Nomoto Takuya, Nishina Takeshi, Tsuneyoshi Hiroshi, Miwa Senri, Nishimura Kazunobu, Komeda Masashi
Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
J Card Surg. 2003 Jul-Aug;18 Suppl 2:S61-8. doi: 10.1046/j.1540-8191.18.s2.9.x.
We reported that the initial beneficial effects of left ventricular repair (LVR) surgery for LV aneurysm after myocardial infarction (MI) did not persist because of postoperative LV remodeling in a rat model. The renin-angiotensin system (RAS) plays an important role in postinfarction LV remodeling. Inhibition of RAS may be useful to preserve LV function by preventing remodeling. We studied the effects of two inhibitors of RAS in an attempt to improve the operative results of LVR. LV aneurysms were created in rats after ligating the left anterior descending artery. These rats underwent LVR by plicating the LV aneurysm and were treated by three methods: no treatment, treatment with angiotensin-converting enzyme inhibitor (ACE-I) (lisinopril 10 mg/kg per day), and treatment with angiotensin II receptor blocker (ARB) (candesartan 5 mg/kg per day). One week after LVR, echocardiography revealed smaller LV size and better LV motion than before surgery. Four weeks after LVR, LV size returned to the preoperative value in the untreated group, but not as much in the treated groups. Cardiac catheterization revealed lower LV end-diastolic pressure and higher E-max in the treated groups. There was no difference between ACE-I and ARB groups except for systolic blood pressure. LVR decreased LV size and improved systolic function only in the early phase. Adjuvant therapy of ACE-I or ARB-attenuated LV remodeling and maintained LV function at the same level after LVR. This probably indicates that tissue RAS is associated with postoperative remodeling. Concomitant use of RAS inhibitors may make LVR a longer-lasting procedure for LV aneurysm.
我们报道，在大鼠模型中，心肌梗死（MI）后左心室修复（LVR）手术的初始有益效果并未持续，原因是术后左心室重塑。肾素-血管紧张素系统（RAS）在梗死后左心室重塑中起重要作用。抑制RAS可能有助于通过防止重塑来保留左心室功能。我们研究了两种RAS抑制剂的作用，试图改善LVR的手术效果。通过结扎左前降支在大鼠中制造左心室动脉瘤。这些大鼠通过折叠左心室动脉瘤接受LVR，并采用三种方法治疗：不治疗、用血管紧张素转换酶抑制剂（ACE-I）（赖诺普利10毫克/千克/天）治疗和用血管紧张素II受体阻滞剂（ARB）（坎地沙坦5毫克/千克/天）治疗。LVR术后1周，超声心动图显示左心室大小比手术前更小，左心室运动更好。LVR术后4周，未治疗组的左心室大小恢复到术前值，但治疗组恢复程度较小。心脏导管检查显示治疗组的左心室舒张末期压力较低，E-max较高。除收缩压外，ACE-I组和ARB组之间没有差异。LVR仅在早期阶段减小了左心室大小并改善了收缩功能。ACE-I或ARB的辅助治疗减轻了左心室重塑，并在LVR后将左心室功能维持在同一水平。这可能表明组织RAS与术后重塑有关。同时使用RAS抑制剂可能会使LVR成为治疗左心室动脉瘤更持久的手术。
