In Vitro Effects of Dopamine on Internal Thoracic Artery Graft Used in Coronary Artery Bypass Surger

Yıl 2010, , 344 - 350, 01.05.2010

Ümit Halıcı Turan Ege Çetin Hakan Karadağ Enver Duran

https://doi.org/10.5174/tutfd.2009.01869.1

Öz

Objective: The aim of this study was to investigate in vitro effects of dopamine on internal thoracic artery (ITA) graft. Material and Methods: Between December 2003- June 2005, 32 patients (2 women and 30 men, mean age; 59.26±8.34, range 37-75 years old) who were subjected to coronary artery bypass grafting (CABG) operation in our clinic were enrolled in this study. ITA remnants were suspended in an isolated organ bath. Constrictor or relaxant responses to dopamine were recorded isometrically. Results: Dopamine in the concentration range of 10-9 M-10-7 M produced a mild relaxant effect on phenylephrine-precontracted ITA, and at higher concentrations than 10-7 M it produced a constrictor response. Ther relaxant effect of dopamine was partially antagonized by L-NAME (nitric oxide synthase inhibitor, 10-6 M), propranolol (10-6 M), and cis-α-flupenthixol (dopaminergic receptor antagonist, 10-6 M), but not by metoclopramide (D2-dopaminergic receptor antagonist). The constrictor effect of dopamine was partially antagonized by phentolamine, prazosin and, yohimbine. Conclusion: It was concluded that, while dopamine produces a vasodilator response at the lower concentrations, it causes a constrictor effect on ITA at the higher concentrations. Both a β-adrenergic and a nitric oxide mediated mechanism (via D1-dopaminergic receptor) may play a role in the relaxant effect of dopamine on ITA at the lower concentrations. Constrictor response to dopamine at the higher concentrations on ITA may be produced by the activation of α1- and α2-adrenergic receptors. Turkish Başlık: Dopaminin Koroner Arter Bypass Cerrahisi Operasyonlarında Kullanılan İnternal Torasik Arter Grefti Üzerine İn Vitro Etkileri Anahtar Kelimeler: İnternal torasik arter; koroner arter bypass cerrahisi; dopamin Amaç: Bu çalışmanın amacı dopaminin internal torasik arter (İTA) grefti üzerine etkilerini, invitro araştırmaktır. Gereç ve Yöntemler: Aralık 2003- Haziran 2005 tarihleri arasında kliniğimizde koroner arter bypass greft (CABG) operasyonu olan toplam 32 hasta (2'si kadın 30'u erkek, ortalama yaş; 59.256±8,.34, 37-75 yaşları arası) çalışmaya alındı. İn vitro organ banyosunda hastaların ITA'larından arta kalan parçacıklar üzerinde dopaminin oluşturduğu kasıcı ve gevşetici yanıtlar isometrik olarak kaydedildi. Bulgular: Dopamin 10-9 M-10-7 M konsantrasyon aralığında fenilefrinle önceden kastırılmış ITA'da hafif bir gevşeme yanıtı, sonrasında artan konsantrasyonlarında (>10-7 M) kasılma yanıtı gerçekleştirdiği gözlendi. Dopaminin gevşetici etkisinin kısmen L-NAME (nitrik oksit sentaz inhibitorü, 10-6 M), propranolol (10-6 M) ve cis-α-flupentiksol (dopaminerjik reseptör antagonisti, 10-6 M) ile kısmen azaldığı fakat metoklopramidin (D2-dopaminerjik reseptör antagonisti) dopaminin kaynaklı gevşemeye etki yapmadığı gözlendi. Dopaminin ITA'daki kasıcı etkisi kısmen fentolamin, prazosin ve yohimbin ile antagonize edildiği gözlendi. Sonuç: Sonuç olarak dopamin düşük konsantrasyonlarda ITA'da vazodilatasyon yanıtını oluştururken daha yüksek konsantrasyonlarda ITA'da vasokonstriksiyon yanıtını oluşturmaktadır. β-adrenerjik ve nitrik oksit aracılı mekanizma (D1-dopaminerjik reseptör yoluyla) dopaminin düşük konsantrasyonlarında ITA'da oluşturduğu gevşetici etkide rol alabilir. Dopaminin yüksek konsantrasyonlardaki ITA'da oluşturduğu kasıcı etki α1- ve α2-adrenerjik reseptörlerin aktivasyonu ile oluşturulmaktadır.

Anahtar Kelimeler

Internal thoracic artery; coronary artery bypass surgery; dopamine

Dopaminin Koroner Arter Bypass Cerrahisi Operasyonlar×nda Kullan×lan únternal Torasik Arter Grefti Üzerine ún Vitro Etkileri

Öz

Amaç: Bu çal×üman×n amac× dopaminin internal torasik
arter (úTA) grefti üzerine etkilerini, invitro araüt×rmakt×r.
Gereç ve Yöntemler: Aral×k 2003- Haziran 2005 tarihleri
aras×nda kliniùimizde koroner arter bypass greft (CABG)
operasyonu olan toplam 32 hasta (2’si kad×n 30’u erkek,
ortalama yaü; 59.256±8,.34, 37-75 yaülar× aras×) çal×ümaya
al×nd×. ún vitro organ banyosunda hastalar×n ITA’lar×ndan
arta kalan parçac×klar üzerinde dopaminin oluüturduùu
kas×c× ve gevüetici yan×tlar isometrik olarak kaydedildi.
Bulgular: Dopamin 10-9 M-10-7 M konsantrasyon aral×ù×nda
fenilefrinle önceden kast×r×lm×ü ITA’da hafif bir
gevüeme yan×t×, sonras×nda artan konsantrasyonlar×nda
(>10-7 M) kas×lma yan×t× gerçekleütirdiùi gözlendi.
Dopaminin gevüetici etkisinin k×smen L-NAME (nitrik
oksit sentaz inhibitorü, 10-6 M), propranolol (10-6 M) ve
cis-њ-flupentiksol (dopaminerjik reseptör antagonisti,
10-6 M) ile k×smen azald×ù× fakat metoklopramidin
(D2-dopaminerjik reseptör antagonisti) dopaminin kaynakl×
gevüemeye etki yapmad×ù× gözlendi. Dopaminin
ITA’daki kas×c× etkisi k×smen fentolamin, prazosin ve
yohimbin ile antagonize edildiùi gözlendi.
Sonuç: Sonuç olarak dopamin düüük konsantrasyonlarda
ITA’da vazodilatasyon yan×t×n× oluütururken daha yüksek
konsantrasyonlarda ITA’da vasokonstriksiyon yan×t×n×
oluüturmaktad×r. ћ-adrenerjik ve nitrik oksit arac×l× mekanizma
(D1-dopaminerjik reseptör yoluyla) dopaminin düüük
konsantrasyonlar×nda ITA’da oluüturduùu gevüetici etkide
rol alabilir. Dopaminin yüksek konsantrasyonlardaki ITA’da
oluüturduùu kas×c× etki њ1- ve њ2-adrenerjik reseptörlerin
aktivasyonu ile oluüturulmaktad×r.

Anahtar Kelimeler

Internal torasik arter, koroner arter bypass cerrahisi, dopamin

Kaynakça

• Woo Y, Gardner TJ. Myocardial Revascularization with Cardiopulmonary Bypass.In; Cardiac surgery in the adult. Cohn L.H, Edmunds L.H.(edts). Second edition. New York; McGraw-Hill; 2003;21:581-607.
• Holm P, Franco Cereceda A. Tissue concentrations of endo- thelins and functional effects of endothelin- receptor activa- tion in human arteries and veins. J Thorac Cardiovasc Surg 1996;112: 264-72.
• Sellke FW, Boyle EM, Verrier ED. Endothelial cell injury in cardiovascular surgery: The pathophysiology of vasomotor dysfunction. Ann Thorac Surg 1996;62:1222-8.
• Gaudino M, Toesca A, Maggiano N, Pragliola C, Possati G. Localization of nitric oxide synthase type III in the inter- nal thoracic and radial arteries and the great saphenous vein: A comparative immunohistochemical study. J Thorac Cardiovasc Surg 2003;125:1510-5.
• He GW. Contractility of the human internal mammary artery at the distal section increases toward the end. J Thorac Cardiovasc Surg 1993;106:406-11.
• Sala A, Rona P, Pompilio G, Parolari A, Antona C, Biglioli P, et al. Prostacyclin production by different human grafts employed in coronary operations. Ann Thorac Surg 1994;57:1447-50.
• Wei W, Floten HS, He GW. Interaction between vasodilators and vasopressin in internal mammary artery and clinical significance. Ann Thorac Surg 2002;73:516-22.
• He GW, Rosenfeldt FL, Buxton BF, Angus JA. Reactivity of human isolated internal mammary artery to constrictor and dilator agents. Implications for treatments of internal mam- mary artery spasm. Circulation 1989;80:141-50
• Lin PJ, Chang C-H, Pearson PJ, Tzen K-Y, Chu J-J, Chang J-P, et al. Thromboxane A2: An Endothelium -derived vasoconstrictor in human internal mammary arteries. Ann Thorac Surg 1993;56:97-100.
• Wackenfors A, Ingemansson R, Malmsjö M. Endothelin receptors in endothelium-denuded human coronary artery bypass grafts and coronary arteries. Ann Thorac Surg 2003;75:874-81.
• He GW, Buxton BF, Rosenfeldt FL, Angus JA, Tatoulis J. Pharmacologic dilatation of the internal mammary artery during coronary bypass grafting. J Thoracic and Cardiovas Surg 1994;107;1440-4.
• Blake KL, Watt PAC, Smith JMT, De Souza AC, Spyt TJ, Thurston H. Randomized comparison of ultrasonic aspira- tion versus conventional electrocautery for dissection of the human internal thoracic artery. J Thorac Cardiovasc Surg 1996;111:1194-9.
• Flynn MJ, Winters D, Bren P, O’Sullivan G, O’Connel D, O’Donnell A, et al. Dopexamine increases internal mam- mary artery blood following coronary artery bypass graft- ing. Eur J Cardiothorac Surg 2003;24:547-51.
• He GW, Yang C-Q, Star A. Overwiew of the nature of vaso- constriction in arterial grafts for coronary operations. Ann Thorac Surg 1995;59:676-83.
• Chardigny C, Jebara VA, Acar C, Descombes JJ, Verbeuren TJ, Carpentier A, et al. Vasoreactivitity of the radial artery comparison with the internal mammary and gastroepi- ploic arteries with implications for coronary artery surgery. Circulation 1993;88:115-27.
• Lüscher TF, Diederich D, Siebenmann R, Lehmann K, Stulz P, Segesser LV, et al. Difference between endothelium- dependent relaxation in arterial and in venous coronary bypass grafts. N Engl J Med 1988;319:462-7.
• Kobayashi Y, Cavallotti D, Ricci AA. Localization of D2- like receptors in pulmonary artery of the human and rabbit but not of the rat. Eur J Pharmacol 1994;261:229-36.
• Amenta F. Light microscope autoradiography of periph- eral dopamine receptor subtypes. Clin Exp Hypertens 1997;19:27-41.
• Mori M, Hoshino Y, Obara H, Iwai S. Maturation-related changes in dopamine- induced relaxation of isolated rabbit pulmonary artery. Pediatr Res 1998;24:160-5.
• Lokhandwala MF. Cardiovascular and renal effects of dopamine receptor agonists. ISA Atlas Science: Pharmacol 1998;261-6.
• Lokhandwala MF, Hedge SS. Cardiovascular pharmacol- ogy of dopamine receptor agonists. In Peripheral dopamine pathophysiology, By F Amenta (Ed). First edition. Boca Raton: CRC Pres; 1990;63-77.
• Hughes A, Inkpen P, Sever P. Action of dopamine on isolated human saphenous veins. J Cardiovas Pharmacol 1998;11:373-7.
• Goldberg LI, Rajfer SI. Dopamine receptors: applications in clinical cardiology. Circulation 1985;72:245-8.
• Yamuchi M, Kobayashi Y, Hattori K, Yamada K, Nakase A. Dopamine- induced relaxation in pulmonary arteries. Experienta 1989;45:150-2.
• Katai R, Tsuneyoshi I, Hamasaki J, Onomoto M, Suehiro S, Sakat R, et al. The variable effects of dopamine among human isolated arteries commonly used for coronary bypass grafts. Anesth Analg 2004;98:915-20.
• O’Neil GS, Chester AH, Schyns CJ, Tadjkarimi ST, Pepper JR, Yacoub MH, et al: Vascular reactivity of human internal mammary and gastroepiploic arteries. Ann Thorac Surg 1991;52:1310-4.
• Myers ML, Li GH, Yaghi, NcCormack D. Human inter- nal thoracic artery reactivity to dopaminergic agents. Circulation 1993;88:110-4.
• Forster C, Drew GM, Hilditch A, Whalley ET. Dopamine receptors in human basilar arteries. Eur J Pharmacol 1983;87:227-35.
• He GW. Arterial grafts for coronary artery bypass graft- ing: Biological characteristics, functional classification, and clinical choice. Ann Thorac Surg 1999;67:277-84.
• Rosenfeldt FL, He GW, Buxton BF, Angus JA. Pharmacology of coronary artery bypass grafts. Ann Thorac Surg 1999;67:878-88.
• Amenta F, Barili P, Bronzetti E, Felici L, Mignini F, Ricci A. Localization of dopamine receptor subtypes in sistemic arteries. Clin Exp Hypertens 2000;22:277-88.
• He GW. Contractility of the human internal mammary artery at the distal section increases toward the end. J Thorac Cardiovasc Surg 1993:106:406-11.
• He GW, Ryan WH, Acuff TE, Yang C-Q, Mack MJ. Greater contractility of internal mammary artery bifurcation: possible cause of low patency rates: Ann Thorac Surg 1994;58:529-32.
• Weinstein JS, Grossman W, Weintraub RM, Thurer RL, Johnson RG, and Morgan KG. Differences in alpha-adren- ergic responsiveness between human internal mammary arteries and saphenous veins. Circulation 1989;79:1264-70.
• He GW, Shaw J, Hughes CF, Yang CQ, Thomson DS, McCaughan B, et al. Predominant _×- adreneceptor medi- ated contraction in the human internal mammary artery. J Cardiovasc Pharmacol 1993;21:56-63.
• Goldberg LI, Rajfer SI. The role of adrenergic and dopamine receptors. Hospital Pract 1985;20:67-80.
• Turkay C, Golbasi I, Ak I, Sahin N, Korgun K, Erbasan O, et al. The effect of renal dose dopamine use on renal tubu- lar function following coronary bypass surgery. Turkish J Thorac and Cardiovas Surg 2000;8:674-7.
• Girard DS, Sutton III JP, Williams TH, Crumbley III AJ, Zellner JL, Kratz JM, et al. Papaverine delivery to the inter- nal mammary artery pedicle effectively treats spasm. Ann Thorac Surg 2004;78:1295-8.
• He GW, Yang CQ, Starr A. Overview of the nature of vaso- constriction in arterial grafts for coronary operations. Ann Thorac Surg 1995;59:676-83.