Examination of Serume GSTP1 Isoenzyme Changes at Pediatric Cardiac Operations and Evaluation of Relation of This Changes to Early Postoperative Morbidity and Mortality

TEZ10345Tez (Uzmanlık) -- Çukurova Üniversitesi, Adana, 2014.Kaynakça (s. 58-64) var.viii, 64 s. : res. (bzs. rnk.), tablo ; 29 cm.Günümüzde kardiyak operasyonların büyük bir kısmı kardiyopulmoner by-pass(CPB) kullanılarak yapılmaktadır. Kardiyopulmoner by-pass sırasında kardiyopulmoner bypass esnasında kanın yabancı yüzeyle teması, iskemi ve reperfüzyon hasarı, soğuma ve ısıtma dönemlerinde gelişen ısı değişiklikleri ve bunların süreleri, endotoksinler ve nihai olarak operatif travma nedeniyle ortaya çıkan proinflamatuar ajanlar sistemik inflamatuar yanıt sendromu(SIRS) adı verilen pulmoner, renal nörolojik veya koagulasyon sistemiyle ilgili bozuklukların gelişmesine sebep olabilir. Anestezi,cerrahi ve perfüzyon tekniklerindeki ilerlemelere rağmen kardiyo pulmoner bypass uygulamalarında enflamatuar yanıt ve SIRS, morbidite ve mortalitenin ciddi bir nedeni olarak karşımızda dumaktadır. İnflamasyon ve antiinflamatuar mekanizmaların açıklanması için yoğun çaba harcanmasına karşın CPB? la ilişkili mortalite ve morbiditenin büyük kısmının SIRS ile ilişkili olması prognozu belirlemede yeni markırlara ihtiyaç olduğunu göstermektedir. Kardiyopulmener bypass sırasında oluşan oksidatif stres inflamatuar yanıtın oluşmasındaki en önemli etkenlerdendir. Oksidatif strese karşı savunma mekanizmasında önemli rol oynayan glutatyon s-transferaz P1(GSTP1) izoenziminin üretiminin CPB gibi fizyolojik olmayan koşullarda yetersiz kalabileceği, bu eksikliğin metabolizma için olumsuz sonuçlar doğurabileceği gösterilmiş, ayrıca bu enzimin değişikliklerinin kalp yetmezliği derecesiyle de ilişkili olduğu gösterilmiştir. Bu bilgiler ışığında GSTP1 enzim değişikliklerinin incelenmesi ile postoperatif erken dönemde prognoz belirlenmesi, erken müdahale ile CPB sonrası morbidite ve mortalitede belirgin azalma sağlanması mümkün olacaktır. Bu prospektif çalışmada CPB altında açık kalp cerrahisi uygulanan 30 pediatrik hasta incalendi. Hastalar problemsiz taburcu edilenler (Grup 1, N=23) ve exitus olanlar(Grup 2, N=7) olarak iki gruba ayrıldı. Olgulardan anestezi indüksyonu, pompa başlangıcından 10 dakika sonra, kros klemp konduktan 10 dakika sonra, pompa sonrası 30. dakika ve postoperatif 8. saatte olmak üzere 5 defa kan örneği alındı. Alınan örnekler Human GSTPi ELİSA Kit ile incelendi. Ayrıca CPB sonrası mortalite ve morbiditeyle ilişkisi ortaya konmuş olan kreatinin düzeyleri de çalışılarak GSTP1 sonuçlarıyla korele edildi. Elde edilen bulgular ışığında iki grup arasında kreatinin değerlerinde ancak postoperatif 8. saatte belirgin farklılık saptanmışken, GSTP1 izoenziminin grup 2?de pompa sonrası 30. Dakikada belirgin yükseklik saptanmıştır. GSTP1 izoenzimi CPB eşliğinde yapılan pediatrik kalp cerrahisi olguları sonrası erken dönemde kötü prognoz belirteci olarak kullanılabilir.In modern era, most of the cardiac operations are performed under cardiopulmonary bypass(CPB). In the course of cardiopulmonary bypass, contact of the blood to foregin surface, ischemia end reperfusion damage, heat change and duration, endotoksins and operational trauma provakes release of pro-ınflamatory agents and this agents cause systemic ınflammatory response syndrome (SIRS) that causes pulmonary, renal, haemostatic and cerebral failure. Despite the developments of anesthesia, surgical and perfusion techniques SIRS is still a majör cause of morbitity and mortality after cardipulmonary bypass. Thereof, a new marker for defininition of prognozis and cardiopulmonary bypass releates mortality is needed. Oxidative stress is one of the major cause of ınflammatory response. Glutathione S-Transferase P1 (GSTP1) isoenzyme, one of the main protection systems against oxidative stress, may be defective in pathological conditions such as CPB and this may cause negative results fort he organism. Besides GSTP1 isoenzym is to shown to be related with cardiac failure. With the enlightment of this facts, we aimed to examine the changes of GSTP1 in early postoperative period, define the poor prognozis for starting the agressive therapy to prevent mortality and morbidity. In this prospective study 30 pediatric patients that underwent to CPB were examined. Patints were divided in to two groups as discharged with no problems (Group 1, N=23) and exitus(Group 2,N=7) groups. During induction of anesthesia, after 10 minutes from staring of CPB, after 10 minutes from starting of cross-clemping, 30 minutes later from end of CPB and postoperative 8. hours venous blood samples were collected. Samples were examined with Human GSTPi ELİSA Kit. Then results were corelated to creatinine levels The finding showed that; creatinine levels were significantly elevated at phase 5, but GSTP1 levels were elevated at phase 4. This results shows that; GSTP1 evaluation may be an early prognosis indicator after CPB

Comparison between minimal right vertical infra-axillary thoracotomy and standard median sternotomy for repair of atrial septal defects

The minimal right vertical infra-axillary thoracotomy could be a safe and cosmetic alternative to standard median sternotomy. This study reviews our results and experience with a minimal right vertical infra-axillary thoracotomy technique for the repair of atrial septal defects compared with standard median sternotomy. The study was designed as a retrospective, observational, and case-controlled study. Between May 2007 and November 2012, 26 patients underwent atrial septal defect closure with standard median sternotomy (Group 1). This group was compared with 21 patients who underwent repair of atrial septal defects using minimal right vertical infra-axillary thoracotomy (Group 2). Quantitative data were given as mean ± standard deviation, and qualitative values were expressed as percentages. In the comparison of the normal variables between the two groups, we used independent sample t test, and in the comparison of categorical variables between groups, Chi-square test was used. The mean length of incision was significantly shorter in Group 2 than in Group 1 (p = 0.03). The time it took to establish cardiopulmonary bypass was longer in Group 2 (p = 0.04). There were no statistically significant differences in cardiopulmonary bypass time (p = 0.11), aortic cross-clamp time (p = 0.10), and total operation time (p = 0.10) between the two groups. Group 2 had less chest tube drainage (p = 0.04), less blood transfusion (p = 0.02), and shorter postoperative mechanical ventilation time (p = 0.09) than Group 1. Minimal right vertical infra-axillary thoracotomy can be performed with favorable cosmetic and clinical results for atrial septal defects closure. Infra-axillary thoracotomy provides a good alternative to standard median sternotomy for patients with atrial septal defects

A comparison between the bovine pericardial and Dacron patch in repair of intracardiac defects: the short and mid-term results

WOS: 000321798900010Background: In this study, we compared the short- and mid-term clinical and transthoracic echocardiographic results of bovine pericardial and Dacron patch materials used in repair of intracardiac defects. Methods: We compared the short (30 days postoperatively) and mid-term (up to 24 months postoperatively) results of 498 patients with intracardiac defect who underwent surgical correction using Dacron patch (group 1) between March 1993 and December 2003 with 533 patients who received a bovine pericardial patch (group 2) between January 2004 and April 2010. Results: The short- and mid-term postoperative echocardiographic studies showed no evidence of calcification, thrombus, aneurysmal dilatation around the patch in either group. Vegetation-endocarditis developed in three patients in group 1 and two patients in group 2. Residual ventricular septal defect developed in 15 patients in group 1 and in 14 patients in group 2. The incidence of these complications was not statistically significant between the groups. Conclusion: Our study results suggest that bovine pericardial patch is more appropriate in repair of simple and complex intracardiac defects thanks to its elasticity and easy-to-use nature, compared to Dacron patch

The effects of normoxic and hyperoxic cardiopulmonary bypass on oxidative stress in cyanotic pediatric patients

Amaç: Bu çalışmada siyanotik doğuştan kalp defekti nedeniyle ameliyat edilen hastalarda, kontrollü reoksijenasyon ile yapılan kardiyopulmoner baypasın oksidatif stres üzerine etkisi değerlendirildi. Ça­lış­ma pla­nı: Çalışmaya doğuştan kalp hastalığı (Fallot tetralojisi) nedeniyle kardiyopulmoner baypas kullanılarak ameliyat edilen 30 siyanotik çocuk (ort. yaş 24.2±17.4 ay; dağılım 6 ay-5 yıl) alındı. Hastalar normoksik (PaO 2: 80-150 mmHg) ve hiperoksik (PaO 2: 150-250 mmHg) kardiyopulmoner baypas uygulananlar olarak ikiye ayrıldı. Serum malondialdehit düzeyleri, glutatyon peroksidaz ve glutatyon redüktazın kardiyopulmoner baypasa yanıtını değerlendirmek için anestezi indüksiyonundan sonra, aortik kros klempin 30. dakikasında ve aortik kros klemp kaldırıldıktan 10 dakika ve 12 saat sonra kan örnekleri alındı. Bul­gu­lar: Hiperoksik kardiyopulmoner baypas uygulanan grupta, malondialdehit ve antioksidan enzim düzeyleri aortik kross klempin 30. dakikasında ve aortik kros klemp kaldırıldıktan 10 dakika sonra yüksek olduğu ve istatistiksel olarak anlamlı olduğu bulundu. So­nuç: Kardiyopulmoner baypasta rutin uygulanan yüksek parsiyel oksijen basıncı değerleri, siyanotik çocuklarda oksiradikal hasarının artmasına neden olmaktadır. Bu istenmeyen tablonun önüne geçmek veya azaltmak için kontrollü reoksijenasyon stratejisi kullanılmalıdır.Background: This study aims to investigate the effects of controlled reoxygenation cardiopulmonary bypass on oxidative stress in children undergoing repair of cyanotic congenital heart defect. Methods: Thirty cyanotic children (mean age 24.2±17.4 month; range 6 month to 5 years) who underwent surgery using cardiopulmonary bypass for congenital heart defect (Tetralogy of Fallot) were included. The patients were randomly allocated into two groups as normoxic (PaO2: 80-150 mmHg) and hyperoxic (PaO2: 150-250 mmHg) cardiopulmonary bypass. Blood samples for serum malondialdehyde levels, glutathione peroxidase and glutathione reductase response to cardiopulmonary bypass were collected after induction of anesthesia, and at 30 minutes after placement of aortic cross clamp, and 10 minutes and 12 hours after removal of the aortic cross clamp. Results: Hyperoxic cardiopulmonary bypass in the group, serum malondialdehyde and antioxidant enzyme levels were found to be high, at 30 minutes after placement of aortic cross clamp, 10 minutes after removal of the aortic cross clamp, indicating a statistical significance. Conclusion: High level of partial oxygen pressure which is routinely used in cardiopulmonary bypass leads to increased oxyradical damage in cyanotic children. Controlled reoxygenation strategy should be implemented to prevent or minimize this undesired condition

The effects of normoxic and hyperoxic cardiopulmonary bypass on oxidative stress in cyanotic pediatric patients

WOS: 000326410100004Background: This study aims to investigate the effects of controlled reoxygenation cardiopulmonary bypass on oxidative stress in children undergoing repair of cyanotic congenital heart defect. Methods: Thirty cyanotic children (mean age 24.2 +/- 17.4 month; range 6 month to 5 years) who underwent surgery using cardiopulmonary bypass for congenital heart defect (Tetralogy of Fallot) were included. The patients were randomly allocated into two groups as normoxic (PaO2: 80-150 mmHg) and hyperoxic (PaO2: 150-250 mmHg) cardiopulmonary bypass. Blood samples for serum malondialdehyde levels, glutathione peroxidase and glutathione reductase response to cardiopulmonary bypass were collected after induction of anesthesia, and at 30 minutes after placement of aortic cross clamp, and 10 minutes and 12 hours after removal of the aortic cross clamp. Results: Hyperoxic cardiopulmonary bypass in the group, serum malondialdehyde and antioxidant enzyme levels were found to be high, at 30 minutes after placement of aortic cross clamp, 10 minutes after removal of:the aortic cross clamp, indicating a statistical significance. Conclusion: High level of partial oxygen pressure which is routinely used in cardiopulmonary bypass leads to increased oxyradical damage in cyanotic children. Controlled reoxygenation strategy should be implemented to prevent or minimize this undesired condition

Comparison between minimal right vertical infra-axillary thoracotomy and standard median sternotomy for repair of atrial septal defects

Background: The minimal right vertical infra-axillary thoracotomy could be a safe and cosmetic alternative to standard median sternotomy. This study reviews our results and experience with a minimal right vertical infra-axillary thoracotomy technique for the repair of atrial septal defects compared with standard median sternotomy. Methods: The study was designed as a retrospective, observational, and case-controlled study. Between May 2007 and November 2012, 26 patients underwent atrial septal defect closure with standard median sternotomy (Group 1). This group was compared with 21 patients who underwent repair of atrial septal defects using minimal right vertical infra-axillary thoracotomy (Group 2). Quantitative data were given as mean ± standard deviation, and qualitative values were expressed as percentages. In the comparison of the normal variables between the two groups, we used independent sample t test, and in the comparison of categorical variables between groups, Chi-square test was used. Results: The mean length of incision was significantly shorter in Group 2 than in Group 1 (p = 0.03). The time it took to establish cardiopulmonary bypass was longer in Group 2 (p = 0.04). There were no statistically significant differences in cardiopulmonary bypass time (p = 0.11), aortic cross-clamp time (p = 0.10), and total operation time (p = 0.10) between the two groups. Group 2 had less chest tube drainage (p = 0.04), less blood transfusion (p = 0.02), and shorter postoperative mechanical ventilation time (p = 0.09) than Group 1. Conclusion: Minimal right vertical infra-axillary thoracotomy can be performed with favorable cosmetic and clinical results for atrial septal defects closure. Infra-axillary thoracotomy provides a good alternative to standard median sternotomy for patients with atrial septal defects

Kardiyak miksomaların tedavisinde klinik ve cerrahi deneyimimiz: Erken ve orta dönem sonuçlar

Amaç: Kardiyak miksoma en sık görülen iyi huylu kalp tümörleridir. Bu çalışmada, eksizyon cerrahisi yapılan intrakardiyak miksomalı hastaların erken ve orta dönem sonuçları değerlendirilmiştir. Yöntemler: Miksoma nedeni ile 1988 ve 2012 yılları arasında opere edilen, ortalama yaşı 56 olan (yaş aralığı 33-78) 31 hasta değerlendirildi. Hastaların 18’i kadın, 13’ü erkek idi. On iki hastada (%38,7) konjestif kalp yetmezliği ve 19 hastada (%61,3) mitral obstruksiyon semptomları mevcuttu. Operasyon öncesi tanı transtorasik 2 boyutlu ekokardiyografi ile kondu. On dokuz hastada sağ atrial mixoma,12 hastada sol atriyal miksoma mevcuttu. Cerrahi tedavide kardiyopulmoner bypass altında geniş eksizyon uygulandı. Bulgular: Serebral embolisi olan bir hasta postoperatif erken dönemde öldü. Ortalama takip süresi 9,8±1,4 yıl idi. Otuz hasta NYHA sınıf I olarak dü- zenli olarak takip edilmiş ve hastalarda nüks görülmemiştir. Sonuç: Miksomalı tüm hastalarda hemen cerrahi tedavi indikasyonu vardır. Atrial miksomanın cerrahi eksizyonunun erken ve orta dönem sonuçları mükemmeldir.Objective: Cardiac myxoma is the most common benign heart tumor. In this study, early and mid-term results of patients who underwent intracardiac myxoma exicision surgery were examined. Methods: Between to 1988 and 2012 years, 31 patients with a median age of 56 years (range, 33 to 78 years) were operated for myxoma. Eighteen female and 13 male underwent surgical excision of primary intracardiac myxomas. Twelve patients (38.7%) presented with congestive heart failure symptoms and 19 patients (61.3%) with mitral obstruction symptoms. Preoperative diagnosis was established by transthoracic two dimensional echo- cardiography. Nineteen had right atrial (RA) myxomas, 12 patients had left atrial (LA) myxoma. The surgical management was performed by wide excision under cardiopulmonary bypass. Results: One patient with cerebral embolism died during the early postoperative period. Mean follow-up was 9.8±1.4 years. Thirty patients had on regular follow-up in NYHA Class I symptoms with no documented recurrences. Conclusions: All patients with cardiac myxoma have immediate surgical treatement indication. Surgical excision of atrial myxoma gives excellent short and mid-term results

Acomparison between the bovine pericardial and Dacron patchinrepair of intracardiac defects: the short and mid-term results

Amaç: Bu çalışmada intrakardiyak defektlerin kapatılmasında farklı dönemlerde kullanılan sığır perikard ve Dakron yama materyalinin kısa ve orta dönem sonuçları klinik ve transtorasik ekokardiyografik olarak karşılaştırıldı. Ça­lış­ma pla­nı: Mart 1992 - Aralık 2003 tarihleri arasında kliniğimizde intrakardiyak defekt onarımında Dakron yama (grup 1) kullanılan 498 hasta ile Ocak 2004 - Nisan 2010 tarihleri arasında sığır perikard yaması (grup 2) kullanılan 533 hastaya ilişkin kısa (ameliyat sonrası 30 gün) ve orta (ameliyat sonrası 24 ay) dönem sonuçlar karşılaştırıldı. Bul­g u­l ar: Her iki grupta kısa ve orta dönemde yapılan ekokardiyografik çalışmalarda yamada kalsifikasyon, trombüs, anevrizmatik dilatasyon görülmedi. Grup 1’de üç hastada, grup 2’de iki hastada yamada vejetasyon-endokardit tespit edildi. Grup 1’de 15 ve grup 2’de 14 hastada rezidüel ventriküler septal defekt görüldü. Bu komplikasyonların görülme oranı, gruplar arasında istatistiksel olarak anlamlı bulunmadı. So­nuç: Çalışma bulgularımız, klinik olarak sığır perikard yamasının elastikiyeti, ve kolay kullanım özelliği nedeniyle, basit ve kompleks intrakardiyak defektlerin onarılmasında, Dakron yamaya kıyasla, daha uygun olduğunu göstermektedir.Background: In this study, we compared the short- and mid-term clinical and transthoracic echocardiographic results of bovine pericardial and Dacron patch materials used in repair of intracardiac defects. Methods: We compared the short (30 days postoperatively) and mid-term (up to 24 months postoperatively) results of 498 patients with intracardiac defect who underwent surgical correction using Dacron patch (group 1) between March 1993 and December 2003 with 533 patients who received a bovine pericardial patch (group 2) between January 2004 and April 2010. Results: The short- and mid-term postoperative echocardiographic studies showed no evidence of calcification, thrombus, aneurysmal dilatation around the patch in either group. Vegetation-endocarditis developed in three patients in group 1 and two patients in group 2. Residual ventricular septal defect developed in 15 patients in group 1 and in 14 patients in group 2. The incidence of these complications was not statistically significant between the groups. Conclusion: Our study results suggest that bovine pericardial patch is more appropriate in repair of simple and complex intracardiac defects thanks to its elasticity and easy-to-use nature, compared to Dacron patch