Is Periaortic Fat Pad Only Adipose Tissue?

Year 2012, Volume: 15 Issue: 2, 55 - 59, 01.02.2011

Hasan Sunar Serpil Taş Mustafa Çıkrıkçıoğlu Gülara Hüseyinova Enver Duran

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.

References

• Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, et al. American College of Cardiology Foundation/ American Heart Association Task Force. 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 2011;123:e269-367. Epub 2011 Mar 7.
• Creswell LL. Postoperative atrial arrhythmias: risk factors and associated adverse outcomes. Semin Thorac Cardiovasc Surg 1999;11:303-7.
• Sener E, Göl MK, Yapıcı F, Zorlutuna Y, Tasdemir, Bayazıt K. Koroner bypass yapılan olgularda postoperatif dönemde gelişen atrial fibrilasyonun nedenlerinin araştırılması. Turkiye Klinikleri J Cardiol 1993;6:79-83.
• Ceyran H, Tezcaner T, Tasdemir K, Emiroğulları ON, Andac MH, Akcali Y. The effect of metoprolol for preventing atrial fibrillation after coronary artery surgery. Turkiye Klinikleri J Cardiovasc Surg 2003;4:139-43.
• Davis Z, Jacobs HK, Bonilla J, Anderson RR, Thomas C, Forst W. Retaining the aortic fat pad during cardiac surgery decreases postoperative atrial fibrillation. Heart Surg Forum 2000;3:108-12.
• Pardini BJ, Patel KP, Schmid PG, Lund DD. Location, distribution and projections of intracardiac ganglion cells in the rat. J Auton Nerv Syst 1987;20:91-101.
• Quigg M. Distribution of vagal afferent fibers of the guinea pig heart labeled by anterograde transport of conjugated horseradish peroxidase. J Auton Nerv Syst 1991;36:13-24.
• Burkholder T, Chambers M, Hotmire K, Wurster RD, Moody S, Randall WC. Gross and microscopic anatomy of the vagal innervation of the rat heart. Anat Rec 1992;232:444-52.
• Yuan BX, Ardell JL, Hopkins DA, Losier AM, Armour JA. Gross and microscopic anatomy of the canine intrinsic cardiac nervous system. Anat Rec 1994;239:75-87.
• Gatti PJ, Johnson TA, McKenzie J, Lauenstein JM, Gray A, Massari VJ. Vagal control of left ventricular contractility is selectively mediated by a cranioventricular intracardiac ganglion in the cat. J Auton Nerv Syst 1997;66:138-44.
• Chiou CW, Eble JN, Zipes DP. Efferent vagal innervation of the canine atria and sinus and atrioventricular nodes. The third fat pad. Circulation. 1997;95:2573-84.
• Dickerson LW, Rodak DJ, Fleming TJ, Gatti PJ, Massari VJ, McKenzie JC, et al. Parasympathetic neurons in the cranial medial ventricular fat pad on the dog heart selectively decrease ventricular contractility. J Auton Nerv Syst 1998;70:129-41.
• Tsuboi M, Furukawa Y, Nakajima K, Kurogouchi F, Chiba S. Inotropic, chronotropic, and dromotropic effects mediated via parasympathetic ganglia in the dog heart. Am J Physiol Heart Circ Physiol 2000;279:H1201-7.
• Janes RD, Brandys JC, Hopkins DA, Johnstone DE, Murphy DA, Armour JA. Anatomy of human extrinsic cardiac nerves and ganglia. Am J Cardiol 1986;57:299-309.
• Trenin SO. The topographic anatomy of the nerves supplying the human heart. Morfologiia 1994;106:101-8. (abstract)
• Singh S, Johnson PI, Lee RE, Orfei E, Lonchyna VA, Sullivan HJ, et al. Topography of cardiac ganglia in the adult human heart. J Thorac Cardiovasc Surg 1996;112:943-53.
• Armour JA, Murphy DA, Yuan BX, Macdonald S, Hopkins DA. Gross and microscopic anatomy of the human intrinsic cardiac nervous system. Anat Rec 1997;247:289-98.
• Amar D, Zhang H, Miodownik S, Kadish AH. Competing autonomic mechanisms precede the onset of postoperative atrial fibrillation. J Am Coll Cardiol 2003;42:1262-8.
• Jons C, Raatikainen P, Gang UJ, Huikuri HV, Joergensen RM, Johannesen A, et al. Cardiac Arrhythmias and Risk Stratification after Acute Myocardial Infarction (CARISMA) Study Group. Autonomic dysfunction and new-onset atrial fibrillation in patients with left ventricular systolic dysfunction after acute myocardial infarction: a CARISMA substudy. J Cardiovasc Electrophysiol 2010;21:983-90. doi: 10.1111/j.1540-8167.2010.01795.x.
• Kinoshita T, Asai T, Ishigaki T, Suzuki T, Kambara A, Matsubayashi K. Preoperative heart rate variability predicts atrial fibrillation after coronary bypass grafting. Ann Thorac Surg 2011;91:1176-81.
• Kazemi B, Ahmadzadeh A, Safaei N, Jodati A, Sohrabi B, Afrasiabi A. Influence of anterior periaortic fat pad excision on incidence of postoperative atrial fibrillation. Eur J Cardiothorac Surg 2011;40:1191-6. Epub 2011 Apr 5.
• White CM, Sander S, Coleman CI, Gallagher R, Takata H, Humphrey C, et al. Impact of epicardial anterior fat pad retention on postcardiothoracic surgery atrial fibrillation incidence: the AFISTIII Study. J Am Coll Cardiol 2007;49:298-303. Epub 2007 Jan 8.
• Coleman CI, Kluger J, Dale K, Sander S, Gallagher R, Reinhart K, et al. Impact of amiodarone on the ability of anterior fat pad retention to prevent postcoronary arterial bypass grafting atrial fibrillation incidence: a substudy of the AFIST III (Atrial Fibrillation Suppression Trial III). Expert Opin Pharmacother 2008;9:7-13.