Magnesium flux caused by coronary artery bypass operation: Three patterns of deficiency

Satur, Christopher M.R.; Andersen, John Roger; Jennings, Alison; Newton, K. E.; Martín, Paul; Nair, Unikrishnan; Walker, Duncan R.

doi:10.1016/0003-4975(94)91657-8

Cited by 25 publications

(18 citation statements)

References 22 publications

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“…Isto explica, pelo menos em parte, os efeitos benéficos de sua presença no momento da reperfusão, fato que permanecia ainda obscuro quando considerados seus efeitos apenas por ação direta nas musculaturas cardíaca e lisa vascular. Assim, justifica-se sua indicação precoce na vigência do binômio isquemia/reperfusão comum na prática cardiológica moderna incluindo recanalização de artérias após trombólise, angioplastias e particularmente despinçamento aórtico (4)(5)(6)18,44) .…”

Section: Implicações Clínicasunclassified

“…Ressaltese, o uso de diuréticos, o estresse, as restrições dietéticas e a administração pré-operatória de catecolaminas contribuem significativamente para queda dos níveis circulantes de magnésio nos pacientes cirúrgicos (6,44,45) . Adicionalmente a composição do perfusato por soluções que não possuem magnésio, como a solução de Ringer, propicia queda adicional na concentração sérica de magnésio induzida pela hemodiluição (4,6,44,47) . Os fatores acima descritos são relativamente freqüentes e exacerbam a disfunção endotelial causada pela isquemia/reperfusão.…”

Section: Implicações Clínicasunclassified

“…O conhecimento dos efeitos benéficos da infusão de magnésio no per-operatório de cirurgias cardíacas (3,4,5,6) levantou a possibilidade de sua influência positiva atenuando a disfunção endotelial decorrente da lesão de isquemia/reperfusão. Na tentativa de compreender os mecanismos responsáveis pelo efeito protetor observado com a infusão do magnésio em cirurgia cardíaca, estudos demonstraram que o magnésio tem um papel importante na via clássica da liberação de NO (7,8) .…”

Section: Introductionunclassified

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Disfunção endotelial após isquemia global e reperfusão em cirurgia cardíaca com circulação extracorpórea: estudo do papel do magnésio em artérias coronarianas caninas

Volpe

Carneiro

Magna³

et al. 2002

Rev Bras Cir Cardiovasc

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Introduction: Hypomagnesemia and ischemia followed by reperfusion often occur in cardiac surgery. Both of them are associated with endothelial dysfunction which interfers VOLPE, MA ET AL -Disfunção Endotelial após Isquemia Global e Reperfusão em Cirurgia Cardíaca com Circulação Extracorpórea: Estudo do Papel do Magnésio em Artérias Coronarianas Caninas Atualização e análise crítica. Cardiovasc 2002; 17(3): 187-200 Objective: The present study focuses on the endothelial dysfunction consequent to the lesion resulting from global ischemia followed by reperfusion and the potential protective influence of magnesium on the endothelium functional integrity in isolated coronaries of dogs. Rev Bras CirMethod: Segments of canine coronary arteries were suspended in organ chambers to measure isometric force. Endothelial dysfunction was evaluated by the ability of these segments to produce nitric oxide changing the initial isometric force. Four groups with six dogs in each one were selected: SEM CEC (control), CEC (110 minutes of perfusion without ischemia), ISQ (45 minutes of ischemia), ISQ/REP (45 minutes of ischemia followed by 60 minutes of reperfusion). The magnesium action was evaluated in three different phases: I (organ chambers with magnesium), II (organ chambers without magnesium) and III (organ chambers with restored magnesium). Three pharmacological agonists were used which represented the main steps involved in the nitric oxide production: the membrane receptor of the endothelial cell -acetylcholine (ACh); transduction of the signal between the receptor and the intracellular processes through the G-protein -sodium fluoride (NaF); liberation of intracellular stocks of calcium -calcium ionophore (A 23187 ). The study of endothelial function was combined with the evaluation of smooth muscle activity dependent on GMPcsodium nitroprusside (NPS).Results: The major findings of this investigation were as follows: 1) presence of magnesium in priming seemed to attenuate the endothelial dysfunction caused by global ischemia followed by reperfusion; 2) presence of magnesium in the organ chamber (phase I) was associated with the greatest relaxation in response to agonists of the nitric oxide production; 3) removal of magnesium in the organ chamber (phase II) was linked to the reduction in the relaxation intensity in response to agonists of the nitric oxide production; 4) the magnesium restoration to the organ chamber (phase III) allowed restoration of the relaxation observed in the phase I, only in response to the direct stimulation of the G-proteins. For the rest of the remaining agonists, the restoration was associated with the additional reduction in the relaxation intensity; 5) the smooth muscle received the influence of the magnesium concentration in the organ chamber.Conclusion: It was concluded that magnesium favorably influences the nitric oxide production by the coronary endothelium attenuating the endothelial dysfunction caused by global ischemia followed by reperfusion.Descriptors: Magnesium. Endotheli...

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Section: Implicações Clínicasunclassified

Section: Introductionunclassified

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Disfunção endotelial após isquemia global e reperfusão em cirurgia cardíaca com circulação extracorpórea: estudo do papel do magnésio em artérias coronarianas caninas

Volpe

Carneiro

Magna³

et al. 2002

Rev Bras Cir Cardiovasc

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“…Interestingly, Satur et al (1994) found that the levels of serum Mg were significantly reduced at 3 and 30 min after CABG compared to the preoperative value and lasted for more than 24 h. They proposed that the decrease in serum Mg levels was related to the following factors: (1) blood diluting-induced hypomagnesaemia; (2) paroxysmal ischemia and blood dilution; (3) acute catecholamine secretion, stress, and associated high free fatty acid concentrations (Ryzen et al, 1986). However, the exact mechanism of Mg decline associated with PCI is unclear.…”

Section: Fig 4 Associations Between P-selectin (A)/mg (B) and Adversmentioning

confidence: 99%

“…Some other studies have demonstrated the cardioprotective effects of Mg after ischemiareperfusion injury (Headrick et al, 1998;Ravn et al, 1999;Moens et al, 2005) and that intravenous or oral application of Mg has marked antithrombotic effects (Shechter et al, 1999). A significant decrease in serum Mg levels at 3 and 30 min after coronary artery bypass graft (CABG) surgery has been reported (Satur et al, 1994), but limited data exist on changes in serum Mg concentrations in patients after PCI.…”

Section: Introductionmentioning

confidence: 99%

Temporal changes in circulating P-selectin, plasminogen activator inhibitor-1, magnesium, and creatine kinase after percutaneous coronary intervention

Ying

Xiang

Lü

et al. 2010

J. Zhejiang Univ. Sci. B

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Abstract:Objective: This study aims to determine the mechanisms underlying restenosis and ischemia-reperfusion injury of the myocardium after percutaneous coronary intervention (PCI). Methods: The present study examined serial changes (5 min, 30 min, 2 h, 6 h, and 24 h after PCI) in circulating P-selectin, plasminogen activator inhibitor-1 (PAI-1), magnesium (Mg), and creatine kinase-myocardial band fraction (CK-MB) levels, which may be associated with restenosis and myocardial injury in patients undergoing PCI. The occurrence rates of major adverse cardiovascular events were collected over a six-month follow-up. Results: PCI induced an early elevation of P-selectin, which correlated positively with the inflation pressure used in the PCI procedure. PCI also caused a significant and sustained decrease in serum Mg in PCI patients, without an effect on PAI-1. An increase in CK-MB was observed in PCI patients, although values were within normal reference range. In addition, elevated P-selectin and decreased Mg measured shortly after the coronary angioplasty procedure were associated with recurrent treatment and heart failure, respectively. Conclusions: Our study demonstrates that PCI induces temporal changes of P-selectin, Mg, and CK-MB, which may be involved in restenosis and ischemia-reperfusion injury. These findings highlight the need for using antiplatelet therapy and Mg to reduce the risks associated with PCI.

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Magnesium and calcium changes in serum and atrial muscle caused by open heart surgery and the effect of preoperative oral magnesium administration

Ichikawa

1998

Jpn J Thorac Caridovasc Surg

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The study was undertaken to compare magnesium and calcium serum concentration levels and magnesium and calcium atrial muscle content of between the non-magnesium group (20 patients) and the magnesium group (11 patients) in the perioperative period of open heart surgery. In addition, the incidence of arrhythmias was compared between the two groups. Late ventricular potentials and postoperative ventricular arrhythmias were evaluated in both groups. The patients of the magnesium group were administered a daily oral intake of 3.0 g of magnesium oxide for ten days before operation. In both groups, serum concentration of magnesium decreased abruptly due to hemodilution after the operation and began increasing gradually from 24 hours after the operation. However, in the non-magnesium group the concentration decreased below the normal range in the 24 hour period after the operation and elevated to above the preoperative value from the third to fifth postoperative days. In the magnesium group serum concentration of magnesium was higher during the 24 hours after the operation and lower from the third to fifth postoperative days than the non-magnesium group. Thus, the fluctuation was smaller in the magnesium group than the non-magnesium group. Serum concentration of calcium also decreased abruptly after the operation and gradually increased in the postoperative days in both groups. However, the level was always higher in the magnesium group than the non-magnesium group. The concentration ratio of serum calcium to magnesium was relatively unchanged postoperatively in the magnesium group, whereas it decreased significantly from the second to seventh postoperative days in the non-magnesium group. Magnesium and calcium contents in the atrial muscle were measured before and after cardiopulmonary bypass. Before bypass, magnesium and calcium contents were higher in the magnesium group than the non-magnesium group. However, in the non-magnesium group the calcium content increased significantly after bypass compared to pre-bypass levels, whereas it was unchanged in the magnesium group. Ventricular arrhythmias severer than grade 3 were found in 4 cases in the non-magnesium group. On the other hand, no ventricular arrhythmias severer than grade 3 were found in the magnesium group. As to the incidence of supraventricular arrhythmias, no difference was demonstrated between both groups. The appearance of late ventricular potentials on signal averaged electrocardiograms was found variable and often transient, and no association was found between the appearance of late ventricular potentials and the incidence of ventricular arrhythmias. Smaller fluctuations of magnesium and calcium concentrations in serum as well as in the atrial muscle were observed in the postoperative days in the magnesium group. Magnesium and calcium ratio also showed smaller fluctuations in the postoperative days in the magnesium group. In conclusion, these factors, along with suppression of calcium influx in the cardiac muscle, appeared to serve to reduce the inciden...

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Magnesium flux caused by coronary artery bypass operation: Three patterns of deficiency

Cited by 25 publications

References 22 publications

Disfunção endotelial após isquemia global e reperfusão em cirurgia cardíaca com circulação extracorpórea: estudo do papel do magnésio em artérias coronarianas caninas

Disfunção endotelial após isquemia global e reperfusão em cirurgia cardíaca com circulação extracorpórea: estudo do papel do magnésio em artérias coronarianas caninas

Temporal changes in circulating P-selectin, plasminogen activator inhibitor-1, magnesium, and creatine kinase after percutaneous coronary intervention

Magnesium and calcium changes in serum and atrial muscle caused by open heart surgery and the effect of preoperative oral magnesium administration

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