[en] To assess the concentrations of cardiac troponin I (cTnI) and tumor necrosis factor-alpha (TNFalpha) in cardiac lymph compared with coronary sinus (CS) blood and to measure cardiac lymph flow before and after cardiopulmonary bypass (CPB). In 21 pigs, the main cardiac lymph trunk was cannulated before institution of standardized CPB. Lymph flow, cTnI and TNFa in cardiac lymph and CS blood were measured before and after CPB for 6 hours. Before CPB, cTnI concentration was 215 +/- 36 nglml in cardiac lymph and 0.5 +/- 0.1 nglml in CS blood, respectively. After aortic declamping a significant elevation of cTnI values was measured in cardiac lymph and CS blood. cTnl concentration in cardiac lymph and CS blood peaked 6 hrs after CPB (10,556 +/- 4,735 vs. 22.2 +/- 3.7 nglml, p < 0.01). TNFalpha concentration at baseline was 23.2 +/- 5.6 pg/ml in lymph and 18.7 +/- 9.5 pg/ml in CS blood, and there was no significant release of TNFalpha up to the end of the experiment. Baseline cardiac lymph flow was 3.07 +/- 0.35 ml/h and declined after aortic clamping (0.72 +/- 0.16 ml/h; p < 0.01) and peaked one hour after CPB (5.66 +/- 0.97 ml/h; p < 0.01). In conclusion, very high cTnI concentrations in cardiac lymph suggest serious perioperative myocardial damage after CPB with cardioplegia, which is underestimated by cTnI release into the bloodstream. In our study, the myocardium was not a major source of TNFalpha release.
Disciplines :
Cardiovascular & respiratory systems Pediatrics
Author, co-author :
Vazquez-Jimenez, J. F.; Rheinisch - Westfälische Technische Hochschule Aachen - RWTH > Thoracic and Cardiovascular Surgery
Liakopoulos, O. J.; Rheinisch - Westfälische Technische Hochschule Aachen - RWTH > Thoracic and Cardiovascular Surgery
Sadony, V, M Korber, G Albes, et al: Cardiac troponin I plasma levels for diagnosis and quantitation of perioperative myocardial damage in patients undergoing coronary artery bypass surgery. Eur J Cardiothorac Surg 13 (1998), 57-65.
Kirklin, JK, S Westaby, EH Blackstone, et al: Complement and the damaging effects of cardiopulmonary bypass. J Thorac & Cardiovasc Surg 86 (1983), 845-857.
Faymonville, ME, J Pincemail, J Duchateau, et al: Myeloperoxidase and elastase as markers of leukocyte activation during cardiopulmonary bypass in humans. J Thorac & Cardiovasc Surg 102 (1991), 309-317.
Hennein, HA, H Ebba, JL Rodriguez, et al: Relationship of the proinflammatory cytokines to myocardial ischemia and dysfunction after uncomplicated coronary revascularization. J Thorac & Cardiovasc Surg 108 (1994), 626-635.
Balderman, SC, JN Bhayana, JJ Steinbach, et al: Perioperative myocardial infarction: a diagnostic dilemma. Ann Thorac Surg 30 (1980), 370-377.
Mehlhorn, U, KL Davis, EJ Burke, et al: Impact of cardiopulmonary bypass and cardioplegic arrest on myocardial lymphatic function. Am J Physiol 268 (1995), H178-H183.
Ullal, SR, TH Kluge, F Gerbode: Studies on cardiac lymph during extracorporeal circulation. Chest 61 (1972), 662-667.
Feola, M, G Glick. Cardiac lymph flow and composition in acute myocardial ischemia in dogs. Am J Physiol 229 (1975), 44-48.
Butler, J, GM Rocker, S Westaby: Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg 55 (1993), 552-559.
Yokoyama, T, M Nakano, JL Bednarczyk, et al: Tumor necrosis factor-a provokes a hypertrophic growth response in adult cardiac myocytes. Circulation 95 (1997), 1247-1252.
Frering, B, I Philip, M Dehoux, et al: Circulating cytokines in patients undergoing normothermic cardiopulmonary bypass. J Thorac Cardiovasc Surg 108 (1994), 636-641.
Jansen, NJ, YJ Gu, L Eijsman, et al: Endotoxin release and tumor necrosis factor formation during cardiopulmonary bypass. Ann Thorac Surg 54 (1992), 744-747.
Menasche, P, S Haydar, J Peynet, et al: A potential mechanism of vasodilation after warm heart surgery. The temperature-dependent release of cytokines. J Thorac & Cardiovasc Surg 107 (1994), 293-299.
Wan, S, AP Yim: Cytokines in myocardial injury: Impact on cardiac surgical approach. Eur J Cardiothorac Surg 16 Suppl 1 (1999), S107-S111.
Adams, JE, GS Bodor, VG Davila-Roman, et al: Cardiac troponin I. A marker with high specificity for cardiac injury. Circulation 88 (1993), 101-106.
Vazquez-Jimenez, JF, MC Seghaye, Ma Qing, et al: Cannulation of the cardiac lymphatic system in swine. Eur J Cardiothorac Surg 18 (2000), 228-232.
Allen, SJ, HJ Geissler, KL Davis, et al: Augmenting cardiac contractility hastens myocardial edema resolution after cardio-pulmonary bypass and cardioplegic arrest. Anesthesia & Analgesia 85 (1997), 987-992.
Meldrum, DR: Tumor necrosis factor of the heart. Am J Physiol 274 (1998), R577-R595.
Wan, S, JM DeSmet, L Barvais, et al: Myocardium is a major source of proinflammatory cytokines in patients undergoing cardiopulmonary bypass. J Thorac & Cardiovasc Surg 112 (1996), 806-811.
Saatvedt, K, H Lindberg, OR Geiran, et al: Complement activation and release of tumour necrosis factor alpha, interleukin-2, interleukin-6 and soluble tumour necrosis factor and interleukin-2 receptors during and after cardiopulmonary bypass in children. Scand J Clin & Lab Invest 55 (1995), 79-86.
Jansen, NJ, W van Oeveren, HM Oudemansvan Straaten, et al: Inhibition by dexamethasone of the reperfusion phenomena in cardiopulmonary bypass. J Thorac & Cardiovasc Surg 102 (1991), 515-525.
Michie, HR, KR Manogue, DR Spriggs: Detection of circulating tumor necrosis factor after endotoxin administration. N Engl J Med 318 (1988), 1481-1486.
Mair, J, I Wagner, B Morass, et al: Cardiac troponin I release correlates with myocardial infarction size. Eur J Clin Chem Clin Biochem 33 (1995), 869-872.
Gao, WD, D Atar, Y Liu, et al: Role of troponin I proteolysis in the pathogenesis of stunned myocardium. Circ Res 80 (1997), 393-399.
Huang, X, Y Pi, KJ Lee, et al: Cardiac troponin I gene knockout: A mouse model of myocardial troponin I deficiency. Circ Res 84 (1999), 1-8.
McDonough, JL, DK Arrell, JE Van Eyk: Troponin I degradation and covalent complex formation accompanies myocardial ischemia/reperfusion injury. Circ Res 84 (1999), 9-20.
