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2004, Número 1

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Cir Cir 2004; 72 (1)


Hallazgos estructurales durante la preservación miocárdica con solución HTK

Argüero-Sánchez R, Mansilla-Olivares A, Rosales MLM

Idioma: Español
Referencias bibliográficas: 35
Paginas: 31-35
Archivo PDF: 923.53 Kb.


RESUMEN

Aun cuando los avances científicos desarrollados en el campo de la protección miocárdica han mejorado los resultados de la cirugía cardíaca, la circulación extracorpórea continúa enfrentando graves problemas clínicos durante y después de la reperfusión. Con esta inquietud, se decidió observar las alteraciones que presentan las células del endotelio capilar y las terminaciones nerviosas después de la derivación cardiopulmonar. Mediante microscopia electrónica se analizaron las biopsias de muestras de la aurícula derecha, que se obtuvieron antes y después de la cardioplejía con solución Bretschneider, de cuatro pacientes con estenosis mitral sometidos a implante valvular. Las muestras obtenidas después de la derivación cardiopulmonar mostraron desprendimiento de la membrana basal de los capilares miocárdicos, edema endotelial y destrucción de las terminaciones nerviosas. Estas alteraciones parecen demostrar que aun con el efecto protector de las soluciones de cardioplejía, el edema endotelial y la destrucción neuronal no pueden evitarse. Posiblemente esto dependa de la baja concentración de Na+ intersticial que activa al intercambiador Na+/Ca++, así como al influjo de Ca++ que se presenta durante la isquemia-reperfusión, provocando daño neuronal y endotelial y alteraciones en la contractilidad miocárdica. Este fenómeno explica algunos de los problemas clínicos que los pacientes enfrentan durante el postoperatorio inmediato.


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