1 Introduction
A secundum atrial septal defect is a common congenital heart disease, the incidence rate of which accounts for about 10% of the incidence of congenital heart disease. The progress of the disease is slow, the clinical symptoms and signs are not obvious, and patients can be seriously affected in adulthood. The hemodynamic level of the patient and the occurrence of serious complications such as heart failure and pulmonary vascular occlusion seriously affect the health of the patient and can even endanger their lives. The secundum atrial septal defect was treated with intracardiac index surgery.[1,2] [3] [4] [5]
2 Methods
2.1 General information
Eighty-four infants who underwent extracorporeal circulation surgery for an atrial septal defect at our hospital from January 2016 to June 2018 were randomly divided into an observation group and a control group, with 42 cases in each group. Inclusion criteria[6] [7] P > .05). The general data were comparable.
2.2 Treatment methods
Both groups received treatment for respiratory diseases, malnutrition, arrhythmia, and other complications or symptoms before surgery. In the control group, modified St Thomas II high-potassium cold crystal cardioplegia was routinely used. In the observation group, sodium creatine phosphate for the injection was added to the cardioplegia. The dosage of the myocardial protective solution was 10 mmol/L, which was equivalent to 2.5 g/L.[8]
2.2.1 Infants with a polyester patch for secundum type interatrial septum
At the same time, the De Vega method or Kays method was used for tricuspid valvuloplasty. Postoperatively, the 2 groups were supported by different degrees of cardiopulmonary function according to the specific conditions. For patients with good preoperative cardiopulmonary function, the tracheal intubation was inserted according to the situation immediately. For patients with severe pulmonary hypertension, mechanical ventilation was appropriately extended.
2.2.2 Time
All the infants were treated with positive in otropic drugs and vasodilators according to their condition. Infants with arrhythmia still received antiarrhythmic drugs after treatment.
2.3 Detection methods
Before and 3, 6, 12, and 24 hours after the operation, the changes in the myocardial enzyme index, myocardial energy, and hemodynamic parameters were measured and vasoactive drugs were used within 2 days of the operation. On the day of the test, 3 mL of venous blood was taken from the 2 groups and centrifuged at 3500 rpm for 5 minutes, and then stored in a −20°C incubator for testing. Lactate dehydrogenase (LDH), creatine-phosphokinase (CPK), aspartate transaminase (AST), cardiac troponin I (CTnI), creatine kinase - MB (CK-MB), and other myocardial zymogram indicators: The detection kits for myocardial zymogram indicators were provided by Beckman Coulter (Beckman Coulter Company, Brea, California, USA). The enzyme-labeling instrument used was the ELx800 light-absorbing enzyme from Biotek (American Berton Company, Vermont, USA), standard instrument. Myocardial energy substance detection: The levels of myocardial energy substances such as adenosine triphosphate (ATP), adenosine diphosphate (ADP), adenosine monophosphate (AMP), and creatine phosphate (CP), were measured using a high-performance liquid phase method. Hemodynamic indicators: Hemodynamic observation indicators included heart rate (HR), central venous pressure (CVP), mean arterial pressure (MAP), etc. The detection instrument used FMS noninvasive hemodynamics provided by Beijing Baianji Technology Co, Ltd, monitor. Blood sample extraction operations were aseptic and all inspections were strictly performed according to the kit and instrument instructions.
2.4 Statistical methods
The SPSS19.0 software was used for statistical data processing. Measurement data were expressed as mean ± standard deviation and a 1-way analysis of variance was used for comparison between groups. Categorical data between the groups were compared using the Chi-squared test. Repeated measure analysis of variance was used for the comparison at multiple time points. P < .05 was considered statistically significant.
3 Results
3.1 The comparison of the changes in myocardial zymogram index before and after the operation
In both the control and observation groups, the preoperative values of myocardial zymograms indexes were significantly increased compared to those measured after the operation (P < .05, Table 1 ). By comparing the indexes between the 2 groups, we found that there were no significant preoperative differences in LDH, CPK, AST, CTnI, and CK-MB between them (P > .05), whereas the changes in myocardial zymograms at 3, 6, 12, and 24 hours after the operation were significantly higher in the observation group when compared to the control group (P < .05, Table 1 , Fig. 1 ).
Table 1: Comparison of changes in myocardial zymogram indexes before and after surgery in both groups (n = 42).
Figure 1: The comparison of the myocardial zymogram indexes in both groups before and after surgery. The concentrations of (A) lactate dehydrogenase (LDH), (B) creatine-phosphokinase (CPK), (C) aspartate transaminase (AST), (D) cardiac troponin I (CTnI), and (E) creatine kinase - MB (CK-MB) in the control and observation groups were measured before the operation and at 3, 6, 12, and 24 hours after the surgery.
3.2 The comparison of the myocardial energy level and recovery rate before and after the operation
The preoperative and postoperative levels of ATP, ADP, AMP, and CP in both groups were measured. There were no significant differences in the preoperative concentrations of ATP, ADP, AMP, and CP between the 2 groups (P > .05, Table 2 ). The levels of ATP, ADP, AMP, and CP in the observation group were significantly higher than those in the control group in the postoperative period (P < .05, Table 2 ). The recovery rate was also significantly increased in the group treated with phosphate cardioplegia compared with the controls (Table 2 ).
Table 2: Comparison of myocardial energy levels and recovery rates before and after surgery in both groups (n = 42, mmol/g).
3.3 The comparison of the hemodynamic changes between the 2 groups
In both groups, the hemodynamic parameters were significantly improved after the surgery compared to those measured before the operation (Table 3 ). The preoperative hemodynamic parameters, including HR, CVP, and MAP, were not statistically significant between the 2 groups (P > .05, Table 3 , Fig. 2 ). The HR and CVP in the observation group measured at 3, 6, 12, and 24-hour postoperation were significantly higher than those in the control group, whereas the MAP was lower when compared to the control group (P < .05, Table 3 , Fig. 2 ).
Table 3: Comparison of hemodynamic changes between the 2 groups (n = 42).
Figure 2: The comparison of the hemodynamic indicator indexes in both groups before and after surgery. The (A) heart rate (HR), (B) central venous pressure (CVP), and (C) mean arterial pressure (MAP) in the control and observation groups were measured before and at 3, 6, 12, and 24 hours after the surgery.
3.4 The comparison of postoperative vasoactive drug use in the 2 groups
The doses of vasoactive drugs such as dopamine, adrenaline, and milrinone in the observation group were lower than those in the control group on days 1 and 2 after the operation, the difference was statistically significant (P < .05, Table 4 ).
Table 4: Comparison of postoperative vasoactive drug use between the 2 groups (n = 42, mg/kg).
4 Discussion
A secundum atrial septal defect is a common congenital disease with no apparent clinical symptoms or signs in the early stages while the patient has obvious clinical features in adulthood, or even in old age.[9] [10] [11] [12,13]
Cardiac cardioplegia has a high protective effect on myocardial function during open-heart surgery.[14] [15,16]
During a myocardial ischemia-reperfusion injury, the permeability of the myocardial muscle cell membrane is increased, resulting in the release of myocardial enzymes into the blood. LDH, CPK, AST, CTnI, and CK-MB are key myocardial enzymes used to estimate the degree of myocardial injury.[17] [18] [19] [20–22] [23,24]
5 Conclusion
In summary, cardiac cardioplegia with sodium creatine phosphate is used in infants with a secundum atrial septal defect requiring a cardiopulmonary bypass to reduce myocardial ischemia-reperfusion injury, maintain energy supply during ischemia, and enhance the St Thomas II effect. The protective effect of high-potassium cold crystal cardioplegia is beneficial to the recovery of cardiac function in infants with a secundum atrial septal defect after cardiopulmonary bypass.
Author contributions
Conceptualization: Fang Yang, Bo Zhai.
Data curation: Fang Yang, Bo Zhai.
Formal analysis: Fang Yang, Bo Zhai.
Methodology: Fang Yang.
Resources: Fang Yang.
Writing – original draft: Fang Yang, Bo Zhai.
Writing – review & editing: Fang Yang, Bo Zhai.
References
[1]. Kan Y, Li L, Mo L, et al. Correlation between R wave notch in the inferior wall lead and secondary atrial septal defect in infants and young children. J Clin Pediatrics 2013;31:612–4.
[2]. Gao F, Yuan J, Zhu H. Evaluation of left atrial size and function in adult secondary atrial septal defect with pulmonary hypertension by left atrial volume tracking technique. Chin J Med Imaging 2014;22:263–7.
[3]. Chen Y, Pang W, Liu X. Clinical evaluation of 205 cases of congenital heart disease interventional closure. J China Med Univ 2012;4:281–2.
[4]. Morita K, Yamashiro M. Imaging diagnosis: Q & A. Cor triatriatum and ostium secundum atrial septal defect [in Japanese]. Kyobu Geka 2012;65:58–62.
[5]. Xu LF, Feng R, Yu W. Evaluation of myocardial protective effect of creatine phosphate on patients undergoing heart valve replacement. Chin J Public Health 2014;30:235–6.
[6]. Siddiqui WT, Parveen S, Siddiqui MT, et al. Clinical outcomes of surgically corrected atrial septal defects. J Pak Med Assoc 2013;63:662–5.
[7]. Gupta P, Kumar A. Amelia-meromelia sequence with atrial septal defect-a rare occurrence. Fetal Pediatr Pathol 2014;33:92–7.
[8]. Zang HJ, Liu YL, Long C, et al. Exogenous phosphocreatine was used to enhance the myocardial protective effect of stop infusion on infants. Chin J Thorac Cardiovasc Surg 2002;46–8.
[9]. Kan YN, Li L, Mo LJ, et al. Correlation between hook-type R wave and the degree of secondary atrial septal defect in infants and young children. Chin J Maternal Child Health 2013;28:5993–4.
[10]. Lou YM, Shen WJ, Xu WF. Evaluation of right ventricular function in adult atrial septal defect by two-dimensional speckle tracking imaging technique. Shanghai Med J 2013;36:716–20.
[11]. Tang Q, Zhang W, Guo SL. Real-time three-dimensional echocardiography to evaluate right atrial function before and after atrial septal defect surgery. J Practical Med 2014;30:1261–3.
[12]. Li W, Zhang L, Wang ZP. Analysis and mid-term follow-up of arrhythmia after interventional closure of atrial septal defect in children. Guangdong Med J 2013;34:3595–7.
[13]. James AT, Corcoran JD, McNamara PJ, et al. The effect of milrinone on right and left ventricular function when used as a rescue therapy for term infants with pulmonary hypertension. Cardiol Young 2016;26:90–9.
[14]. Zhang T, Gao CQ, Wang JL. Application of combined ultrafiltration combined with negative pressure assisted venous drainage in extracorporeal circulation in infants with open heart surgery. Med J Chin People Liberation Army 2014;39:57–60.
[15]. Savi M, Rossi S, Bocchi L, et al. Titanium dioxide nanoparticles promote arrhythmias via a direct interaction with rat cardiac tissue. Part Fibre Toxicol 2014;11:63.
[16]. Hussain T, Dragulescu A, Benson L, et al. Quantification and significance of diffuse myocardial fibrosis and diastolic dysfunction in childhood hypertrophic cardiomyopathy. Pediatr Cardiol 2015;36:970–8.
[17]. Zeng C, Jiang W, Zheng R, et al. Cardioprotection of tilianin ameliorates myocardial ischemia-reperfusion injury: role of the apoptotic signaling pathway. PLoS One 2018;13:e0193845.
[18]. Hu QS, Suzuki G, Young RF, et al. Reductions in mitochondrial O(2) consumption and preservation of high-energy phosphate levels after simulated ischemia in chronic hibernating myocardium. Am J Physiol Heart Circ Physiol 2009;297:H223–32.
[19]. Demirgan S, Erkalp K, Sevdi MS, et al. Cardiac condition during cooling and rewarming periods of therapeutic hypothermia after cardiopulmonary resuscitation. BMC Anesthesiol 2014;14:78.
[20]. Røsjø H, Vaahersalo J, Hagve TA, et al. Prognostic value of high-sensitivity troponin T levels in patients with ventricular arrhythmias and out-of-hospital cardiac arrest: data from the prospective FINNRESUSCI study. Crit Care 2014;18:605.
[21]. Han QY, Wang HX, Liu XH, et al. Circulating E3 ligases are novel and sensitive biomarkers for diagnosis of acute myocardial infarction. Clin Sci (Lond) 2015;128:751–60.
[22]. Malik S, deRubio RG, Trembley M, et al. G protein βγ subunits regulate cardiomyocyte hypertrophy through a perinuclear Golgi phosphatidylinositol 4-phosphate hydrolysis pathway. Mol Biol Cell 2015;26:1188–98.
[23]. Durak I, Kudaiberdieva G, Gorenek B. Prognostic implications of arrhythmias during primary percutaneous coronary interventions for ST-elevation myocardial infarction. Expert Rev Cardiovasc Ther 2015;13:85–94.
[24]. Wang SX, Tan L, Wang J, et al. Effect of levocarnitine on TIMP-1, ICAM-1 expression of rats with coronary heart disease and its myocardial protection effect. Asian Pac J Trop Med 2016;9:269–73.
