Article

lock Open Access lock Peer-Reviewed

0

Views

ARTIGO ORIGINAL

Proteção cerebral no tratamento cirúrgico dos aneurismas do arco aórtico: estudo experimental em cães

Gaudêncio Lopes EspinosaI; Henrique MuradI; Antônio de Pádua JazbikI; Eduardo Sérgio BastosI; João de Deus e BritoI; José L FeitosaI; Rogério Antônio Silva BarrosII; Cláudio Miguel D'AvilaI

DOI: 10.1590/S0102-76381994000400002

RESUMO

É realizado estudo experimental comparativo entre dois métodos de proteção cerebral na abordagem cirúrgica dos aneurismas do arco aórtico, avaliando a sua eficácia: hipotermia sistêmica profunda isolada (menor que 20ºC) com pinçamento arterial braquiocefálico e hipotermia sistêmica profunda associada à perfusão carotídea seletiva. Dois grupos de 15 cães cada foram submetidos, respectivamente, à hipotermia sistêmica profunda com pinçamento arterial braquiocefálico (Grupo I) e à hipotermia sistêmica profunda associada à perfusão seletiva da carótida direita (Grupo II). Foram analisadas amostras seriadas das alterações metabólicas de pH e PaCO2 que ocorreram no retorno venoso cerebral aferidas na veia julgular interna, bem como as alterações histopatológicas encontradas com 45 min., 90 min. e 135 min. de cada procedimento. Os resultados demonstram que, apesar de ambos os métodos de proteção cerebral serem eficazes por um período de 45 minutos, o método utilizado no Grupo II mostrou ser superior em períodos de até 90 minutos de isquemia cerebral. Em períodos de 135 minutos os métodos tiveram resultados semelhantes, não oferecendo proteção cerebral adequada.

ABSTRACT

The authors proposition is to make an experimental study of two methods of cerebral protection to be used during aortic arch aneurysm resection. The methods to be evaluated were profound systemic hypothermia (under 20ºC) whith great vessels occlusion and profound systemic hypothermia with selective right carotid artery perfusion. Two groups of 15 dogs each were submitted either to profound systemic hypothermia with great vessels occlusion (Group I), or to profound systemic hypothermia with selective right carotid artery perfusion (Group II). Serial jugular vein samples for pH and PaCO2 were analyzed to evaluate ischemic cerebral metabolic derangements. Hystopathological studies were also performed 45, 90 and 135 minutes, through animal sacrifice in each experiment. The results have shown good cerebral protection with both methods in the 45 minutes ischemic interval. At 90 minutes Group II method has conferred better cerebral protection than Group I. At 135 minutes of cerebral ischemia neither method could afford cerebral protection against ischemia.
Texto completo disponível apenas em PDF.

REFERÊNCIAS

1. BACHET, J.; TEODORI, G.; GOUDOT, B.; DIAZ, F.; KERDANY, A.; DUBOIS, C; BRODATY, D.; DE LENTDEKER, P.; GUILMET, D. - Replacement of the transverse aortic arch during emergency operations for type A acute aortic dissection. J. Thorac. Cardiovasc Surg., 96: 878-886, 1988. [MedLine]

2. BLOODWELL, R. D.; HALLMAN, G. L; COOLEY, D. A. - Total replacement of the aortic arch and the "Subclavian Steal" phenomenon. Ann. Thorc Surg., 5: 236-245, 1968.

3. COOLEY, D. A.; OTT, D. A.; FRAZIER, O. H.; WALKER, W. E. - Surgical treatment of aneurysms of the transverse aortic arch: experience with 25 patients using hypothermic techniques. Ann. Thorac Surg., 32: 260-272, 1981. [MedLine]

4. CRAWFORD, E. S. & SALEH, S. A. - Transverse aortic arch aneurysm: improved results of treatment employng new modifications of aortic reconstruction and hypothermic cerebral circulatory arrest. Ann. Surg., 194: 180-188, 1981. [MedLine]

5. DE BAKEY, M. E. - Succesful resection of fusiform aneurysm of aortic arch with replacement by homograft. Surg. Gynecol. Obstet., 105: 657-664, 1957. [MedLine]

6. DE BAKEY, M. E.; CRAWFORD, E. S.; COOLEY, D. A. - Successful resection of fusiform aneurysm of aortic arch with replacement by homograft. Surg, Gynecol. Obstet, 105: 657-664, 1957.

7. DEMOPOULOS, H. B.; FLAMM, E. S.; PIETRONIGRO, D. D.; SELIGMAN, M. L. - The free radical pathology and the microcirculation in the major central nervous system. Acta Physiol. Scand., 91: (Supl. 492): 119, 1980.

8. EKROTH, R.; THOMPSON, R. J.; LINCOLN, C; SCALLAM, M.; ROSSI, R.; TSANG, V. - Elective deep hypothermia with total circulatory arrest: changes in plasma creatine kinase BB, blood glucose, and clinical variables. J. Thorac Cardiovasc Surg., 97: 30-35, 1989. [MedLine]

9. FISH, K. J.; HELMS, K. N.; SARQUIST, F. H.; VAN STIEENNIS, C; LINET, O. I.; HILBERMAN, M.; MITCHELL, R. S.; JAMIELSON, S. W.; MILLER, D. C; TINCLENBERG, J. S. - A prospective, randomized study of the effects of prostacyclin on neuropsychologic dysfuction after coronary artery operation. J. Thorac Cardiovasc. Surg., 93: 605-615, 1987.

10. FOX, L. S.; BLACKSTONE, E. H.; KIRKLIN, J. W.; BISHOP, S. P.; BERGDAHL, L. A.; BRADLEY, E. L. - Relationship of brain blood flow and oxygen consumption to perfusion flow rate during profoundly hypothermic cardiopulmonary bypass. J. Thorac. Cardiovasc. Surg., 87: 658-664, 1984. [MedLine]

11. FRIDOVICH, I. - The biology of oxygen radicals; the superoxide radical is an agent of oxygen toxicity; superoxide dismutases provide an important defense. Science, 201: 875-880, 1978. [MedLine]

12. FRIST, E. H.; BALDWIN, J. C; STARNES, V. A.; DYER, P. E.; MILLER, D. C; JAMIESON, S. W.; MITCHELL, R. S.; SHUMWAY, N. E. - A reconsideration of cerebral perfusion in aortic arch replacement. Ann. Thorac Surg., 42: 273-281, 1986. [MedLine]

13. GARCIA, J. H. & KAMIJYO, Y. - Cerebral infarction: evolution of histopathological changes after occlusion of a middle cerebral artery in primates. J. Neuropathol. Exp. Neurol., 33: 408-421, 1974. [MedLine]

14. GREELEY, W. J.; BUSHMAN, G. A.; KONG, D. L; OLDHAM, H. N.; PETERSON, M. B. - Effects of cardiopulmonary bypass on metabolism during pediatric cardiovascular surgery. J. Thorac. Cardiovasc. Surg., 95: 842-849, 1988. [MedLine]

15. GREELEY, W. J.; UNGERLEIDER, R. M.; SMITH, R. L; REVES, J. G. - The effects of deep hypothermic cardiopulmonary bypass and total circulatory arrest on cerebral blood flow in infants and children. J. Thorac Cardiovasc Surg., 97: 737-745, 1989. [MedLine]

16. GRIEPP, R. B.; STINSON, E. B.; HOLLINGSWORTH, J. F.; BUEHLER, G. - Prosthetic replacement of the aortic arch. J. Thorac. Cardiovasc. Surg., 70: 1051-1063, 1975. [MedLine]

17. KAMIJYO, Y.; GARCIA, J. H.; COOPER, J. - Temporary regional cerebral ischemia in the cat: a model of hemorrhagic and subcortical infarction. J. Neuropathol. Exp. Neutrol., 36: 338-350, 1977.

18. KATISUHIKO, M.; YASUNARU, K.; MATSUDA, H.; OKUDA, A.; ELLIS, E. F. - Optimal perfusion flow rate for the brain during deep hypothermic cardiopulmonary bypass at 20ºC: an experimental study. J. Thorac. Cardiovasc. Surg., 92: 1065-1070, 1986. [MedLine]

19. KONTOS, H. A.; WEI, E. P.; POVLISHOCK, J. T.; DIETRICH, W. D.; MAGIERA, G. T.; ELLIS, E. F. - Cerebral arteriolar dammage by arachidonic acid and prostaglandin G2. Science, 209: 1242-1245, 1980. [MedLine]

20. LASSEN, N. A.; Cerebral blood flow and oxygen consumption in man. Physiol. Rev., 39: 183-238, 1959. [MedLine]

21. LUOSTO, R.; MAAMIES, T.; PELTOLA, K.; JARVINEN, A.; MATTILA, S. - Hypothermia and circulatory arrest in reconstruction of aortic arch: a report of nine cases. Scand. J. Thorac Cardiovasc. Surg., 21: 113-117, 1987. [MedLine]

22. MINORU, A.; FLASTERSTEIN, A. H.; BARNETTE, J.; KOCH, L. V.; ROSS Jr., J. N.; KENNEDY, J. H. - Cerebral effects of profound hypothermia (18ºC) and circulatory arrest. Circulation, 51, 52 (Supl. 1): 52-59, 1975.

23. PHILIPS, P. A. & MIYAMOTO, A. M. - Use of hypothermic and cardiopulmonary bypass in resection of aortic arch aneurysms. Ann. Thorac Surg., 17: 398-404, 1974. [MedLine]

24. RANCK, J. B. & WINDLE, W. F. - Brain damage in the monkey, maccaca mulatta, by asphyxia neonatorum. Exp. Neurol. 1: 130, 1959. [MedLine]

25. SHU-HSUN, C; YUAN-TEH, L.; WEN-PIN, L.; CHU, S. H.; LEE, Y. T.; LIEN, W. P.; HSU, K. Y.; WU, T. L. - Resection of aneurysm of the aortic arch without cardiopulmonary bypass. J. Thorac. Cardiovasc. Surg., 74: 928-934, 1977. [MedLine]

26. SWAN, H. - The importance of acid-base management for cardiac and cerebral preservation during open heart operations. Surg. Gynecol. Obstet, 158: 391-414,1984. [MedLine]

27. TABADOR, K.; GARDNER, T. J.; WALKER, A. E. - Cerebral circulation and metabolism at deep hypothermia. Neurology, 22: 1065-1070, 1972. [MedLine]

28. TANAKA, J.; SHIKI, K.; ASOU, T.; YASUI, H.; TOKUNAGA, K. - Cerebral autoregulation during deep hypothermic nonpulsatile cardiopulmonary bypass with selective cerebral perfusion in dogs. J. Thorac. Cardiovasc. Surg., 95: 124-132, 1988. [MedLine]

29. TREASURE, T.; NAFTEL, D. C; CONGER, K. A.; GARCIA, KIKLIN, J. W.; BLACKSTONE, E. H. - The effect of hypothermic circulatory arrest time on cerebral function, morphology, and biochemistry: an experimental study. J. Thorac. Cardiovasc. Surg., 86: 761-770, 1983. [MedLine]

30. WEI, E. P.; DIETRICH, D.; POVLISHOCK, T. J.; NAVARI, R. M.; KONTOS, H. A. - Functional, morphological and metabolic anormalities of the cerebral microcirculation after concussive brain injury in cats. Circulation Res., 46: 37-47, 1980.

31. YASUHIRO, S.; TAKASHI, M.; RYOHEI, Y.; SOMA, Y.; HIROTANI, T.; YOZU, R.; ONOGUSHI, K.; MISUMI, T.; KAWADA, K.; INOUE, T. - A clinical study of cerebral circulation during extracorporeal circulation. J. Thorac. Cardiovasc. Surg., 97: 187-193, 1989. [MedLine]

32. YASUURA, K.; OGAWA, Y.; OKAMOTO, H. S.; ASAKURA, T.; OSHINO, M.; SAWAZAKI, M.; MATSURA, A.; MASEKI, T.; ABE, T. - Clinical application of total body retrograde perfusion to operation for aortic dissection. Ann. Thorac Surg., 53: 655-660, 1992.

Article receive on quinta-feira, 10 de março de 1994

CCBY All scientific articles published at www.rbccv.org.br are licensed under a Creative Commons license

Indexes

All rights reserved 2017 / © 2024 Brazilian Society of Cardiovascular Surgery DEVELOPMENT BY