ABSTRACT
Objective: To evaluate cardioprotective effects of adenosine on myocardial recovery during repair of CHD using CPB and included 40 pediatric patients ASA II and III
Patients and Methods: Patients were allocated into 2 equal groups [n=20]: Control group [group C] and Adenosine group [group A]. In group A, 3 minutes after starting the CPB, adenosine 150 micro g/kg/minute was infused for 6 minute and was added to the cardioplegia in a concentration of 200 micro mol/L. In group C, 3 minutes after starting CPB, equal volume of saline infused for the same period of time. Ischemic time, duration of CPB, total duration of mechanical ventilation and PICU stay were recorded. Cardiac indices were obtained using trans-esophageal Doppler probe. Hemodynamic parameters were recorded at different times. Blood levels of CK-MB isoenzyme and neutrophil count were measured before and after CPB
Results: Adenosine administrations improved the cardiac indices and significantly induced elevation of SVI, CI and PVI at 15-min and 1-hr after CPB and till 6-hrs after admission to PICU in comparison to group C. The sum of epinephrine doses was significantly higher in group C than in group A from 6-hrs till 36-hrs, and also its duration of infusion was significantly higher in group C than in group A at 24,36, and 48-hrs. The total duration of mechanical ventilation, and ICU stay were higher in group C than in group A nevertheless this difference did not reach a statistical significance. There was a non-significant difference between both groups as regards changes of HR, SBP, DBP and CVP. There was a non-significant difference between both groups as regards the mean ischemia time and CPB duration. Mean of estimated levels of CK-MB were significantly elevated at 24, 48hrs after admission to PICU in both groups compared to their baseline levels and significantly decreased at 48-hrs compared to levels estimated at 24-hrs hours after admission to PICU with a non-significant difference between both groups. Neutrophil count was non-significantly elevated in group C but decreased in group A compared to their baseline levels, with a significantly higher count in group C compared to group A
Conclusion: Use of Adenosine resulted in improvement of postoperative cardiac performance in terms of CI, PVI and SVI in patients undergoing surgical correction of CHD. It also decreased the sum of epinephrine doses, the total duration of epinephrine use and the number of patients needed inotropic support
Abbreviation: SV: Stroke volume; Cardiac index; SVI: Stroke volume index; SVRI: Systemic vascular resistance index; FTc: Time of systolic flow corrected for heart rate determines the preload; PVI: Peak velocity index to determine myocardial contractility [It is the maximum velocity of blood measured during systole normalized for body surface area]; CK-MB: creatinine kinase isoenzyme; HR: Heart rate; SBP: Systolic BP; DBP: Diastolic BP, CVP:Central venous pressure; CPB: Cardiopulmonary bypass; PICU: Pediatric ICU; CHD: Congenital heart disease; BIS: Bispectral index; ACT: Activated clotting time; CO=SV*HR [L/min]; SVI = SV/BSA [ml/m2]; CI=CO/BSA [L/min/m2]; SVR=[MAP-CVP]/CO*79.7 [dyne.sec.cm-5]; SVRI =SVR/BSA [dyne.sec.cm-5.m2]; PVI=PV/BSA [dyne/sec/m2]