Luna OP, Serrano VX, González CO, Santibañez EF

Idioma: Español
Referencias bibliográficas: 125
Paginas: 112-128
Archivo PDF: 333.83 Kb.

RESUMEN

La disfunción ventricular en cirugía cardiaca se observa con mucha frecuencia en el postoperatorio de los casos que se operan con circulación extracorpórea, se debe a muchos factores que se clasifican en: disfunción ventricular pre-existente, factores transoperatorios, tipo de cirugía, circulación extracorpórea y factores fisiopatológicos relacionados con la isquemia y reperfusión miocárdica. A esta disfunción ventricular, que es reversible, se le ha llamado “corazón contundido”. En este artículo se revisan los mecanismos relacionados con la patogénesis de esta disfunción ventricular, como son: la homeostasis del calcio, el acoplamiento excitación-contracción y la disfunción, tanto sistólica como diastólica, y el efecto del uso de la solución cardioplégica. El manejo de pacientes con disfunción ventricular necesita de confirmar el diagnóstico para poder establecer un tratamiento adecuado, con fármacos como: los agonistas de receptores beta-adrenérgicos, los inhibidores de fosfodiesterasa III, la hormona tiroidea, terapias combinadas y la solución de glucosa, insulina, potasio. También se revisó el papel que juega el calcio y los sensiblizadores del calcio, la arginina vasopresina, los calcio antagonistas y la adenosina, prostaciclina, inhibidores de la enzima convertidora de angiotensina. Activadores de canales de potasio, inhibidores del intercambio sodio-hidrógeno y el sulfato de magnesio. Cuando la disfunción ventricular produce el síndrome de bajo gasto cardiaco, la selección de un régimen terapéutico adecuado es crucial para poder separar a los pacientes de la circulación extracorpórea y lograr así mejores resultados.

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