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Myocardioprotective Effect and Contribution to the c-fos Gene Expression of Adenosine Preconditioning on Open Heart Surgery

Author: ShiGuangYong
Tutor: ZhangGong；LiYueHua
School: Shandong University
Course: Cardiac Surgery
Keywords: Pretreatment Adenosine Myocardial protection Open heart surgery Gene c-fos
CLC: R654.2
Type: Master's thesis
Year: 2008
Downloads: 29
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Abstract

Objective: To study the heart during open heart surgery in ischemic myocardial protective effect and its mechanism of adenosine preconditioning. The prerequisite for the success of open-heart surgery is effective myocardial protection. Currently, the main method of myocardial protection both exogenous and endogenous. Exogenous myocardial protection by reducing cardiac stress, reduce myocardial energy consumption as well as increased myocardial oxygen and energy supply are exogenous limited myocardial protective effect of ischemic preconditioning (ischemic preconditioning, IPC) including humans in within mammalian strong endogenous myocardial protection mechanism, has a long and reliable myocardial protective effect. Adenosine preconditioning more research and has an initial clinical application. Some studies have shown that the c-fos gene involved in ischemia - reperfusion myocardial apoptosis gene regulation. In this study, according to the IPC principle, investigate adenosine preconditioning open intracardiac surgery protective effect and mechanism of ischemic myocardium, and strive to do an exploration at the gene level, the results for the adenosine preconditioning expand help of theoretical research and clinical applications. Methods: 25 patients with severe pulmonary hypertension in patients with congenital heart disease were randomly divided into adenosine preconditioning group (A: n = 13) and control group (C: n = 12) control group in the ascending aorta. with cool improved St.Thomas liquid after blocking cardiac arrest rows myocardial protection (20 ml / kg), repeated every 30 min; adenosine group in cardiopulmonary bypass (CPB) before slow intravenous bolus of adenosine 2 mg / kg line pretreatment push finished within 30 min, CPB and myocardial protection methods After the purposes and the same as the control group. Cardiac arrest underwent correction of cardiac abnormalities, cardiac resuscitation before take small pieces of the right atrial specimens using real-time polymerase chain reaction (real-time polymerase chain reaction, RT-PCR) to detect where c-fos gene level; operation after the completion of heart to restore cardiac blood supply. Observe the heart rate of resuscitation and postoperative cardiac rhythm changes before the CPB, after 2h, 12h, and 48h serum creatine kinase (CK) and its isoenzyme (CK-MB), lactate dehydrogenase (LDH), myocardial calcium protein Ⅰ (cTn Ⅰ) level. Results: 1 intraoperative and postoperative general were no operative deaths. The heart of the adenosine group automatically resuscitation rate was 84.6% (11/13), while the control group was 58.3% (7/12) compared the two groups, the difference was statistically significant (P <0.05). Were in sinus rhythm min after addition to the control group, 2 cases of early postoperative occasional premature ventricular contractions, other pathologic arrhythmia. Three cases of the control group required dopamine 2 ~ 3μg / (kg · min) Auxiliary 3 to 4 h, and the adenosine group did not require the use of adjuvant drugs. Tip the the adenosine pretreatment effectively maintain the stability of the cell membrane, reducing the incidence of arrhythmias, and is conducive to the recovery of heart function. 2 two sets of CK, CK-MB and LDH in myocardial ischemia time points were higher, but the adenosine group was significantly lower than the control group (P <0.05). Tip light of both groups myocardial cell injury, adenosine group compared with the control group damage. 3 RT-PCR results the adenosine group c-fos gene expression levels were significantly higher (P <0.05). Suggest that adenosine preconditioning may play a role by upregulating the expression of myocardial c-fos gene Conclusion: application of exogenous adenosine. Before heart surgery to improve postoperative general, reduce the amount of postoperative dopamine and CK-MB, cTn-I release, myocardial protection. 2.RT-PCR results that the adenosine group c-fos gene expression levels were significantly higher (P <0.05 or P <0.01). Prompted adenosine preconditioning may play a role by upregulating the expression of myocardial c-fos gene

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