CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 3, May/June 2014
AFRICA
103
contraction, and restrict left ventricular diastolic filling. They
can also obscure the anatomy of the heart, coronary arteries
and great vessels, and coronary grafts if present, immensely
complicating the procedure for re-operation by prolonging
surgery time, and potentially escalating serious mediastinal
injury during re-entry.
17,18
Adhesion formation occurs as a consequence of the
inflammatory response to surgical trauma, which can start within
a few hours of surgery, as routine surgical procedures consist
of tissue handling, including abrasion, desiccation, ischaemia,
haemorrhage, exposure to foreign material and overheating
by lamps.
18
Histological examination of pericardial tissues
from animals undergoing cardiac surgical procedures indicates
that damage to the mesothelium (especially by abrasion) is
adhesiogenic.
19,20
It is known that mesothelial cells are responsible for the
fibrinolytic properties of coelomic cavities, and damage to these
cells is the trigger for adhesion formation.
5
According to several
previous studies, although the mechanism of adhesion formation
is not fully understood, fibroblast activity and inflammatory
Fig. 3.
A. Histopathological section showing grade II fibro-
sis (**) in the control group (H&E ×200). B.
Histopathological section showing severe fibrosis
(**) around the myocardium (*) in the Ankaferd
group (H&E ×200).
A
B
Fig. 4.
Microscopic pictures of the control (A) and Ankaferd
(B) groups showing dense lymphocyte infiltration (**)
near the myocardial tissue (*) (H&E ×200).
A
B
Table 2. The distribution of the macroscopic and microscopic
scores between the control and Ankaferd groups
Variables
Ankaferd
group
n
(%)
Control
group
n
(%)
c
2
p
Macroscopic scores
Pericardial adhesions
Mild – moderate (1+2)
1 (12.5)
6 (75) 6.904 0.009
Severe – very severe (3+4)
7 (87.5)
2 (25)
Visibility of coronary vessels
Blurred (1)
1 (12.5) 5 (62.5) 4.557 0.033
Completely obscured (2)
7 (87.5) 3 (37.5)
Microscopic scores
Inflammation
None – mild (0+1)
0 (0.0)
1 (12.5) 1.453 0.220 (NS)
Moderate – severe (2+3)
Fibrosis
8 (100) 7 (87.5)
Mild – moderate (1+2)
0 (0.0)
3 (37.5) 4.857 0.028
Severe (3)
8 (100) 5 (62.5)
NS, not statistically significant (p > 0.05).
