Proteção miocárdica ao coração hipertrofiado: o eterno desafio

Cressoni, Elthon Silveira; Avanci, Luiz Ernesto; Braile, Domingo Marcolino; Cicogna, Antônio Carlos; Lima-Oliveira, Ana Paula Marques; Gerez, Milena Alonso Egéa; Martins, Antônio Sérgio

doi:10.1590/s0102-76382008000100015

Cited by 7 publications

(5 citation statements)

References 45 publications

(38 reference statements)

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“…It is known that the hypertrophied myocardium already presents ultra structural changes that rend it more susceptible to ischemia and fibrosis. 10 Moreover, these changes and the relative deficiency of microcirculation hinder the delivery of the cardioplegic solution to the sub-endocardium, compromise intra-operative myocardial preservation and render the heart particularly susceptible to ischemic damage and infarction. 2…”

Section: Discussionmentioning

confidence: 99%

Operative Myocardial protection in patients with Left Ventricular Hypertrophy: The Role of systemic Hypothermia

Elghobary

Ali

Ahmad

2011

Open�J Cardiovasc Surg

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ObjectivesMyocardial hypertrophy represents a great challenge in cardiac surgery. Several strategies have been described to protect the hypertrophied myocardium during cardiopulmonary bypass, and aortic clamping, yet the ideal strategy has not been identified. This study investigates the use of moderate systemic hypothermia (MSH) as an adjuvant method to protect the hypertrophied myocardium in patients undergoing aortic valve replacement (AVR).MethodsTwenty eight patients undergoing AVR were divided into two groups, (Group I) received continuous cold 5–8 °C retrograde blood cardioplegia (CRBC) and their body temperature was cooled down to 23–26 °C. (Group II) also received CRBC but their body temperature was kept at 32–34 °C.ResultsNo operative morality (30 days) was noted in both groups. Postoperative reduction in ejection fraction (EF) was seen in nine patients of group I and in twelve patients of group II (P < 0.05). The need for multiple inotropes was more in group II (eight patients) than in group I (two patients) (P < 0.001). IABP was needed in three patients of group II and non in group I (P < 0.01).ConclusionModerate systemic hypothermia might have a role in protecting hypertrophied myocardium in patients undergoing AVR.

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Section: Discussionmentioning

confidence: 99%

Operative Myocardial protection in patients with Left Ventricular Hypertrophy: The Role of systemic Hypothermia

Elghobary

Ali

Ahmad

2011

Open�J Cardiovasc Surg

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“…[2] Hypertrophy also decreases the myocardial compliance and thereby impairs diastolic filling. [3] Furthermore, it is associated with increased myocardial oxygen consumption during cardiac surgery[45] and more liable for atrial fibrillation or flutter. [67] Ventricular hypertrophy can compromise the subendocardial blood flow by increasing coronary resistance and the increased filling pressures.…”

Section: Introductionmentioning

confidence: 99%

The perioperative effect of magnesium sulfate in patients with concentric left ventricular hypertrophy undergoing cardiac surgery: A double-blinded randomized study

Soliman

Abukhudair

2019

Ann Card Anaesth

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Objective: The objective of this study was to assess the cardioprotective effect of magnesium sulfate in patients with left ventricular concentric hypertrophy undergoing cardiac surgery. Design: The study was a double-blinded randomized study. Setting: This study was conducted at a cardiac center. Patients: The study included 250 patients. Intervention: The study included two groups (each = 125): Group M – the patients who received magnesium sulfate infusion (15 mg/kg/h). The infusion was started 20 min before induction, during surgery, and the first postoperative 24 h. Group C – the patients who received an equal amount of normal saline. Measurements: The variables included troponin I level, creatinine kinase-MB (CK-MB) level, electrocardiograph (ECG) with automatic ST-segment analysis (leads II and V), E/A peak ratio, end-diastolic volume, cardiac index (CI), heart rate, mean arterial blood pressure (MAP), mean arterial pulmonary pressure (mPAP), pulmonary and systemic vascular resistances, and pharmacological and mechanical support. Main Results: The troponin I level, CK-MB, and ECG changes were lower in Group M than Group C ( P < 0.05). The E/A peak ratio and end-diastolic volume increased in Group M than Group C ( P < 0.05). There was a significant increase in the CI and a decrease in the heart rate, mPAP, pulmonary vascular resistances, and pharmacological and mechanical support in Group M compared to Group C ( P < 0.05). There were minimal changes in the MAP and systemic vascular resistance in Group M compared to Group C ( P < 0.05). Conclusion: The magnesium sulfate provides a cardioprotective effect in patients with concentric ventricular hypertrophy undergoing cardiac surgery. It decreases the incidence of perioperative myocardial infarction and arrhythmia. Furthermore, it decreases the requirement of pharmacological and mechanical support.

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“…Ocorre um aumento da massa ventricular com manutenção ou aumento dos diâmetros cavitários 1 e EPR normal 5 . Surge em decorrência da sobrecarga de volume, que pode ser observada durante a prática de exercícios aeróbios 1 contínuos de intensidade moderada à intensa, onde o estiramento muscular imposto favorece a degradação do colágeno, favorecendo a função diastólica 4 .…”

Section: Introductionunclassified

Efeito do treinamento aquático no perfil lipídico e na hipertrofia ventricular esquerda de camundongos hiperlipidêmicos

Terra

Rosa²,

Santos³

et al. 2013

Rev Bras Ativ Fis Saude

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ResumoO objetivo do presente estudo foi analisar os efeitos do treinamento aquático (TA) no perfil lipídico e nas estruturas ventriculares esquerdas de camundongos hiperlipidêmicos. Foram utilizados 28 camundongos LDLr-/-, machos, divididos aleatoriamente em 4 grupos: sedentários alimentados com ração padrão (C); treinados alimentados com ração padrão (C+TRE), sedentários alimentados com ração hiperlipídica (HL) e treinados alimentados com ração hiperlipídica (HL+TRE). Os animais dos grupos treinados praticaram TA em intensidade moderada, por 60 minutos durante 60 dias consecutivos. Após 48 horas do término do período de treinamento e 12 horas de jejum de repouso os animais foram eutanasiados, o sangue coletado e o soro utilizado para análises laboratoriais de triglicérides, colesterol total e suas frações (LDL, HDL, VLDL). O coração foi removido e o ventrículo esquerdo foi pesado a fresco para se calcular a proporção do peso ventricular esquerdo (mg)/ peso do animal (g). Os resultados mostraram que o TA sem cargas adicionais foi mais eficiente na melhora das concentrações plasmáticas de lipídeos quando acompanhado por uma dieta adequada, confirmando que a associação exercício físico com dieta equilibrada é essencial para obtenção de seus benefícios. O treinamento ocasionou hipertrofia ventricular esquerda excêntrica no grupo alimentado com dieta padrão e, principalmente, diminuiu o depósito de colágeno intersticial no miocárdio dos animais alimentados com dieta hiperlipídica, o que pode indicar uma melhora na função diastólica com consequente melhora da função sistólica. Concluiu-se que o treinamento aquático de intensidade leve a moderada induz adaptações benéficas e profiláticas ao coração, promovendo saúde e prevenindo doenças. Palavras-chaveHipertrofia ventricular; Natação,;Dislipidemias. AbstractThis study assessed the effects of Water training on the lipid profile and left ventricular structures in hyperlipidemic mice. Twenty-eight male LDLr-/-mice were randomly separated into 4 groups: sedentary, fed a standard diet (C); exercising, fed a standard diet (C+TRE); sedentary, fed a hyperlipidic diet (C+HL); and exercising, fed a hyperlipidic diet (E+HL). The exercising mice trained daily for 60 minutes during 60 days. After 48 hours of the end of the training period and 12 hours of rest fasting the animals were underwent euthanasia and the blood was collected for measuring the plasma levels of triglycerides, total cholesterol and its fractions (LDL, HDL, VLDL). The heart was removed and the left ventricle was weighed fresh to calculate the ratio left-ventricle weight (mg)/body weight (g). The results showed that the training was more effective in improving lipid plasma levels when combined with a balanced diet, thereby confirming that it is essential to associate physical exercise and diet. The training protocol resulted in eccentric left ventricular hypertrophy in the standard-diet group and decreased interstitial collagen deposition in the myocardium of the high-fat-diet animals, which may indicate an impro...

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Proteção miocárdica ao coração hipertrofiado: o eterno desafio

Cited by 7 publications

References 45 publications

Operative Myocardial protection in patients with Left Ventricular Hypertrophy: The Role of systemic Hypothermia

Operative Myocardial protection in patients with Left Ventricular Hypertrophy: The Role of systemic Hypothermia

The perioperative effect of magnesium sulfate in patients with concentric left ventricular hypertrophy undergoing cardiac surgery: A double-blinded randomized study

Efeito do treinamento aquático no perfil lipídico e na hipertrofia ventricular esquerda de camundongos hiperlipidêmicos

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