İlhan GÖLBAŞI, Nursel ŞAHİN, Ömer BAYEZİD, Ercan AKBULUT, Harun GÜLMEZ, Ayşen ŞAHİNOĞLU, Cengiz TÜRKAY

Glukoz-6-fosfat dehidrogenaz eksikliğinde koroner bypass cerrahisi

Eritrositlerde oksidan hasara karşı savunma, esas olarak glukoz-6-fosfat dehidrogenaz (G6PD) aktivitesine bağlıdır. Bu enzimin eksikliğinde, kardiyopulmoner bypass esnasında gelişen oksidan ajanlar ve peroperatif medikasyonlar hemolitik krize neden olabilirler. G6PD eksikliği bulunan 51 yaşındaki erkek hastamıza koroner bypass ameliyatı yapıldı. İntraoperatif ve postoperatif takipde sorun olmadı ve postoperatif 8. günde taburcu edildi.

Coronary bypass surgery in glucose-6-phosphate dehydrogenase deficiency

In red cells, defense against oxidative damage is essentially dependent on glucose-6- phosphate dehydrogenase (G6PD) enzyme activity. Hemolysis can be caused by oxidan agents generated during cardiopulmonary bypass and peroperative medications in G6PD deficiency. The case of a 51 year-old male with G6PD deficiency underwent coronary bypass surgery. Intraoperative and postoperative course was uneventful and he was discharged on the eighth day. We think that open heart surgery can be performed succesfully with special attention in patients with G6PD deficiency.

PDF

___

1. Smith CL, Snowdon SL. Anaesthesia and glucose-6- phosphate dehydrogenase deficiency. Anaesthesia 1987;42:281-8.
2. Martin LD, Casella ES. Anesthesia and glucose-6- phosphate dehydrogenase deficiency in a child with congenital heart disease. J Cardiothorac Vasc Anesth 1991;5:596-9.
3. Sazama K, Klein HG, Davey RJ, Corash L. Intraoperative hemolysis. Arch Intern Med 1980;140:845-6.
4. Beutler E. Glucose-6-phosphate dehydrogenase deficiency. Blood 1994;84:3613-6.
5. Younker D, De vore M, Hortlage P. Malignant hyperthermia and glucose-6-phosphate dehydrogenase deficiency. Anaesthesiology 1984;60:601-3.
6. Zimmer HG, Ibel H, Suchner U. Beta adrenergic agonists stimulate the oxidative pentose phosphate pathway in the rat heart. Circ Res 1990;67:1525-34.
7. Çiftçi M, Kufrevioğlu OI, Gündoğdu M, Özmen I. Effects of some antibiotics on enzyme activity of glucose-6- phosphate dehydrogenase from human erythrocytes. Pharmacol Res 2000;4:107-11.
8. Szentpetery S, Robertson L, Lower R. Complete repair of tetralogy associated with sickle cell anemia and G6PD deficiency. J Thorac Cardiovasc Surg 1976;72:276- 9.
9. Kirklin JW, Barratt- Boyes BG, eds. Hypothermia, circulatory arrest, and cardiopulmonary bypass. In: Cardiac Surgery. Churchill Livingstone: New York, 1993:61-116.
10. Das DK, Engelman RM, Maity S. Oxygen-derived free radicals and hemolysis during open heart surgery. Moll Cell Biochem 1992;111:77-86.
11. Yokoyama T, Baumgartner FJ, Gheissari A, Capouya ER. Off-pump versus on-pump coronary bypass in high risk subgroups. Ann Thorac Surg 2000;70:1546-50.
12. Murakami F, Usui A, Hiroma M, Kawamura M. Clinical study of totally roller pumpless cardiopulmonary bypass system. Artif Organs 1997;21:803-7.
13. Aderka D, Garfinkel D, Bograd H, FriedmanJ, Pinkhas J. Isosobide dinitrate induced haemolysis in G6PD- deficient subjects. Acta Haematologica 1983;69:63-4.