Pediatrik Miyokard Korunması

Yıl 2014, Cilt: 11 Sayı: 3, 271 - 279, 15.12.2014

Abdussemet Hazar Mustafa Göz Mehmet Salih Aydın Aydemir Koçarslan

https://izlik.org/JA48NB24PY

Öz

Miyokard korunmasında temel prensipler elektromekanik diastolik arrest, ventrikül dekompresyonu ve
hipoterminin amacı, kansız bir ortam sağlamak ve miyokardın iskemi süresini güvenli bir şekilde uzatmaktır.
Pediatrik kalp cerrahisinde, erişkin kalp cerrahisinde olduğu gibi myokardın yetersiz korunması önemli bir
morbidite ve mortalite nedenidir. Miyokard koruması cerrah, anestezist ve perfüzyonistin birlikte uygulanan
karmaşık bir işlemdir. Bu yazıda pediatrik kalbin özellikleri ve onun korunması tartışıldı. 

Anahtar Kelimeler

Pediatri , miyokard , kardiyopleji

Pediatric Miyocardial Protection

https://izlik.org/JA48NB24PY

Öz

The basic principles of the protection of myocardium with diastolic electromechanical arrest, ventricular
decompression and hypothermia purpose of providing an environment bloodless and safely extend the
duration of myocardial ischemia. Pediatric cardiac surgery as well as Adult cardiac surgery, inadequate
protection of the myocardium is an important cause of morbidity and mortality. Myocardial protection is a
complex procedure and applied with surgeon, the anesthesiologist, and perfusionist. Features of pediatric
heart and its preservation are discussed in this article. 

Anahtar Kelimeler

Pediatri , miyocardium , cardioplegia

Kaynakça

• 1) Hammon JW. Myocardial protection in the immature heart. Ann Thorac Surg. 1995;60: 839–42. 2) Murphy CE, Salter DR, Morris JJ, et al. Age-related differences in adenine nucleotide metabolism during in vivo global ischemia. Surg Forum. 1986;37:288 –90. 3) Imura H, Caputo M, Parry A, Pawade A, Angelini GD, Suleiman MS. Age-Dependent and Hypoxia-Related Differences in Myocardial Protection During Pediatric Open Heart Surgery,Circulation. 2001;103:1551-6. 4) Wittnich C, Belanger MP, Bandali KS. Newborn hearts are at greater 'metabolic risk' during global ischemia – advantages of continuous coronary washout Can J Cardiol 2007;23(3):195-200. 5) Buckberg GD. Studies of hypoxemic/roxigenasyon injury; Lincage between cardiac function and oxidant damage. J Thorac Cardiovasc Surg 1995;110:1164-70. 6) Allen BS, Rahman SK, İlbawi M, Feinberg H, Bolling KS, Kronon M.The detrimental effects of cardiopulmoner bypass in cyanotic in cyanotic infants: preventing the reoxygenasyon injury. Ann Thorac Surg 1997;64:1381-8 7) Durandy Y. Pediatric myocardial protection. Curr Opin Cardiol. 2008 Mar;23(2):85-90. 8) Rezkalla SH, Kloner RA. No-Reflow phenomenon Circulation 2002;105:656-62. 9) Heyndrickx GR, Millard RW, McRitchie RJ, Maroko PR, Vatner SF. Regional myocardial functional and electrophysiological alterations after brief coronary artery occlusion in conscious dogs. J. Clin. Invest. 1975; 56:978-85. 10) Kloner RA, Ellis SG, Lange R, Braunwald E. Studies of experimental coronary artery reperfusion: effectson infarct size, myocardial function, biochemistry, ultrastructure and microvascular damage. Circulation. 1983; 68(Suppl. I):8-15. 11) Braunwald E, Kloner RA. The stunned myocardium: Prolonged, postischemic ventricular dysfunction. Circulation. 1982; 66:1146-9. 12) Reimer KA, Hill ML, Jennings RB. Prolonged depletion of theadenine nucleotide pool due to delayed resynthesis of adenine nucleotides following reversible myocardial ischemic injury in dogs. J. Mol. Cell. Cardiol. 1981;13:229-39. 13) Myers ML, Bolli R, Lekich RF, Hartley CJ, Roberts R. Enhancement of recovery of myocardial function by oxygen free-radical scavengers after reversible regional ischemia. Circulation. 1985; 72:915-21. 14) Przyklenk K, Kloner RA. Superoxide dismutase plus c a t a l a s e i m p r o v e c o n t r a c t i l e f u n c t i o n inthecaninemodelofthe "stunned" myocardium. Circ. Res.1986; 58:148-56. 15) Myers ML, Bolli R, Lekich RF, Hartley CJ, Roberts R. N-2-mercaptopropionylglycine improves recovery of myocardial function after reversible regional ischemia. J. Am. Coll. Cardiol. 1982; 8:1161-8. 16) Bolli R, Zhu WX, Hartley CJ, Michael LH, Repine J, Hess Ml and et al. Dimethylthiourea attenuates dysfunction in the postischemic "stunned" myocardium. Circulation. 1987;76:458-68. 17) Puett DW, Forman MB, Cates CU, Wilson BH, Hande KR, Friesinger GC and et al. 1987. Oxypurinol limits. 18) Bolli R, Patel BS, Zhu WX, O'Neill PG, Charlat ML, Roberts R. The iron chelator desferrioxamine attenuates postischemic ventricular dysfunction. Am. J. Physiol. 1987;253:1372- 80. 19) Kern FH ,Ungerlieder RM,Raves JG,et al.The effect of altering pump flow rate on cerebral blood flow and metabolism in neonates,infants and children.Ann Thorac Surg 1993;56:1366-1372 20) Kern FH, Greeley WJ. Monitoring of nasopharyngeal and rectal temperatures is not an adequate guide of brain cooling before deep hypotermic circulatory arrest.J Cardiothorac Vasc Anesth 1994;8:363-365. 21) Bjork J VO, Hultquist G.Brain damage in children after deep hypothermia. Thorax 1960;15:284 22) Wittnich C, Peniston C, Ianuzzo D, Abel JG, Salerno TA. Relative vulnerability of neonatal and adult hearts to ischemic injury. Circulation 1987;76(1):56-60. 23) Fisher DJ. Oxygenation and metabolism in the developing heart. Semin Perinatol 1984;8:217-25. 24) Allen BS, Barth MJ, Ilbawi MN. Pediatric myocardial protection: An overview. Semin Thorac Cardiovasc Surg 2001;13:56-72. 25) Parrish MD, Payne A, Fixler DE. Global myocardial ischemia in the newborn, juvenile, and adult isolated isovolumic rabbit heart. Agerelated differences in systolic function, diastolic stiffness, coronary resistance, myocardial oxygen consumption, and extracellular pH. Circ Res 1987;61:609-15 26) Wells RJ, Friedman WF, Sobel BE. Increased oxidative metabolism in the fetal and newborn lamb heart. Am J Physiol 1972;222:1488-93. 27) Dawes GS, Mott JC, Shelley HJ. The importance of cardiac glycogen for the maintenance of life in foetal lambs and newborn animals during anoxia. J Physiol 1959;146:516-38. 28) Magovern JA, Pae WE Jr, Miller CA, Waldhausen JA. The mature and immature heart: Response to normothermic ischemia. J Surg Res 1989;46:366-9. 29) Yano Y, Braimbridge MV, Hearse DJ. Protection of the pediatric myocardium. Differential susceptibility to ischemic injury of the neonatal rat heart. J Thorac Cardiovasc Surg 1987;94:887-96 30) Ascuitto RJ, Ross-Ascuitto NT. Substrate metabolism in the developing heart. Semin Perinatol 1996;20:542-63 31) Kingsley PB, Sako EY, Yang MQ, et al. Ischemic contracture begins when anaerobic glycolysis stops: A 31P-MNR study of isolated rat hearts. Am J Physiol 1991;261:469-78. 32) Vanoverschelde JL, Janier MF, Bakke JE, Marshall DR, Bergmann SR. Rate of glycolysis during ischemia determines extent of ischemic injury and functional recovery after reperfusion. Am J Physiol 1994;267:1785-94 33) Tian G, Shen J, Su S, et al. Assessment of retrograde cardioplegia with magnetic resonance imaging and localized 31P spectroscopy in isolated pig hearts. J Thorac Cardiovasc Surg 1997; 114:109–16. 34) Feng J, Li H, Rosenkranz ER. Pinacidil pretreatment extends ischemia tolerance of neonatal rabbit hearts. J Surg Res. 2000 ;90(2):131-7. 35) Bremer YA, Salloum F, Ockaili R, et al. Sildenafil citrate (Viagra) induces cardioprotective effects after ischemia/reperfusion injury in infant rabbits. Pediatr Res 2005; 57:22–7. 36) Raja SG. Cardioprotection with sildenafil: implications for clinical practice. Curr Med Chem 2006; 13:3155–64. 37) Köksal C, Süzer O, Bozkurt AK, Köseoğlu S. Comparison of enoximone, amrinone or levosimendan enriched St Thomas' hospital cardioplegic solutions used for myocardial preservation in isolated guinea pig hearts. Acta Medica (Hradec Kralove) 2002; 45:93–7. 38) Yamaguchi S, Watanabe G, Tomita S, Tabata S. Lidocaine-magnesium blood cardioplegia was equivalent to potassium blood cardioplegia in left ventricular function of canine heart. Interact Cardio Vasc Thorac Surg 2007; 6:172–6. 39) Jakobsen O, Muller S, Aarsaether E, et al. Adenosine instead of supranormal potassium in cardioplegic solution improves cardioprotection. Eur J Cardiothorac Surg 2007; 32:493–500. 40) Sloots KL, Vinten-Johansen J, Dobson GP. Warm nondepolarizing adenosine and lidocaine cardioplegia: continuous versus intermittent delivery. J ThoracCardiovasc Surg 2007; 133:1171–8. 41) Mizunati S, Al-Dadah AS, Bloch JB, et al. Hyperkalemic cardioplegia-induced myocyte swelling and contractile dysfunction: prevention by diazoxide. Ann Thorac Surg 2006; 81:154–9. 42) Al-Dadah AS, Voeller RK, Schuessler RB, et al. Maintenance of myocyte volume homeostasis during stress by diazoxide is cardioprotective. AnnThorac Surg 2007; 84:857–62. 43) Buckberg GD. Update on current techniques of myocardial protection. Ann Thorac Surg. 1995;60:805– 14. 44) Caputo M, Ascione R, Angelini GD, et al. The end of the cold era: from intermittent cold to intermittent warm blood cardioplegia. Eur J Cardiothorac Surg. 1998;14:467– 75. 45) Bull C, Cooper J, Stark J. Cardioplegic protection of the child's heart. J Thorac Cardiovasc Surg. 1984;88:287–93. 46) Chaturvedi RR, Lincoln C, Gothard JW, et al. Left ventricular dysfunction after repair of simple congenital heart defects in infants and children: quantitation with the use of conductance catheter immediately after bypass. J Thorac Cardiovasc Surg. 1998;115:77– 83 47) Young JN, Choy IO, Silva NK, et al. Antegrade cold blood cardioplegia is not demonstrably advantageous over cold crystalloid cardioplegia in surgery for congenital heart disease. J Thorac Cardiovasc Surg. 1997;114:1002–9. 48) Lofland GK, Abd-Elfattah AS, Wyse R, et al. Myocardial adenine nucleotide metabolism in pediatric patients during hypothermic cardioplegic arrest and normothermic ischemia. Ann Thorac Surg. 1989;47:663– 8. 49) Buckberg GD, Brazier JR, Nelson RL, et al. Studies on the effects of hypothermia on regional myocardial blood flow and metabolism during cardiopulmonary bypass. I. The adequately perfused beating, fibrillating and arrested heart. J Thorac Cardiovasc Surg 1977; 73:87–94. 50) Buckberg GD. A proposed 'solution' to the cardioplegic controversy. J Thorac Cardiovasc Surg 1979; 77:803–15. 51) Mubarak AC, Philip RB, Stephen PD, et al. Erythrocyte-containing versus crystalloid cardioplegia in the rat: effects on myocardial capillaries. Ann Thorac Surg 2003; 75:890–8 52) Amark K, Berggren H, Björk K, Ekroth A, Ekroth R, Nilsson K, Sunnegårdh J. Blood cardioplegia provides superior protection in infant cardiac surgery. Ann Thorac Surg. 2005 ;80(3):989-94. 53) Guru V, Omura J, Alghamdi AA, et al. Is blood superior to crystalloid cardioplegia? A meta-analysis of randomized clinical trials. Circulation 2006; 114 (1 Suppl):1331–8. 54) Caputo M, Modi P, Imura H, et al. Cold blood versus cold crystalloid cardioplegia for repair of ventricular septal defects in pediatric heart surgery:a randomized controlled trial. Ann Thorac Surg 2002; 74:530–5. 55) Amark K, Berggren H, Bjo¨ rk K, et al. Myocardial metabolism is beter preserved after blood cardioplegia in infants. Ann Thorac Surg 2006; 82:172–8. 56) Lichtenstein SV, El dalati H, Panos A, Slutsky AS. Long cross-clamp times with warm heart surgery. Lancet 1989; 1:1443. 57) Li GC, Vasquez JA, Gallagher KP, Luchesi BR. Myocardial protection with preconditioning. Circulation 1990; 82:609–19. 58) Mezzetti A, Calafiore AM, Lapenna D, et al. Intermittent antegrade warm cardioplegia reduces oxidative stress and improves metabolism of the ischemic reperfused human myocardium. J Thorac Cardiovasc Surg 1995; 109:787–95. 59) Jacquet LM, Noirhomme PH, Van Dyck MJ, et al. Randomized trial of intermittent antegrade warm blood versus cold crystalloid cardioplegia. Ann Thorac Surg 1999; 67:471–7. 60) Doenst T, Schlensak C, Beyersdorf F. Cardioplegia in pediatric surgery: Do we believe in Magic? Ann Thorac Surg 2003; 75:1668–77. 61) Kohman LJ, Veit LJ. Single dose versus multidose cardioplegia in neonatal hearts. J Thorac Cardiovasc Surg 1994; 107:1512–8. 62) Modi P, Suleiman SM, Reeves BC, et al. Changes in myocardial free amino acids during pediatric cardiac surgery: a randomised controlled trial of three cardioplegic techniques. Eur J Cardiovasc Surg 2006; 30: 41–8. 63) Najm HK, Wallen WJ, Belanger MP, et al. Does the degree of cyanosis affect myocardial adenosine triphosphate levels and function in children undergoing surgical procedures for congenital heart disease? J Thorac Cardiovasc Surg 2000;119:515-24. 64) Catinella FP, Cunningham JN Jr, Spencer FC. Myocardial protection during prolonged aortic crossclamping. Comparison of blood and crystalloid cardioplegia. J Thorac Cardiovasc Surg 1984; 88:411–23. 65) Karamlou T, Hickey E, Silliman CC, et al. Reducing risk in infant cardiopulmonary bypass: the use of a miniaturized circuit and a crystalloid prime improves cardiopulmonary function and increases cerebral blood flow. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2005; 3–11. 66) Golab HD, Takkenberg JJM, van Gerner-Weelink GL, et al. Effects of cardiopulmonary bypass circuit reduction and residual volume salvage on allogeneic transfusion requirements in infants undergoing cardiac surgery.Interact Cardio Vasc Thorac Surg 2007; 6:335–9. 67) Miyaji K, Kohira S, Miyamoto T, et al. Pediatric cardiac surgery without homologous blood transfusion, using a miniaturized bypass system in infants with lower body weight. J Thorac Cardiovasc Surg 2007; 134: 284–9. 68) Durandy Y. Usefulness of low prime perfusion pediatric circuit in decreasing blood transfusion. ASAIO J 2007; 53:659–61. 69) Schirmer U. Hypothermia in cardiac surgery. Anaesthesist 2007; 56:930–5. 70) Mallidi HR, Sever J, Tamariz M, et al. The short-term and long term effects of warm or tepid cardioplegia. J Thorac Cardiovasc Surg 2003; 125:711–20. 71) Buckberg GD, Drinkwater DC, Laks H.A new technique for delivering antegrade/retrograde blood cardioplegia without right heart isolation. Eur J Cardiothorac Surg. 1990;4(3):163-7. 72) Minatoya K, Okabayashi H, Shimada I, et al. Intermittent antegrade warm blood cardioplegia for CABG: extended interval of cardioplegia. Ann Thorac Surg 2000; 69:74–6. 73) Kronon M, Bolling KS, Allen BS, Rahman S, Wang T, Halldorsson A, Feinberg H. J The relationship between calcium and magnesium in pediatric myocardial protection. Thorac Cardiovasc Surg. 1997 ;114(6):1010-9. 74) Mori F, Miyamoto M, Tsuboi H, Noda H, Esato K.Clinical trial of nicardipine cardioplegia in pediatric cardiac surgery. Ann Thorac Surg. 1990 ;49(3):413-7:417- 8. 75) Abdel-Rahman U, Kleine P, Seitz U, Moritz A. Biventricular pacing for successful weaning from extracorporeal circulation in an infant with complex tetralogy of Fallot. Pediatr Cardiol 2002; 23:553–4. 76) Zimmerman FJ, Starr JP, Koenig PR, et al. Acute hemodynamic benefit of multisite ventricular pacing after congenital heart surgery. Ann Thorac Surg2003; 75:1775–80. 77) Guzzetta NA. Phenoxybenzamine in the treatment of hypoplastic left heart syndrome: a core review. Anesth Analg 2007; 105:312–5. 78) De Oliveira NC, Ashburn DA, Khalid F, et al. Prevention of early sudden circulatory collapse after the Norwood operation. Circulation 2004; 110:33–8. 79) Hassantash SA, Omrani GR, Givtaj N, Afrakhteh M. Pharmacological prevention of the deleterious effects of cardiopulmonary bypass. Asian Cardiovasc Thorac Ann 2007; 15:218–24. 80) Liakopoulos OJ, Scmitto JD, Kazmaier S, et al. Ca r d i o p u lmo n a r y a n d s y st emi c e ff e c ts o f methylprednisolone in patients undergoing cardiac surgery. Ann Thorac Surg 2007; 84:110–9. 81) Schroth M, Plank C, Meissner U, et al. Hypertonic–hyperoncotic solutions improve cardiac function in children after open-heart surgery. Pediatrics 2006; 118:776–84. 82) Lim KH, Halestrap AP, Angelini GD, Suleiman MS. Propofol is cardioprotective in a clinically relevant model of normothermic blood cardioplegic arrest and cardiopulmonary bypass. Exp Biol Med 2005; 230: 413–20. 83) Hoffman TM, Wernovsky G, Atz AM, et al. Efficacy and safety of milrinone in preventing low cardiac output syndrome in infants and children after corrective surgery for congenital heart disease. Circulation 2003; 107: 996–1002. 84) Hayashi Y, Sawa Y, Nishimura M, Ichikawa H, Kagisaki K, Ohtake S, Matsuda H.Clinical evaluation of leukocytedepleted blood cardioplegia for pediatric open heart operation. . Ann Thorac Surg. 2000 ;69(6):1914-9. 85) Lazar HL. Enhanced Preservation of Acutely Ischemic Myocardium and Improved Clinical Outcomes Using Glucose-Insulin-Potassium (GIK) Solutions. Am. J. Cardial 1997; 80(3): 90-3.