GKD Anest Yoð Bak Dern Derg. 2017; 23(3): 71-77 | DOI: 10.5222/GKDAD.2017.071

Evaluation of cardiac functions to acute normovolemic hemodilution in diabetic patients undergoing coronary surgery with transoesophageal echocardiography

Tülün Öztürk¹, Özgür Bayturan², Funda Yýldýrým³, Ýhsan Ýþkesen³, Ömer Tetik^3
1Celal Bayar University. Faculty Of Medicine. Department Of Anaesthesiology And Ranimation. Manisa, Turkey
²Celal Bayar University. Faculty Of Medicine. Department Of Cardiology. Manisa, Turkey.
³Celal Bayar University. Faculty Of Medicine. Department Of Cardiovascular Surgery. Manisa, Turkey.

INTRODUCTION: The aim of this study is to evaluate the cardiac response to acute normovolemic hemodilution in patients with diabetic normal or low ejection fraction undergoing coronary surgery with transoesophageal echocardiography.
METHODS: The patiens were divided in four group:
Group 1ANH (n: 15): Ejection fraction>%40 and the patiens were performed ANH.
Grup 1C(n: 15): Control group. Ejection fraction>%40 and the patiens were not performed ANH.
Grup 2ANH (n: 15): Ejection fraction≤40 and the patiens were performed ANH.
Grup 2C(n: 15): Control group. Ejection fraction≤40 and the patiens were not performed ANH.
The TEE measurements were obtained before ANH and 30 minutes later the application. With 2D echocardiography systolic (left ventricle end diastolic area(LVEDA), left ventricle end systolic area (LVESA), fractional area difference (FAD), stroke volume (SV), cardiac index (CI) and diastolic functions; early mitral fullment velocity (Em Vmax), atrial contraction (Am Vmax), ratio ( E/A) and deceleration
RESULTS: Hemodynamic and TEE data in Group 1K and Group 1ANH were not different according to beginning data. However, LVEDA was significantly higher in Group 2ANH after ANH, according to those at the beginning in Group 2ANH (p<0.01). LVESA was not different in these groups. EmVmax. was also similar, but AmVmax. was significantly increased and E/A ratio was significantly decreased in Group 2ANH after ANH, compared to those at the beginning in Group 2ANH. (p<0.001).
DISCUSSION AND CONCLUSION: In summary, to apply mildy acute normovolemic hemodilution in patients with diabetic normal or low ventricular fraction were well tolerated without disturbing left ventricular functions. However, in the presence of atrial fibrillation in diabetic patients with low ejection fractions undergoing cardiac surgery, ANH should be performed be carefully, because of increasing the AmVmax. with ANH

Keywords: acute normovolemic hemodilution, diabetetes mellitus, echocardiography, cardiac surgery

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Koroner arter cerrahisi geçiren diyabetik hastalarda akut normovolemik hemodilüsyon uygulamasýna kardiyak yanýtlarýn transözefageal ekokardiyografi ile deðerlendirilmesi

Tülün Öztürk¹, Özgür Bayturan², Funda Yýldýrým³, Ýhsan Ýþkesen³, Ömer Tetik^3
1Celal Bayar Üniversitesi. Týp Fak. Anesteziyoloji Ve Reanimasyon Ad. Manisa, Türkiye.
²Celal Bayar Üniversitesi Týp Fak. Kardiyoloji AD. Manisa, Türkiye
³Celal Bayar Üniversitesi Kalp ve Damar Cerrahisi AD. Manisa, Türkiye

GÝRÝÞ ve AMAÇ: Çalýþmanýn amacý; koroner arter cerrahisi geçirecek, diabetik ve düþük kalp debili (EF ≤ % 40) veya normal kalp debili (EF >40) olgularýn, akut normovolemik hemodilüsyon uygulamasýna kardiyak yanýtlarýnýn transözefageal ekokardiyografik yöntemle deðerlendirilmesidir
YÖNTEM ve GEREÇLER: Hastalara TÖE 4 gruba ayrýldýlar:
Grup 1ANH (n: 15): Ejeksiyon fraksiyonu > % 40, ANH uygulanacak grup.
Grup 1K(n: 15): Kontrol grubu, Ejeksiyon fraksiyonu > % 40, ANH uygulanmayacak grup.
Grup 2ANH (n: 15): Ejeksiyon fraksiyonu ≤ 40, ANH uygulanacak grup.
Grup 2K(n: 15): Kontrol grubu: Ejeksiyon fraksiyonu ≤ 40, ANH uygulanmayacak grup.
TÖE bulgularý, ANH uygulamadan önce ve 30 dakika sonra elde edildi. 2D ekokardiyografi ile kalbin sistolik; Sol ventrikül diyastol sonu alaný(LVEDA), sol ventrikül sistol sonu alaný(LVESA), sol ventrikül fraksiyonel alan deðiþimi(FAD), atým volümü(SV), kardiyak debi(CI) ve diyastolik fonksiyonlarý; erken mitral dolma(Em Vmax.), atriyal kontraksiyon(Am Vmax.), oranlarý E/A) ve deselerasyon zamaný(DZ), izovolümetrik relaksasyon zamaný( IVRT) parametreleri ölçüldü.

BULGULAR: Hemodinamik ve TÖE ölçümleri, Grup 1K ve Grup 1ANH gruplarýnda baþlangýç deðerlerine göre farklý deðildi. Buna karþýn, LVEDA, Grup 2ANH' de ANH sonrasý, baþlangýç grubuna göre göre anlamlý yüksekti (p<0.001). LVESA bu gruplarda deðiþmedi. Grup 2ANH' da ANH sonrasý, baþlangýç ile karþýlaþtýrýldýðýnda, EmVmax. deðiþmedi, AmVmax. anlamý olarak arttý, E/A oraný da anlamlý olarak azaldý. (p<0.01).
TARTIÞMA ve SONUÇ: Anestezi altýnda, normal ve düþük EF'lu diyabetik hastalarda, orta derecede akut normovolemik hemodilüsyon uygulamasý, LV fonksiyonlarýný bozmadan iyi tolere edildi. Ancak, atriyal fibrilasyonun varlýðýnda düþük EF'lu kardiyak cerrahi geçirecek diyabetik hastalarda, ANH ile AmVmax. arttýðý için, ANH dikkateli uygulanmalýdýr.

Anahtar Kelimeler: Akut normovolemik hemodilüsyon, diyabetetes mellitus, ekokardiyografi, kardiyak cerrahi

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