüksek morbiditeye sahiptir. Bu çalışmada, abdominal I/R sonrası kalp yeterliliği bakımından en önemli role sahip papiller kasa ait aksiyon potansiyelinde meydana gelebilecek değişikliklerin araştırılması amaçlanmıştır. Yetişkin Wistar-Albino sıçanlardan abdominal aortu 1 saat süreyle klemplenip ve 2 saat süreyle reperfüzyon gerçekleştirilenler I/R, yalnızca laparotomi yapılanlar ise SHAM grubu olarak adlandırılmıştır. Reperfüzyon periyodunun hemen ardından sol ventrikül papiller kasları izole edilmiş ve aksiyon potansiyeli kayıtları yapılmıştır. Dinlenim zar potansiyelinin I/R grubunda anlamlı ölçüde hiperpolarize olduğu görülürken, aksiyon potansiyelinin genel görünümünde ise herhangi bir değişiklik meydana gelmemiştir. Kayıtlarda görülen gecikmiş-depolarizasyonlar, dinlenim zar potansiyeli bulguları ile yorumlandığında, Na+ kanal aktivitesindeki kalıcı bir değişimi düşündürmektedir. Sonuç olarak, bu çalışma I/R ile papiller kas hücre zarında hiperpolarizasyon meydana geldiğini fakat aksiyon potansiyeli parametrelerinde anlamlı bir değişikliğin olmadığını göstermiştir. Gözlenen gecikmiş aritmilerin sodyum-kalsiyum değiş-tokuşcusunun (NCX) disfonksiyonu sebebiyle ortaya çıkmış olabileceğini düşündürmektedir.

Papillary Muscle Action Potential Alterations After Abdominal Ischemia-Reperfusion

Abdominal aortic aneurysm (AAA) has a high prevalence and surgical treatment is still the best option for many reasons.Surgical treatment needs abdominal blood flow to be discontinued, which leads to secondary complications caused by ischemiareperfusion (I/R) in different organs. Since distant organ damages are seen after surgery, abdominal ischemia reperfusion results inpost-treatment deaths especially due to heart based problems. In this study, we aimed to investigate the possible alterations in actionpotential parameters of papillary muscle after abdominal I/R injury. Adult Wistar-Albino rats were divided into two groupsrandomly: SHAM group (only laparotomy was performed) and I/R group (abdominal aorta was clamped for 1 hour and reperfusedfor 2 hours). After the operational period, left ventricle papillary muscles were isolated and action potential (AP) recordingexperiments were carried out in-vitro. Significant hyperpolarization was seen in resting membrane potential in I/R group. There wasno alteration in the general shape of the action potential after I/R. Some delayed-after-depolarizations were recorded, that suggestsan impaired persistent Na+ channel activity when interpreted with resting membrane potential findings.This study shows that I/Rdoes not affect the AP parameters except for resting membrane potential. However, it is also likely that the sodium-calciumexchanger (NCX) causes delayed arrhythmias after depolarization due to dysfunction of unknown causes.

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Madu EC, D'Cruz IA. The vital role of papillary muscles in mitral and ventricular function: echocardiographic insights. Clin Cardiol. 1997; 20: 93-8.
Baue ae, mcclerkin ww. a study of shock: acidosis and the declamping phenomenon. Ann Surg. 1965; 161: 41-5.
Sakalihasan N, Limet R, Defawe OD. Abdominal aortic aneurysm. Lancet. 2005; 365: 1577-89.
Katzen BT, MacLean AA. Complications of endovascular repair of abdominal aortic aneurysms: a review. Cardiovasc Intervent Radiol. 2006; 29: 935-46.
Tuncer S, Dalkilic N, Burat I. Electrophysiological alterations in diaphragm muscle caused by abdominal ischemiareperfusion. Respir Physiol Neurobiol. 2017; 238: 7-13.
Chandra V, Trang K, Virgin-Downey W, Dalman RL, Mell MW. Long-term outcomes after repair of symptomatic abdominal aortic aneurysms. J Vasc Surg. 2018; 68: 1360-6.
Bown MJ, Nicholson ML, Bell PR, Sayers RD. Cytokines and inflammatory pathways in the pathogenesis of multiple organ failure following abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg. 2001; 22: 485-95
Kilic S, Saracoglu E, Cekici Y. Clinical Efficacy of transthoracic echocardiography for screening abdominal aortic aneurysm in turkish patients. Acta Cardiol Sin. 2018; 34: 137-43
Shahani R, Marshall JG, Rubin BB, Li RK, Walker PM, Lindsay TF. Role of TNF-alpha in myocardial dysfunction after hemorrhagic shock and lower-torso ischemia. Am J Physiol Heart Circ Physiol. 2000; 278: 942-50.
McLaughlin R, Bowler D, Kelly CJ, Kay E, Bouchier-Hayes D. Taurine protects against early and late skeletal muscle dysfunction secondary to ischaemia reperfusion injury. Eur J Surg. 2000; 166: 375-9.
Moneley D, Barry MC, McLaughlin R, Kelly CJ, Bouchier Hayes DJ. Preoperative treatment with recombinant human growth hormone prevents ischemia reperfusioninduced diaphragmatic dysfunction. J Surg Res. 2001; 97: 81-4.
Lau LL, Halliday MI, Lee B, Hannon RJ, Gardiner KR, Soong CV. Intestinal manipulation during elective aortic aneurysm surgery leads to portal endotoxaemia and mucosal barrier dysfunction. Eur J Vasc Endovasc Surg. 2000; 19: 619-24.
Kukic BP, Savic NB, Stevanovic KS, Trailovic RDj, Cvetkovic SD, Davidovic LB. Effect of IgM-Enriched Immunoglobulin as Adjunctive Therapy in a Patient Following Sepsis After Open Thoracoabdominal Aortic Aneurysm Repair. J Cardiothorac Vasc Anesth. 2016; 30: 746-8.
Baczkó I, Giles WR, Light PE. Resting membrane potential regulates Na(+)-Ca2+ exchange-mediated Ca2+ overload during hypoxia-reoxygenation in rat ventricular myocytes. J Physiol. 2003; 550: 889-98.
Kavak S. Effects of insulin on altered mechanical and electrical papillary muscle activities of diabetic rats. J Membr Biol. 2013;246:31-7.
Yaras N, Sariahmetoglu M, Bilginoglu A, Aydemir-Koksoy A, Onay-Besikci A, Turan B, et al. Protective action of doxycycline against diabetic cardiomyopathy in rats. Br J Pharmacol. 2008; 155: 1174-84.