Impaired endothelial function of the umbilical artery after fetal cardiac bypass
Impaired endothelial function of the umbilical artery after fetal cardiac bypass
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DOI：
10.1016/j.athoracsur.2004.05.057
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发表时间：
2004-12-01
影响因子：
4.6
通讯作者：
Yasui, H
中科院分区：
文献类型：
--
作者：
Oishi, Y;Masuda, M;Yasui, H
背景最近，内皮功能障碍作为一个结果，胎儿心脏搭桥术已被报道。在这里，胎儿心脏转流对脐动脉内皮功能的影响进行了研究的张力研究。14只胎羊分为对照组（n = 7）和泵组（n = 7）。在泵组中，使用带离心泵的低容量预充回路维持心脏转流30分钟。在心脏转流术前、转流术中、转流术后30分钟和60分钟进行血流动力学测量和血气分析。在心脏转流停止后60分钟收获脐动脉。分别用60 mmol/L钾离子或5-羟色胺收缩平滑肌，测定内皮依赖性舒张（缓激肽，钙离子载体A23187）和内皮非依赖性舒张（硝普钠），并比较两组间的差异。胎儿脐动脉血流和主动脉压在心脏转流后30和60分钟显著降低。在心脏搭桥术期间和之后发现缺氧和高碳酸血症。心脏搭桥术期间和术后发生代谢性酸中毒。与对照组相比，泵组的内皮依赖性舒张功能受损（缓激肽：对照组43.6% +/- 6.4%，泵组18.9% +/- 2.5%，p < 0.01; A23187：对照组为37.80% +/-4.6%，泵组为19.6% +/- 3.9%，p < 0.01）。同时，两组均保留了内皮非依赖性舒张功能。胎儿心脏转流术引起脐动脉内皮功能障碍和代谢性酸中毒导致血流动力学恶化。预防内皮损伤和代谢性酸中毒可能是胎儿心脏手术成功的主要目标。(C)2004年由胸外科医师协会发布。
Background. Recently, endothelial dysfunction as a result of fetal cardiac bypass has been reported. Here, the effect of fetal cardiac bypass on the endothelial function of the umbilical artery was investigated by a tension study.Methods. Fourteen fetal lambs were divided into a control group (n = 7) and a pump group (n = 7). In the pump group, cardiac bypass was maintained for 30 minutes using a low-volume priming circuit with a centrifugal pump. Hemodynamic measurements and blood gas analyses were performed before, during, and 30 and 60 minutes after cardiac bypass. The umbilical artery was harvested 60 minutes after cessation of cardiac bypass. End othelium-dependent relaxation (bradykinin, calcium ionophore A23187) and endothelium-independent relaxation (sodium nitroprusside) were measured after smooth muscle contraction by 60 mmol/L potassium or serotonin and compared between the two groups.Results. The umbilical artery flow and aortic pressure of the fetus were significantly decreased at 30 and 60 minutes after cardiac bypass. Hypoxia and hypercapnia were recognized during and after cardiac bypass. Metabolic acidosis progressed during and after cardiac bypass. Endothelium-dependent relaxation was impaired in the pump group compared with the control group (bradykinin: 43.6% +/- 6.4% in the control group, 18.9% +/- 2.5% in the pump group, p < 0.01; A23187: 37.80% +/- 4.6%, in the control group, 19.6% +/- 3.9% in the pump group, p < 0.01). Meanwhile, endothelium-independent relaxation was preserved in both groups.Conclusions. Fetal cardiac bypass caused endothelial dysfunction of the umbilical artery and hemodynamic deterioration as a result of metabolic acidosis. Prevention of endothelial damage and metabolic acidosis could be the main target for successful fetal cardiac surgery. (C) 2004 by The Society of Thoracic Surgeons.