Açık Kalp Ameliyatı Yapılan Konjenital Kalp Hastalığı Olan Çocuk Hastalarda Miyokardiyal Mitokondri Fonksiyonlarının Histopatolojik ve Enzimatik Değişikliklerle Olan İlişkisi

Abstract

The most current innovative approaches such as mitochondria transplantation are promising options for children with congenital heart disease (CHD). In this study, we aimed to determine whether there is a potential pediatric patient group for this surgical option. This prospective study was conducted with 2 groups: children with cyanotic and acyanotic CHD, with 5 patients in each group. Mitochondrial dysfunction, fibrosis, nuclear atypia, and cardiac enzyme levels were evaluated as major parameters of the study. Additionally, the cardiopulmonary bypass duration, aortic clamp duration, intensive care unit follow-up, inotropic agent usage, and hospitalization duration of all patients were recorded. We evaluated the relationship of each parameter with cyanosis and mitochondrial dysfunction. The results showed that mitochondrial dysfunction was positive in all patients in the cyanotic group. However, there was no sign of mitochondrial dysfunction in acyanotic patient group; this finding may be assumed as a strong evidence for the relationship between cyanotic CHD and mitochondrial dysfunction. The cyanotic group with mitochondrial dysfunction had significantly longer cardiopulmonary bypass and aortic clamp duration, and their intensive care unit follow-up and hospitalization time were much longer than those of the acyanotic patient group. The cyanotic patient group with mitochondrial dysfunction also had higher usage of inotropic agent. We classified the fibrosis and nuclear atypia on a scale of 1 to 4, with 1 as normal tissue structure and 4 as severelydamaged tissue. All grades of tissue damage in terms of fibrosis and nuclear atypia were noted for both groups. Lastly, the postoperative cardiac enzyme levels and mitochondrial dysfunction relationship was determined to be statistically significant. Our present research is the first and the only scientific study at Hacettepe University Faculty of Medicine for the investigation of mitochondrial dysfunction and cardiac enzyme level in children with cyanotic CHD. As the pediatric patient group with cyanotic CHD showed mitochondrial dysfunction, mitochondrial transplantation may be considered as a routine approach during surgery for surgical success in patients with cyanotic CHD with mitochondrial dysfunction.