Skip to main content
SpringerLink
Log in

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

  • Original Article
  • Published:
The Japanese Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

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 incidence of ventricular arrhythmias in the magnesium group.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Scheinman MM, Sullivan RW, Hutchinson JC, Hyatt KH: Clinical significance of changes in serum magnesium in patients undergoing cardiopulmonary bypass. J Thorac Cardiovasc Surg 61: 135–140, 1971

    PubMed  CAS  Google Scholar 

  2. Manners JM, Nielsen MS: Magnesium flux during open heart surgery. The effect of St. Thomas’ Hospital cardioplegia solution. Anaesthesia 36: 157–166, 1981

    Article  PubMed  CAS  Google Scholar 

  3. Satur CMR, Anderson JR, Jennings A, Newton K, Martin PG, Nair U, Walker DR: Magnesium flux caused by coronary artery bypass operation. Three patterns of deficiency. Ann Thorac Surg 58: 1674–1678, 1994

    Article  PubMed  CAS  Google Scholar 

  4. Fanning WJ, Thomas CS Jr, Roach A, Tomichek R, Alford WC, Stoney WS Jr: Prophylaxis of atrial fibrillation with magnesium sulfate after coronary artery bypass grafting. Ann Thorac Surg 52: 529–533, 1991

    Article  PubMed  CAS  Google Scholar 

  5. Karmy-Jones R, Hamilton A, Dzavik V, Allegreto M, Finegan BA, Koshal A: Magnesium sulfate prophylaxis after cardiac operations. Ann Thorac Surg 59: 502–507, 1995

    Article  PubMed  CAS  Google Scholar 

  6. Capsi J, Rudis E, Bar I, Safadi T, Saute M: Effects of magnesium on myocardial function after coronary artery bypass grafting. Ann Thorac Surg 59: 942–947, 1995

    Article  Google Scholar 

  7. England MR, Gordon G, Salem M, Chernow B: Magnesium administration and dysrhythmias after cardiac surgery. Aplacebo-controlled, double-blind, randomized trail. JAMA 268: 2395–2402, 1992

    Article  PubMed  CAS  Google Scholar 

  8. Aglio LS, Stanford GG, Maddi R, Boyd JL III, Nussbaum S, Chernow B: Hypomagnesemia is common following cardiac surgery. J Cardiothorac Vasc Anesthesia 5: 201–208, 1991

    Article  CAS  Google Scholar 

  9. Soman SD, Joseph KT, Raut SJ, Mulay CD, Parameshwaran M, Panday VK: Studies on major and trace element content in human tissues. Health Phys 19: 641–656, 1970

    Article  PubMed  CAS  Google Scholar 

  10. Dyckner T, Wester PO: The relation between extra- and intracellular electrolytes in patients with hypokalemia and/or diuretic treatment. Acta Med Scand 204: 269–282, 1978

    Article  PubMed  CAS  Google Scholar 

  11. Reinhart RA: Magnesium metabolism. A review with special reference to the relationship between intracellular content and serum levels. Arch Intern Med 148: 2415–2420, 1988

    Article  PubMed  CAS  Google Scholar 

  12. Cohen L, Kitzes R: Magnesium sulfate and digitalis-toxic arrhythmias. JAMA 249: 2808–2810, 1983

    Article  PubMed  CAS  Google Scholar 

  13. Whang R: Magnesium deficiency. Pathogenesis, prevalence, and clinical implications. Am J Med 82 (Suppl 3A): 24–29, 1987

    Article  PubMed  CAS  Google Scholar 

  14. Lown B, Wolf M: Approaches to sudden death from coronary heart disease. Circulation 64: 130–142, 1971

    Google Scholar 

  15. Simson MB: Use of signals in the terminal QRS complex to identify patients with ventricular tachycardia after myocardial infarction. Circulation 64: 235–242, 1981

    Article  PubMed  CAS  Google Scholar 

  16. Dense P, Santarelli P, Hauser RG, Uretz EF: Quantitative analysis of the high-frequency components of the terminal portion of the body surface QRS in normal subjects and in patients with ventricular tachycardia. Circulation 67: 1129–1138, 1983

    Article  Google Scholar 

  17. Elami A, Merin G, Flugelman MY, Adar L, Rudis E, Halon DA, Lewis BS: Usefulness of late potentials on the immediate postoperative signal-averaged electrocardiogram in predicting ventricular tachyarrhythmias early after isolated coronary artery bypass grafting. Am J Cardiol 74: 33–37, 1994

    Article  PubMed  CAS  Google Scholar 

  18. Ryzen E, Elbaum N, Singer FR, Rude RK: Parenteral magnesium tolerance testing in the evaluation of magnesium deficiency. Magnesium 4: 137–147, 1985

    PubMed  CAS  Google Scholar 

  19. Henzel JH, Deweese MS, Ridenhour G: Significance of magnesium and zinc metabolism in the surgical patient. I magnesium. Arch Surgery 95: 974–990, 1967

    CAS  Google Scholar 

  20. Alfrey AC: Disorders of magnesium metabolism, The kidney, physiology and pathophysiology, Seldin DW, Giebisch G, 2nd ed., New York, 1992, Ravan Press., 2357–2373

    Google Scholar 

  21. Anast CS, Winnacker JL, Forte LR, Burns TW: Impaired release of parathyroid hormone in magnesium deficiency. J Clin Endocrinol Metab 42: 707–717, 1976

    Article  PubMed  CAS  Google Scholar 

  22. Estep H, Shaw WA, Watlington C, Hobe R, Holland W, Tucker SG: Hypocalcemia due to hypomagnesemia and reversible parathyroid hormone unresponsiveness. J Clin Endocr 29: 842–848, 1969

    Article  PubMed  CAS  Google Scholar 

  23. Raisz LG, Niemann I: Effect of phosphate, calcium, magnesium on bone resorption and hormonal responses in tissue culture. Endoclinology 85: 446–452, 1969

    Article  CAS  Google Scholar 

  24. Marier JR: Magnesium content of the food supply in the modern-day world. Magnesium 5: 1–8, 1986

    PubMed  CAS  Google Scholar 

  25. Hollifield JW: Magnesium depletion, diuretics, and arrhythmias. Am J Med 82 (Supple 3A): 30–37, 1987

    Article  PubMed  CAS  Google Scholar 

  26. Dyckner T, Wester PO: Potassium/magnesium depletion in patients with cardiovascular disease. Am J Med 82 (Supple 3A): 11–17, 1987

    Article  PubMed  CAS  Google Scholar 

  27. Minami K, Körner MM, Vyska K, Kleesiek K, Knobl H, Körfer R: Effects of pulsatile perfusion on plasma catecholamine levels and hemodynamics during and after cardiac operations with cardiopulmonary bypass. J Thorac Cardiovasc Surg 99: 82–91, 1990

    PubMed  CAS  Google Scholar 

  28. Corr LA, Grounds RM, Beacham JL, Whitwam JG, Brown MJ: Effects of circulating endogenous catecholamines on plasma glucose, potassium and magnesium. Cli Sci 78: 185–191, 1990

    CAS  Google Scholar 

  29. Romani A, Scarpa A: Hormonal control of Mg2+ transport in the heart. Nature 346: 841–844, 1990

    Article  PubMed  CAS  Google Scholar 

  30. Kirkels JH, Van Echteid JA, Ruigrok TJC: Intracellular magnesium during myocardial ischemia and reperfusion. Possible consequences for postischemic recovery. J Mol Cell Cardiol 21: 1209–1218, 1989

    Article  PubMed  CAS  Google Scholar 

  31. Altura BM, Turlapaty PDMV: Withdrawal of magnesium enhances coronary arterial spasms produced by vasoactive agents. Br. J. Pharmac 77: 649–659, 1982

    CAS  Google Scholar 

  32. Nyler WG: The role of calcium in the ischemic myocardium. Am J Pathol 102: 262–270, 1981

    Google Scholar 

  33. Harris MNE, Crowther A, Jupp RA, Aps C: Magnesium and coronary revascularization. Br J Anesth 60: 779–783, 1988

    Article  CAS  Google Scholar 

  34. Mullen JC, Khan N, Weisel RD, Christakis GT, Teoh KH, Madonik MM, Mickle DAG, Ivanov J: Atrial activity during cardioplegia and postoperative arrhythmia. J Thorac Cardiovasc Surg 94: 558–565, 1987

    PubMed  CAS  Google Scholar 

  35. Borbola J, Serry C, Goldin M, Dense P: Short-term effect of coronar artery bypass grafting on the signal-averaged electrocardiogram. Am J Cardiol 61: 1001–1005, 1988

    Article  PubMed  CAS  Google Scholar 

  36. Lacroix D, Kacet S, Dagano J, Aisenfarb JC, Prat A, Warembourg H, Pol A, Caron J, Libersa C, Lekieffre J: Prognostic value and development of late potentials after aortocoronary bypass surgery. A prospective study of 100 patients. Arch Mal Coeur Vaiss 84: 71–76, 1991

    CAS  Google Scholar 

  37. Hirche HJ, Franz CHR, Bös L, Bissig R, Lang R, Schramm M: Myocardial extracellular K+ and H+ increase and noradrenaline release as possible cause of early arrhythmia following acute coronary artery occlusion in pigs. J Mol Cell Cardiol 12: 579–593, 1980

    Article  PubMed  CAS  Google Scholar 

  38. Wit AL, Janse MJ: The ventricular arrhythmias of ischemia and infarction. Electrophysiological mechanisms. New York, 1993, Futura publishing Co, Inc., p1–648

    Google Scholar 

  39. Woods WT, Katholi RE, Urthaler F, James TN: Electrophysiological effects of magnesium on cells in the canine sinus node and false tendon. Circ Res 44: 182–188, 1979

    PubMed  CAS  Google Scholar 

  40. Kraft LF, Katholi RE, Woods TW, James TN: Attenuation by magnesium of the electrophysiologic effects of hyperkalemia on human and canine heart cells. Am J Cardiol 45: 1189–1195, 1980

    Article  PubMed  CAS  Google Scholar 

  41. Shine KI, Douglas AM: Magnesium effects on ionic exchange and mechanical function in rat ventricle. Am J Physiol 227: 317–324, 1974

    PubMed  CAS  Google Scholar 

  42. Grimm M, Billhardt RA, Mayerhofer KE, Denes P: Prognostic significance of signal-averaged ECGs during acute myocardial infarction. A preliminary report. J Electrocardiol 21: 283–288, 1988

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiovascular Surgery, Tokyo Women’s Medical College Daini Hospital, Tokyo, Japan

    Seiichi Ichikawa

Authors
  1. Seiichi Ichikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ichikawa, S. Magnesium and calcium changes in serum and atrial muscle caused by open heart surgery and the effect of preoperative oral magnesium administration. Jpn J Thorac Caridovasc Surg 46, 287–298 (1998). https://doi.org/10.1007/BF03217744

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03217744

Keywords

Search

Navigation