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[Protective effect of breviscapine on cardiac function in children after cardiopulmonary bypass undergoing open heart
Wen-xi Xie1, Li-min Yue, Hai-long Song
1Department of Anesthesiology, The Second Affiliated Hospital & Yuying Children Hospital, Wenzhou Medical College, Zhejiang 325027.
Insights
Breviscapine (BVC) administration before cardiopulmonary bypass (CPB) in children undergoing open heart surgery reduced myocardial injury markers like troponin I and malondialdehyde. This suggests BVC offers some cardiac protection during and after CPB.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Pharmacology
Context:
- Open heart surgery in children often involves cardiopulmonary bypass (CPB), a procedure associated with myocardial injury.
- Assessing and mitigating this injury is crucial for improving patient outcomes.
- Breviscapine (BVC) is a potential therapeutic agent for cardiac protection.
Purpose:
- To evaluate the effect of breviscapine (BVC) on myocardial injury markers and cardiac function in pediatric patients undergoing open heart surgery with CPB.
- To compare the efficacy of low-dose (0.5 mg/kg) and high-dose (1.0 mg/kg) BVC against a saline control.
Summary:
- Thirty-six pediatric patients undergoing ventricular septal defect repair were randomized into control (saline) and two BVC groups (low/high dose).
- Blood levels of cardiac troponin I (cTn-I) and malondialdehyde (MDA) were measured pre- and post-surgery.
- Both BVC doses significantly reduced cTn-I and MDA levels compared to the control group, indicating reduced myocardial injury and oxidative stress.
Impact:
- Intravenous breviscapine (BVC) at 0.5 or 1.0 mg/kg demonstrates a protective effect on cardiac function in children following open heart surgery and CPB.
- Findings suggest BVC can mitigate CPB-induced myocardial injury, potentially improving post-operative cardiac recovery.
Objective:
To assess the condition of myocardial injury after cardiopulmonary bypass (CPB) and the effects of breviscapine (BVC) on cardiac function in children undergoing open heart surgery.
Methods:
Thirty-six children (ASA II or III, aged 2-65 months) scheduled to receive ventricular septal defect repairing were randomly assigned to three groups, the control group treated with saline, and the BVC treated groups treated respectively with low dose (0.5 mg/kg) and high dose (1.0 mg/kg) BVC, 12 patients in each group. Saline or BVC (in volume of 15 mL) was administered intravenously after induction of anesthesia with micro-pump within 30 min. Blood levels of troponin I (cTn-I ) and malondialdehyde (MDA) were measured at different time points: pre-operation (T0), during aortic unclamping (T1), and 30 min, 1 h, 6 h, 24 h after aortic unclamping (T2, T3, T4, T5). And the time of operation, CPB, aortic unclamping, and the condition of drainage in 24 h after operation as well as the dosages of narcotics (midazolam, propofol and fentanyl) used were recorded.
Results:
No significant difference among groups was found in terms of sex ratio, age, body weight, time of aortic unclamping, CPB and operation, as well as the dosages of narcotics used and the volume of post-operation drainage. Compared with baseline (T0), levels of cTn-I at T1, T4 and T5 increased significantly in all three groups (P<0.01), with the peak revealed at T4; cTn-I in the control group were higher than those in the low dose BVC treated group at T1 and T4 (P<0.01), and those in the high dose BVC group at T1, T4, and T5, while it was insignificantly different between the two BVC treated groups. Level of plasmal MDA began to rise in all groups at T1 with the peak revealed at T2, it lowered after then, and reached the baseline at T5; comparison between groups showed that it was lower in the BVC treated groups than in the control group at T1-T4.
Conclusions:
Different degree of cardiac injury always happens after open heart surgery and CPB, showing high level of cTn- I within 24 h with the peak revealed at 6 h after aortic unclamping. Intravenous perfusion BVC before CPB at the dose of 0.5 or 1 mg/kg could protect the cardiac function to some extent.
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