Erkan İRİZ, Candan ÖZOĞUL, Adem GRBOLAR, Hüseyin BAYRAM, Yeşim BARDAKÇI, Ali YENER, Nuran YENER

Ameliyat sırasında perikardda oluşan değişiklikler: Bir elektronmikroskopi çalışması

Amaç: Bu çalışmada ilk kez kalp ameliyatı geçiren hastalarla daha önce en az bir kez kalp ameliyatı geçirmiş olan hastalar arasında perikard yapısı ve ameliyat sırasında perikarddaki değişimler karşılaştırıldı. Çalışma planı: Çalışmaya Ocak 2005 - Nisan 2006 tarihleri arasında kliniğimizde ameliyat edilen 36 hasta (19 erkek, 17 kadın; ort. yaş 61.2±16.1 yıl; dağılım 47-85 yıl) dahil edildi. Hastalar iki gruba ayrıldı. Grup 1’de ilk kez kalp ameliyatı geçiren 20 hasta, grup 2’de ise daha önce en az bir kez kalp ameliyatı geçirmiş 16 hasta bulunmakta idi. Her iki grupta da perikard ilk açıldığında ve ilk biyopsiden 60 dakika sonra olmak üzere iki biyopsi alındı. Alınan biyopsilerin bir bölümü uPAR (ürokinaz plazminojen aktivatörü reseptörü) ve FGF-2 (fibroblast büyüme faktörü 2) immün boyama ve DNA fragmantasyonu olan hücrelerin belirlenmesi için TUNEL yöntemi ile nötral formalinde tespit edildi. Diğer doku örnekleri transient elektromanyetik (TEM) yöntemi ile incelendi ve toluidin mavi ile boyandı. Bulgular: Her iki grup arasında gerek ameliyat öncesi risk faktörleri gerekse de hastaların demografik verileri açısından istatistiksel herhangi bir fark bulunmadı. Ancak grup 1’de birinci ve ikinci biyopsiler arasında uPAR ve FGF-2 düzeyleri açısından dokularda belirgin farklılıklar tespit edildi. Ayrıca bu grupta birinci biyopsilerde ultrastrüktürel olarak yüzeyel mikrovilluslar ve hücrelerin bazalinde derin interdijitasyonlar gözlenirken, ikinci biyopsilerde ve grup 2’deki her iki biyopside bu bulguların mikrovillus kaybı ve bazal membranda düzleşme şeklinde değiştiği tespit edildi. Grup 2’de ise birinci ve ikinci biyopsiler arasında önemli bir fark tespit edilmedi. Apoptosis açısından gruplar arasında istatistiksel olarak anlamlı bir fark yoktu. Sonuç: Sonuç olarak, ilk kez kalp ameliyatı geçiren hastalarda perikardda görülen reaksiyonların ikinci kez kalp ameliyatı geçiren hastalarda görülmemesi perikardın yapısının bir bütün olarak bozulduğuna işaret etmektedir.

Intraoperative changes in the pericardium: a study via electron microscope

Background: In this study, we compared the pericardial structure and intraoperative pericardial changes between patients undergoing cardiac surgery for the first time and patients who had previously undergone at least one cardiac surgery. Methods: Thirty-six patients (19 males, 17 females; mean age 61.2±16.1 years; range 47 to 85 years) who underwent surgery in our clinic between January 2005 and April 2006 were enrolled in this study. The patients were divided into two groups. Group 1 consisted of 20 patients who underwent surgery for the first time whereas group 2 consisted of 16 patients who had previously undergone at least one cardiac surgery. Two biopsies were obtained in both groups one immediately after opening the pericardium and the other 60 minutes after the first biopsy. A portion of the biopsies that were obtained was fixed in neutral formalin by the TUNEL method for uPAR (urokinase plasminogen activator receptor) and FGF-2 (fibroblast growth factor-2) immunostaining, and it was also used to detect cells with DNA fragmentation. The other tissue samples were examined by the transient electromagnetic (TEM) method and stained with toluidine blue. Results: No statistically significant differences were found between the groups either in the preoperative risk factors or the demographic characteristics of the patients. However, there were marked differences in the tissues between the first and second biopsies in group 1 regarding the uPAR and FGF-2 levels. Moreover, at the ultrastructural level, superficial microvilli and deep basal interdigitations of cells were identified in the first biopsy, while microvilli disappeared and basal interdigitations smoothed out in the second biopsy, and in both biopsies of group 2. No important differences were found between the first and second biopsies in group 2. There was no statistically significant difference between the groups with respect to apoptosis. Conclusion: In conclusion, the fact that the reactions seen in the pericardium of patients undergoing cardiac surgery for the first time are absent in patients undergoing cardiac surgery for the second time suggests that the structure of the pericardium deteriorates as a whole.

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