Chapters authored
Utility of Modified Ultrafiltration in Congenital Heart Disease Patients Operated with Cardiopulmonary Bypass
Modified ultrafiltration is used in cardiac surgery with cardiopulmonary bypass in order to diminish systemic inflammatory response syndrome. We aimed to show its utility for removing pro-inflammatory agents in operated pediatric patients with congenital heart disease and its impact at operative care. A clinical case-control trial was designed, including patients with simple congenital heart disease operated on with cardiopulmonary bypass in a 1-year period. We randomized them to a problem group (with modified ultrafiltration, n = 15) and a control group (without it, n = 16), and blood samples to measure interleukins (6 and 10); 3d and 4d complement fraction concentrations were taken at the following times: baseline, before cardiopulmonary bypass, after it, after modified ultrafiltration, and from the ultrafiltration concentrate. Operative clinical end points of success were defined as hemodynamic stability, absence of morbidity, and lack of mortality. We observed a higher significant interleukin 6 concentration in the problem group patients at baseline, as well as a higher removal of this pro-inflammatory agent at the ultrafiltration concentrate. Modified ultrafiltration has a positive impact over simple congenital heart disease surgery with cardiopulmonary bypass because of removing interleukin 6. We recommend its routine use when hemodynamic conditions are favorable.
Part of the book: Advances in Extra-corporeal Perfusion Therapies
Impact of Modified Ultrafiltration in Congenital Heart Disease Patients Treated with Cardiopulmonary Bypass
Modified ultrafiltration is used in cardiac surgery with cardiopulmonary bypass in order to diminish systemic inflammatory response syndrome. We aimed to show its utility for removing pro-inflammatory agents in operated pediatric patients with congenital heart disease and its impact at operative care. A clinical case control trial was designed, including patients with simple congenital heart disease operated on with cardiopulmonary bypass in a 1-year period. We randomized them to a problematic group (with modified ultrafiltration, n = 15) and a control group (without it, n = 16), and blood samples to measure interleukins (6 and 10), 3d and 4d complement fraction concentrations were taken at the following times: baseline, before cardiopulmonary bypass, after it, after modified ultrafiltration, and from the ultrafiltration concentrate. Operative clinical end points of success were defined as hemodynamic stability, absence of morbidity, and lack of mortality. We observed a higher significant interleukin six concentration in the problematic group patients at baseline, as well as a higher removal of this pro-inflammatory agent at the ultrafiltration concentrate. Modified ultrafiltration has a positive impact over simple congenital heart disease surgery with cardiopulmonary bypass because of removing interleukin 6. We recommend its routinely use when hemodynamic conditions are favorable.
Part of the book: Congenital Heart Disease
Relationship between hypoxia and pulmonary microcirculation hemorheology in pediatric patients with patent ductus arteriosus operated at a moderate altitude
Hypobaric hypoxia due to altitude is a risk factor for patent ductus arteriosus (PDA). In order to explore a relationship between hypoxia and pulmonary microcirculation hemorheology in pediatric patients with surgically corrected PDA, a clinical case control study was carried out in a single medical center at a mean moderate altitude of 2240 meters above sea level (mASL). Patients were divided in two groups, with hypoxia (problems) and without hypoxia (controls), using conventional gasometric criteria. The problem group showed a higher hematocrit value. This suggests that an increase in blood viscosity due to the higher hematocrit level in response to altitude is a factor that promotes hypoxia in the pulmonary microcirculation. A pathophysiological explanation for this acute response in the problem group is provided.
Part of the book: Hypoxia - Recent Advances in the Field of Hypoxic and Ischemic Tissue Damage [Working title]