Effect of Cardioplegia and Cardiopulmonary Bypass on Coronary Microvascular Reactivity

总结： 心脏手术，特别是涉及心脏停搏液（CP）和心肺转流（CPB）的手术， 随着血管调节的显著变化和随后的器官损伤如神经认知缺陷， 中风、肾和肠系膜衰竭、术后全身性低血压和冠状动脉痉挛。高血压 也与严重的自主神经功能障碍和血管调节有关， 手术后的发病率和死亡率。这项研究的目的是确定 控制良好和控制不良的高血压对血管信号改变的影响 转导和功能，并研究这些患者在治疗前后发生的变化， 接受心脏手术，使用CP和CPB。具体来说，高血压相关的微血管差异 将研究功能，特别关注1）肌源性张力，2）β-肾上腺素能和加压素诱导的 微血管信号传导和收缩，3）以及性别和年龄对肌源性， 血管紧张素I和II以及β-肾上腺素能途径。这些目标将在微血管系统中进行检查- 控制和控制不良的高血压和年龄匹配的血压正常患者，使用体外 微血管成像这项工作将通过使用分子和 细胞生物学技术，以检查基因和蛋白质的表达和激活参与维持 心脏手术后的血管完整性和信号传导。这些研究的结果可能具有重要意义。 对高血压和其他心脏手术后患者恢复的影响。

SUMMARY: Cardiac surgery, especially that involving cardioplegia (CP) and cardiopulmonary bypass (CPB), is associated with significant changes in vasomotor regulation and subsequent organ injury such as neurocognitive deficit, stroke, renal and mesenteric failure, post-operative systemic hypotension and coronary spasm. Hypertension is also associated with severe autonomic dysfunction and vasomotor regulation, as well as with increased morbidity and mortality after surgical procedures. The goal of the proposed research is to determine the effect of well-controlled and poorly controlled hypertension on alterations in vascular signal transduction and function and to investigate the changes that occur in these patients before and after undergoing heart surgery with CP and CPB. Specifically, hypertension-related differences in microvascular function will be investigated with specific focus on 1) myogenic tone, 2) -adrenergic and vasopressin-induced microvascular signaling and contraction, 3) and the differential effects of gender and aging on myogenic, angiotensin I and II, and -adrenergic pathway. These aims will be examined in the microvasculature of well- controlled and poorly controlled hypertensive and age-matched normotensive patients, using in vitro microvascular imaging. This work will be accomplished through an exhaustive approach using molecular and cellular biology techniques to examine gene and protein expression and activation involved in maintaining vascular integrity and signaling following cardiac surgery. The results of these studies may have significant implications regarding the recovery of hypertensive and other patients after cardiac surgery.