Is Periaortic Fat Pad Only Adipose Tissue?

Abstract

Introduction: The histology of periaortic tissue was examined by electron-microscope to assess the hypothesis whether resection of tissue to be effective in the development of postoperative atrial fibrillation. Patients and Methods: The study consisted of 20 male patients who were scheduled for coronary artery bypass grafting (CABG) with a mean age of 56.4 ± 7.3 years. The periaortic tissue samples were collected through arterial cannulation, aortic root, cardioplegia needle and aorta-saphenous vein anastomosis areas into saline-filled tubes. Electron-microscobic examination was revealed after preparation of the samples. Results: The histology of tissue samples consists of myelinated and unmyelinated nerve fibers, glial cells and synaptic terminals. All the segments of tissue include nerve cells. Transient atrial fibrillation was developed in 6 (33%) patients and returned to normal sinus rhythm with medical therapy. Conclusion: Periaortic adipose tissue is rich in nerve cells. The resection of this tissue may cause the reduction of parasympathetic innervation of the heart by damaging the periaortic nerve cells. Although the causal mechanisms for development of atrial fibrillation is still unclear, avoiding from resection of periaortic mass could be more appropriate unless there are compelling.

Keywords

• Thoracic surgery; atrial fibrillation; microscopy, electron, scanning transmission; autonomic pathways.

Periaortik Yağ Dokusu Gerçekte Sadece Yağ Dokusu mudur?

Abstract

Giriş: Bu çalışmada periaortik yağ dokusu rezeksiyonunun postoperatif atriyal fibrilasyon gelişiminde etkili olabileceği hipotezinin morfolojik dayanağını değerlendirmek üzere periaortik dokunun histolojisi elektron mikroskopisiyle incelendi. Hastalar ve Yöntem: Çalışmaya koroner baypas operasyonu uygulanan 20 erkek hasta alındı. Yaş ortalaması 56.4 ± 7.3 yıl idi. Arteryel kanülasyon, aort kökü, kardiyopleji iğnesi ve safen greft anastomoz bölgelerinden periaortik doku örnekleri ayrı ayrı serum fizyolojik içine alındı. Üç farklı bölgeden alınan doku örnekleri gerekli hazırlık sonrası elektron mikroskopta incelendi. Bulgular: Doku örneklerinin miyelinize, nonmiyelinize sinir lifleri, glial hücreler, sinir hücreleri ve sinaptik terminaller içerdiği görüldü. Sinir dokusu saptanmayan segment yoktu. Altı (%33) olguda postoperatif atriyal fibrilasyon görüldü. Medikal tedavi ile sinüs ritmine dönüş sağlandı. Sonuç: Periaortik yağ dokusu sinir dokusundan zengindir. Bu dokunun rezeksiyonu periaortik sinir dokusunun da zarar görmesine ve kalbin parasempatik inervasyonunun zayıflamasına neden olabilir. Rezeksiyonun atriyal fibrilasyon gelişimine katkısı tam olarak bilinmemekle beraber zorunlu olmadıkça rezeksiyondan kaçınılmasının uygun olacağını düşünüyoruz.

Keywords

• Torasik cerrahi; atriyal fibrilasyon; mikroskopi, elektron, taramalı geçirimli;otonom yollar.

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