| Objective:The present study was designed to discuss whether wild type gene aldehyde dehydrogenase 2*1(ALDH2) in human have a excellent myocardial protection as to alleviate myocardial ischemic reperfusion injury. And to further ascertain whether the ALDH2 gene mutation can be a biomarker for poor recovery cardial function when surffed acute myocardial ischemia caused by cardiac surgery.Methods:106 patients who accordance with the inclusion criteria were enrolled in this study. Blood samples were taken when the first day they were hospitalized. Polymerase chain reaction in patients (PCR-RFLP) was used to analysis gene G487A polymorphism of ALDH2. According to genotype of ALDH2,106 patients were divided into two groups, the ALDH2 gene in wild-type (GG) group (n=75) and the ALDH2 gene mutations (AA/AG) group (n=31).General information was collected before surgery, including name, age, gender, weight, oxygen saturation, echocardiography, etc. Surgery schedules of two groups were the same, that was, right ventricular outflow tract were expanded, autologous pericardial patch across the pulmonary valve repair, ventricular septal defect repair. Anesthesia scheme were designed by anesthesiologist according to surgery schedules and conditions of patients. Cardiopulmonary bypass was established as conventional, HTK solution was perfuse through aortic root after aortic cross-clamping. Operation time, cardiopulmonary bypass time, clamping time were recorded. Anesthesia, cardiopulmonary bypass and surgical operations was operated by the same group of doctors.All patients were sent into pediatric intensive care unit by anesthesiologist and surgeon after surgery for closely monitoring the general situation and functions of important organs. To maintain absolute calm and mechanical ventilation, sedatives and muscle relaxants were pumped sustained through vein. Adverse event such as hyoxemia, arrhythmia, hypertension and hypotension were recorded. Dose of vasoactive and inotropic drugs were recorded and graded. Time during ICU, using ventilator and hospitalization efter surgery were recorded as well.Blood samples were taken and analysed content of cardiac troponin (TnI), creatine kinase (CK-MB) and human myoglobin (MOY) with ELSA method 24h after surgery. Echocardiography was used to check the left and right cardiac function 7 days after surgery.According to those two indicators, whether ALDH2 gene polymorphism is associated with the postoperative heart function were investigated.Results:In all 106 patients, the GG, AG, AA genotypes frequencies were respectively 70.75%,27.35%,1.9%. Sample distribution were consistent Hardy-Weinbeig equilibrium by X2 test (P> 0.05). TnI, CK-MB and MYO were significantly higher than the standard value after 24 hours in two groups. The TnI, CK-MB and MYO of the mutant group were lower than the wild type group. Trend of useing inotropic drugs was decreasing within 48 hours in two groups. The mutant group's inotropic drug score was lower in immediately,24h,36h,48h after surger than the wild type group, and as the max-dose of inotropic drugs mutant group was less than wild-type group. The postoperative LVEF, VLFS, CL were within the normal range, but the differences between the two groups was no significant difference compared. However, The IVA and RVEF of wild-type patients was significantly lower than mutation-type patients, and Tei-index were significantly higher than that of mutation patients. The indicators of Right ventricular function between the two groups were statistically significant differences, P<0.05. The time of using ventilator, ICU stay and hospitalization of wild-type group was longer than those of mutant group.Conclusions:1.The Chinese ALDH2 gene mutation rate were less than the Japanese, but higher than Western Caucasians ALDH2* 2 gene mutation.2. ALDH2 mutant tetralogy of Fallot patients before hypoxia induced mitochondrial aggregation in long aldehydes, resulting in remodeling of myocardial cell metabolism. In the patients experienced open heart surgery under induced acute ischemia-reperfusion injury, preoperative myocardial cell metabolism resulting reconstruction can significantly reduce the myocardial ischemia-reperfusion injury.ALDH2 gene mutation could not be a prediction index for poor recovery cardial function after tetralogy of Fallot radical operation. In contrast, ALDH2 gene mutation may play a role of cardiac protective function.3. In ALDH2 wild-type gene tetralogy of Fallot patients 4-HNE may occur with the addition reaction of ALDH2, ALDH2 activity significantly reduced before Operation. Underwent surgery in patients with acute myocardial ischemia-reperfusion injury, ALDH2 unable to acute myocardial ischemia-reperfusion injury result in effective protection. |
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