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  3. Comparison of the effect of two different methods of myocardial protection during coronary artery bypass surgery by evaluating enzyme changes

Comparison of the effect of two different methods of myocardial protection during coronary artery bypass surgery by evaluating enzyme changes

Number of pages: 98 File Format: word File Code: 32039
Year: 2011 University Degree: Master's degree Category: Medical Sciences
Tags/Keywords: Coronary artery bypass grafting - Coronary artery diseases - Enzymatic changes - Heart muscles - Heart surgeries - Myocardial protection - myocardium - the heart
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  • Summary of Comparison of the effect of two different methods of myocardial protection during coronary artery bypass surgery by evaluating enzyme changes

    A master's thesis in the field of physiology

    Abstract

    Comparison of the effect of two different methods of myocardial protection during coronary artery bypass surgery by evaluating enzyme changes

    Introduction

    Since the heart is one of the most vital organs of the body, the health of this organ is of particular importance and taking steps to improve its health has been one of the goals of mankind since long ago. Today, heart diseases, especially coronary artery diseases [1] CAD, which are responsible for feeding the heart muscles [2], are common diseases. Coronary heart disease is one of the major causes of death in the world (Venugopal et al. 2009). Also, the increase in diseases such as: diabetes, high blood pressure, increased blood lipids and things like obesity, stress and smoking have increased the prevalence of coronary artery occlusion and heart attacks [3]. In cases where coronary artery narrowing occurs and causes a reduction or interruption of blood supply to parts of the heart muscle, the need for surgery to transplant these vessels is raised. Coronary artery bypass surgery [4] is one of the most important procedures used for CAD patients. (Venugopal et al. 2009)

    In the impact of these vessels, the heart muscle tissue becomes ischemia[5] and loses its efficiency
    . To overcome this problem, coronary artery transplant surgery has been common for the past few decades, by which the affected vessels are replaced with new and healthy vessels that are removed from other parts of the body, such as the internal thoracic artery [6] and superficial leg arteries [7] (Kirklin, 2003). During heart surgery, some degree of damage to the myocardium is inevitable. This damage leads to changes in myocardial blood flow, followed by changes in oxygen supply and demand. The heart surgery team should avoid this complication (ischemia) as much as possible. Otherwise, the resulting injuries will cause fundamental changes in the energy-generating parts of the myocardial cells. This issue has opened a new chapter in cardiac surgery called myocardial protection [8] during heart surgery.

    During the past fifty years, myocardial protection has been the focus of many researchers and the resulting results have led to rapid progress in cardiac surgery.

    Today, while many techniques have been tested and reports of various methods with the best measures to protect the myocardium are published, but still a specific technique that is introduced as the best method has not been agreed upon. During the operation, due to impaired blood flow and myocardial ischemia, damage to this organ is unavoidable, and in the final stages of the operation and re-establishment of blood flow [9] of the heart muscle, there is a possibility of double damage due to reperfusion (Kaminski, et al., 2008). Because various compounds such as creatine phosphokinase [10] CPK (Bonnefoy et al., 1998), troponin [11] cTn (Bonnefoy et al., 1998, Francesco et al., 2007), malondialdehyde [12] MDA (J Aznar, et al., 1983 and Kamunski, 2008) and enzymes including Catalase [13] CAT, superoxide dismutase [14] SOD (Yasuyuki et al., 1991), glutathione peroxidase [15] GPX

    Kaminski et al., 2008) are measurable biomarkers that indicate the degree of tissue damage.

    If the blood supply to the heart through coronary vascular grafts[16] is done step by step and slowly, it is possible to prevent damage to the myocardium to a greater extent.

    Therefore, the general goal is to check the amount of damage to the myocardium, by modifying the way of blood resupply at the end of the operation, by measuring the amount of biomarkers in the blood.

    In this study, the activity of SOD, CAT, GPX, MDA, cTn I, CPK-MB factors was compared in patients who underwent CABG surgery with the new modified method, compared to patients who were operated with the usual method (Kirklin 2008).

    Abstract

    Comparing of two different methods of myocardial protection during coronary artery bypass grafting surgery: by enzymatic evaluation." surgery. This study compares two different methods of myocardial protection during coronary artery bypass grafting, by measuring the level of specific biomarkers such as superoxide dismutase, glutathione peroxidase, catalase & also malondialdehyde, creatine phosphor kinase (CPK) & cardiac troponin I (cTn I).  Two groups of 10 patients were equalized regarding age, sex, and risk factors such as diabetes, hyperlipidemia, hypertension, and smoking.  In both groups (study: A & Control: B) blood samples were taken preoperatively, at the end of operation & 24 hours later, to measure different biomarkers. The result showed that the function of antioxidant enzymes decreases & MDA which is indicative of lipid peroxidation increases. CPK & cTn I were increased during surgery & decreased after surgery. Finally greater decrease of function of antioxidant enzymes & lesser increase of MDA in group A & also faster decrease of CPK & cTn I in early post op phase are meaningfully indicative of lesser myocardial damage in patients of group A. More investigation may be indicative of improvement in cardiovascular status & functional class of group A patients who are managed by modified myocardial protection method.

  • Contents & References of Comparison of the effect of two different methods of myocardial protection during coronary artery bypass surgery by evaluating enzyme changes

    Chapter One: Introduction .. 2

    Chapter Two: An overview of previous researches

    1-2- Anatomy and physiology of the heart. 6

    2-2- Heart muscle metabolism. 7

    2-2-1 - energy sources in heart muscle. 7

    2-2-2- anaerobic glycolysis. 8

    2-3- Heart ischemia.. 9

    2-3-1- Myocardial disorders in ischemia. 10

    2-3-2- ischemia and oxygen free radicals. 11

    2-3-3- damage caused by reperfusion. 12

    2-3-4- Myocardial edema. 12

    2-4- antioxidant enzymes. 13

    2-4-1- Oxidant agents. 13

    2-4-2- The main sources of active oxygen radicals in the living organism:. 14

    2-5- Oxidative stress. 14

    2-5-1- hypoxia and oxidative stress. 17

    Title

    2-6- Antioxidants and antioxidant defense. 18

    2-6-1- superoxide dismutase SOD. 19

    2-6-2- catalase CAT. 20

    2-6-3-glutathione peroxidase GPX. 21

    2-6-4- malondialdehyde MDA. 22

    2-6-5-creatine phosphokinase CPK. 24

    2-6-5-1-CPK isozymes. 25

    2-6-6- cardiac troponin I cTn I. 26

    2-7- History of myocardial protection. 28

    2-8- Coronary artery transplant surgery method. 31

    2-9- Beneficial measures during reperfusion. 33

    2-10- Factors effective in protecting the myocardium during surgery. 34

    2-10-1- complete immobility of the heart. 34

    2-10-2- reducing heart temperature. 35

    2-10-3- Preventing edema. 35

    2-10-4- Buffer system to neutralize acidosis. 35

    2-10-5- calcium regulation. 36

    2-10-6- preventing the harmful effects of oxygen radicals. 36

    2-10-7- Adenosine. 37

    2-10-8- nitric oxide. 37

    2-10-9- Complement system. 38

    2-10-10- Use of hyperpolarizing agents. 38

    2-10-11- inhibition of sodium-hydrogen converter. 38

    2-10-12- Cardioplegia. 38

    2-11- types of cardioplegia. 39

     

    Chapter Three: Materials and Work Methods

    3-1- Materials and tools needed. 41

    3-2- Selection of study patients. 41

    3-3- Sampling time. 43

    3-4- Sampling volume. 43

    3-5- Measurement of SOD superoxide dismutase enzyme activity. 44

    3-6- Measurement of GPX glutathione peroxidase enzyme activity. 44

    3-7- Measurement of CAT catalase enzyme activity in red blood cells. 45

    3-8- Measurement of malondialdehyde MDA in red blood cells. 46

    3-9-Methods for measuring creatine phosphokinase CPK enzyme. 46

    3-9-1- Principles of calorimetry method. 46

    3-9-2- Measurement of CPK by fluorometric method. 47

    3-9-3- New calorimetric method for measuring CPK. 47

    3-9-4- measuring CPK by spectrophotometric method. 48

    3-10- The method of measuring CPK and troponin cTn I in this study. 48

     

    Chapter Four: Results

    4-1- Examining changes in SOD enzyme levels during the study. 50

    4-2- Investigating changes in the amount of GPX enzyme. 51

    4-3- Examining changes in the amount of catalase enzyme. 52

    Title

    4-4- Review of MDA changes. 52

    4-5- Examining the changes of CPK-MB enzyme. 54

    4-6- Investigating cTnI changes. 54

    Chapter Five: Discussion

    5-1- Antioxidant enzymes (SOD, GPX, CAT). 57

    5-2- MDA factor.. 60

    5-3- cardiac troponin and CPK-MB. 61

    Conclusion.. 64

    Suggestions.. 65

    List of sources and references

    Persian sources.. 66

    English sources

    Source:

    Persian sources

    Zargari, Dr. Ali (1370). "Medicinal plants." Volumes 1, 2, and 3, Tehran University Publications

    Waziri Kashani, Seyed Reza (1364). "Clinical diagnosis with laboratory methods." Volume 2, pVolume 2, pp. 459-462.

     

     

     

     

     

     

    English sources

     

    Abd-elfattah, A.S., Jessen,M.E., Lekven, J., Doherty, N.E., Brunsting, L.A., Wechsler, A.S. (1988). Myocardial reperfusion injury. Role of myocardial hypoxanthine and xanthine in free radical-mediated reperfusion injury." Circulation, Vol. 78, III224.

     

    Acar, C., Partington, M.T., Buckberg, G., (1990). "Studies of controlled reperfusion after ischemia. XVIII. Reperfusion conditions. Attenuation of the regional ischemic effect by temporary total vented bypass before controlled reperfusion. J Thorac Cardiovasc Surg, No. 100, pp.737.

     

    Akins, CW. (1994). "Early and late results following emergency isolated myocardial revascularization during hypothermic fibrillatory arrest (Updated in 1994 by Cary W. Akins, MD)."  Ann Thorac Surg. Vol. 58, pp. 1205-6.

     

    Ali, N., Rizwi, F., Lqbal, A. Rashid, A. (2010). "Induced remote ischemic preconditioning on ischemia-reperfusion injury in patients undergoing coronary artery bypass." J Coll Physicians Surg Pak. Vol. 20, No.7, pp.427-31.

     

    Allen, D.G., Orchard, C.H. (1987). "Myocardial contractile function during ischemia and hypoxia. Circ Res, Vol. 60, No. 153.

     

    Aminlari, M. (1992)." Anovel colorimetric method for arginase activity." Clin. Biochem, Vol. 25, pp. 431-436.

     

    Aminlari, M. and Vaseghi, T. (1987). "A new colorimetric method for determination of creatine phosphokinase. Anal Biochem." Vol. 164, pp. 397-404.

    Amrani, M., Yacub, MH., Royston, D. (1999). "Myocardial protection for cardiac surgery: classical views and new trends." Int Anesthesiol Clin. Vol. 37, pp. 39-53.

     

     

     

    Andreas, G., Alicja, B., Dobromir, D., Jan, P., Henning, M., Denis, S., Ingrid, W., Friedrich, W., Carmen, W., Sybille, B., Peter, B., Ursula, R. Uwe, L. (2009). "Acute atrial tachyarrhythmia induces angiotensin II receptor-mediated oxidative stress and microvascular flow." abnormalities in the ventricles." European heart journal. Vol. 30, Issue.11, pp.1411-1420.

    Ataka, K., Yamamoto, S., Nishikawa, Y., Nakamura, K. (1989). "The protective effect of calcium antagonist and free radical scavenger against myocardial ischemic / reperfusion injury in the isolated rat heart." Kobe J Med Sci. Vol. 35, pp. 261-276. Aznar, J., Valles, J., et al. (1983). "Serum malondialdehyde-like material (MDA-LM) in acute myocardial infarction." Vol. 36, pp. 712-715.

     

    Baker, J.B., Bentall, H.H., Dreyer, B., Melrose, D.G. (1957). "Arrest of isolated heart with potassium citrate." Lancet. Vol. 273, pp. 555-9.

     

    Becker, H., Vinten-Johansen, J., Buckberg, G.D. Robertson, J.M., Leaf, J.D., Lazar, H.L., et al. (1981). "Myocardial damage caused by keeping PH 7.40 during systemic deep hypothermia. J Thorac Cardiovasc surg, Vol. 82, No. 810.

     

    Bingyang, J., Mingzheng, L., Feng, L., Linping, L., Guyan, W., Zhengyi, F., Qiang, H. (2006). "Warm induction cardioplegia and reperfusion dose influence the occurrence of the post CABG TnI level." Interactive Cardiovascular and Thoracic Surgery. Vol. 5, pp. 67-70.

     

    Blaustein, AS., Schine, L., Brooks, WW., Fanburg, BL., Bing, OH. (1986). "Influence of exogenously generated oxidant species on myocardial function." Am J Physiol. Vol. 250, pp. 595-599. Boeckxstaens, W.J. "Retrograde cerebral perfusion in nonhuman primates." Ann Thorac Surg, pp. 319-328. G., et al. (1998).

Comparison of the effect of two different methods of myocardial protection during coronary artery bypass surgery by evaluating enzyme changes
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