Basic research for fetal cardiac surgery

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Background : To establish the safe fetal cardiac bypass is mandatory to perform the fetal cardiac surgical interventions. We investigated apoptosis in umbilical vessels related to fetal cardiac bypass. Methods : Thirteen pregnant ewes were used in the present study. Fetal lambs were divided into the cardiac bypass (CB) group (n=7) and the control group (n=6). In the CB group, cardiac bypass was maintained for 30 minutes using a centrifugal pump. After bypass, the fetuses were observed for 60 minutes and then the umbilical artery was harvested. In the control group, sham operation was performed and the umbilical artery was harvested. Umbilical artery tissue samples were used for TUNEL study and western blotting for Cytochrome c,Bax,Bcl-2,Bcl-xL, and Caspase 3. Results : The TUNEL-positive nuclei in umbilical artery were similar in both groups (CB group 0.57±0.29,control group 0.33±0.21 positive nuclei per high-power field, p=0.37). There were no significant differences in total caspase 3 levels between the 2 groups (CB group 1.40±0.43,control group 0.99±0.09,p=0.39). Cleaved caspase 3 were not detected in both groups. There were no significant differences in cytosolic cytochrome c levels between the 2 groups (CB group 1.99±0.75, control group 2.80±1.41,p = 0.60). There were no significant differences in Bax/Bc1-2 ratio between the 2 groups (CB group 1.66±0.66,control group 1.49±0.32,p = 0.83). There were no significant differences in Bcl-xL levels between the 2 groups (CB group 0.59±0.07,control group 0.58±0.10,p=0.93). Conclusions : We have demonstrated that fetal CB have not triggered additional apoptotic signals in the umbilical artery, suggesting that umbilical vessels may be patent after fetal cardiac surgery