RESUMO
The myocardial protection allowed great advance in cardiac surgery, decreasing the mortality and making more feasible complex surgeries. Lately, the patient population elected for cardiac procedures has been changing towards elderly patients with ventricular function depressed and myocardial hypertrophy. The myocardial hypertrophy condition represents a great challenge since the beginning of the cardiac surgery. Several techniques have been described to protect the myocardial hypertrophy, however with no satisfactory results. In this manuscript we present the state of the art technique of myocardial protection.
Assuntos
Soluções Cardioplégicas/uso terapêutico , Parada Cardíaca Induzida/métodos , Hipertrofia Ventricular Esquerda/cirurgia , Hipertrofia Ventricular Direita/cirurgia , Traumatismo por Reperfusão Miocárdica/prevenção & controle , Parada Cardíaca Induzida/normas , Humanos , Hipertrofia Ventricular Esquerda/fisiopatologia , Hipertrofia Ventricular Direita/fisiopatologia , Reperfusão Miocárdica , Miocárdio/metabolismoRESUMO
A proteção miocárdica permitiu enorme avanço na moderna cirurgia cardíaca, reduzindo a mortalidade e permitindo que operações cada vez mais complexas pudessem ser realizadas. A alteração na população eleita para procedimentos cirúrgicos cardiológicos mudou significativamente nas últimas décadas, com o aumento de pacientes mais idosos, com função ventricular deprimida e miocárdio hipertrofiado. Essa última condição, desde os primórdios da cirurgia cardíaca, constituiu-se em grande desafio. Diversas técnicas de proteção ao miocárdio hipertrofiado foram descritas, porém com resultados não alentadores. As características da hipertrofia miocárdica no adulto com cardiopatia cirúrgica apresentam particularidades desafiadoras. Nesse artigo, procuramos atualizar o estado da arte sobre a proteção miocárdica ao coração hipertrofiado.
The myocardial protection allowed great advance in cardiac surgery, decreasing the mortality and making more feasible complex surgeries. Latterly, the patient population elected for cardiac procedures has been changing towards elderly patients with ventricular function depressed and myocardial hypertrophy. The myocardial hypertrophy condition represents a great challenge since the beginning of the cardiac surgery. Several techniques have been described to protect the myocardial hypertrophy, however with no satisfactory results. In this manuscript we present the state of the art technique of myocardial protection.
Assuntos
Humanos , Soluções Cardioplégicas/uso terapêutico , Parada Cardíaca Induzida/métodos , Hipertrofia Ventricular Esquerda/cirurgia , Hipertrofia Ventricular Direita/cirurgia , Traumatismo por Reperfusão Miocárdica/prevenção & controle , Parada Cardíaca Induzida/normas , Hipertrofia Ventricular Esquerda/fisiopatologia , Hipertrofia Ventricular Direita/fisiopatologia , Reperfusão Miocárdica , Miocárdio/metabolismoRESUMO
OBJECTIVE: To experimentally compare the structural and ultrastructural changes in isolated hypertrophied rabbits' hearts submitted to cardiac arrest protected using sanguineous and crystalloid cardioplegia solutions. METHOD: The study comprised two experimental groups and one control group. In Experimental Group I, cardiac arrest was achieved by the continuous infusion of tepid sanguineous cardioplegia solution. In Experimental Group II, cardiac arrest was obtained by an intermittent infusion of a cold crystalloid cardioplegia solution. In the Control Group the hearts were submitted to normothermic anoxic arrest for 45 minutes. After the procedures, eight samples of the left ventricle lateral wall were collected and fixed in 10% formaldehyde and 2.5% glutaraldehyde for structural and ultrastructural analysis. RESULTS: The structural and ultrastructural results demonstrated that the hearts submitted to cardiac arrest protected by continuous tepid sanguineous cardioplegia, Group I, were better preserved and with less accentuated cellular alterations compared to those submitted to cardiac arrest protected using intermittent cold crystalloid cardioplegia and the Control Group. CONCLUSION: Continuous tepid sanguineous cardioplegia was more efficient in the preservation of the structural and ultrastructural integrity of the myocardium when compared to intermittent cold crystalloid cardioplegia.