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Luo ZR, Yu LL, Zheng GZ, Huang ZY. Myocardial injury and inflammatory response in percutaneous device closures of pediatric patent ductus arteriosus. BMC Cardiovasc Disord 2022; 22:228. [PMID: 35585489 PMCID: PMC9118593 DOI: 10.1186/s12872-022-02666-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/10/2022] [Indexed: 11/23/2022] Open
Abstract
Background The percutaneous device closure of patent ductus arteriosus (PDA) is widely used in clinical practice, however full data on the changes in myocardial injury and systemic inflammatory markers’ levels after PDA in children are not fully reported. Methods We have conducted a retrospective analysis of the medical records of 385 pediatric patients in our hospital from January 2017 to December 2019. The patients were distributed into five groups. The first four (A, B, C and D) included patients divided by the type of the surgical closure methods, namely ligation, clamping, ligation-combined suturing and ligation-combined clamping, respectively. The fifth group E comprised of percutaneous device PDA patients. All recorded medical and trial data from the five groups were statistically studied. Results No serious complications in the patients regardless of the classification group were reported. Our results suggested that there were no considerable differences between the groups at the baseline (with all P > 0.05). Group E demonstrated a significantly smaller operative time (42.39 ± 3.88, min) and length of hospital stay (LOS) (4.49 ± 0.50, day), less intraoperative blood loss (7.12 ± 2.09, ml) while on the other hand, a higher total hospital cost (24,001.35 ± 1152.80, RMB) than the other four groups (with all P < 0.001). Interestingly, the comparison of the inflammatory factors such as white blood cells (WBC) count, C-reactive protein (CRP), procalcitonin (PCT) and interleukin-6 (IL-6), as well as the myocardial injury markers (CKMB and troponin I) did not show a significant increase (P > 0.05) among the four groups. On the contrary, when the aforementioned factors and markers of all the surgical groups were compared to those in group E, we observed significantly higher speed and magnitude of changes in group E than those in groups A, B, C, and D (with all P < 0.001). Conclusion Although the percutaneous device closure of PDA is more comforting and drives fast recuperation in comparison to conventional surgery, it provokes myocardial injury and overall inflammation. Timely substantial and aggressive intervention measures such as the use of antibiotics before operation and active glucocorticoids to suppress inflammation and nourish the myocardium need be applied if the myocardial and inflammatory markers are eminent.
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Affiliation(s)
- Zeng-Rong Luo
- Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, People's Republic of China
| | - Ling-Li Yu
- Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, People's Republic of China
| | - Guo-Zhong Zheng
- Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, People's Republic of China
| | - Zhong-Yao Huang
- Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China. .,Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, People's Republic of China.
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Rao H, Dutta S, Menon P, Attri S, Sachdeva N, Malik M. Procalcitonin and C-reactive protein for diagnosing post-operative sepsis in neonates. J Paediatr Child Health 2022; 58:593-599. [PMID: 34636117 DOI: 10.1111/jpc.15774] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/13/2021] [Accepted: 09/19/2021] [Indexed: 11/28/2022]
Abstract
AIM To determine whether serum procalcitonin (PCT) or C-reactive protein (CRP) can diagnose post-operative sepsis among neonates undergoing major non-cardiac surgery. METHODS In this diagnostic study, we included neonates who underwent major non-cardiac surgery and were monitored for post-operative sepsis. We excluded pre-existing septic, inflammatory or life-threatening conditions. Subjects either had 'definite' (culture-positive, n = 14), 'probable' (clinical sepsis, culture-negative, n = 25) or no sepsis (n = 31). We measured serum CRP and PCT at 48 ± 6 h, 72 ± 6 h and 96 ± 6 h post-operatively and compared 'definite or probable sepsis' with 'no sepsis'. RESULTS Median (Q1, Q3) CRP (mg/L) in 'definite or probable' sepsis group was higher than 'no sepsis' at 72 h (91.48 (57.87, 143.50) vs. 51.32 (33.0, 80.1); P = 0.009) and 96 h (87.51 (45.19, 128.22) vs. 31.00 (25.3, 45.2); P < 0.001). Median (Q1, Q3) PCT (ng/mL) in 'definite or probable' sepsis was higher than 'no sepsis' at 72 h (4.22 (2.04, 12.73) vs. 1.78 (0.9, 6.4); P = 0.01) and 96 h (3.54 (1.96, 9.65) vs. 0.97 (0.4, 3.0); P < 0.001). Ninety-six-hour CRP and PCT cut-offs (based on Youden's index) were 74.16 mg/L and 1.65 ng/mL, respectively. If both CRP and PCT were positive, specificity was 100% (95% confidence interval: 88.78-100). If either one was positive, sensitivity was 88.89% (95% confidence interval: 73.94-96.89). CONCLUSIONS Septic neonates have significantly higher serum CRP and PCT compared to non-septic neonates at 72 and 96 h post-operatively. If both CRP and PCT are positive at 96 h after surgery, it has 100% specificity, and if either one is positive, 89% sensitivity.
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Affiliation(s)
- Hitendra Rao
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sourabh Dutta
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Prema Menon
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Savita Attri
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Naresh Sachdeva
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Muneer Malik
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Cai L, Zeng G, Li Y, Peng X. A study of clinical implementation of ventricular septal defect closure using three transthoracic approaches. Am J Transl Res 2021; 13:11833-11841. [PMID: 34786112 PMCID: PMC8581886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 05/08/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To investigate the clinical implementation of ventricular septal defect closure using the three transthoracic approaches. METHODS A total of 70 children with septal defects admitted to our hospital from January 2017 to December 2020 were selected as the study subjects. Among them, 10 children with the left thorax-right ventricle-left ventricle approach were assigned to Group A, 8 children with the right thorax-atrium dextrum-right ventricle-left ventricle approach were assigned to Group B, and 52 children with the subxyphoid-right ventricle-left ventricle approach were assigned to Group C. The surgical indices were recorded, the success rates of closure and cardiopulmonary function indices were compared, electrocardiogram (ECG), echocardiogram and X-ray film were investigated at 1, 3 and 12 months after surgery, and the incidence of complications was recorded. RESULTS There was no statistically significant difference in the success rate of closure among the three groups (P > 0.05). The duration of intracardiac operations in Groups A and C was remarkably shorter than that in Group B, and the duration of skin incision and suture and hospital stay in Groups A and B were noticeably shorter than those in Group C (P < 0.05). After surgery, there was statistically significant difference in the contents of creatine kinase MB (CK-MB) isoenzyme, lactate dehydrogenase (LDH), serum malondialdehyde (MDA) and superoxide dismutase (SOD) among the three groups (P > 0.05). Airway resistance (Raw), oxygenation index (OI), and alveolar-arterial oxygen gradient (AaDO2) indicated that the postoperative pulmonary function in Group C was more effectively protected. There was no statistically significant difference in the incidence of complications among the three groups (P > 0.05). CONCLUSION Ventricular septal defect closure using the three transthoracic approaches exhibited a high success rate and a high safety profile.
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Affiliation(s)
- Longren Cai
- Department of Cardiac Surgery, Ganzhou People's Hospital Ganzhou 341000, Jiangxi Province, China
| | - Ganhua Zeng
- Department of Cardiac Surgery, Ganzhou People's Hospital Ganzhou 341000, Jiangxi Province, China
| | - Yan Li
- Department of Cardiac Surgery, Ganzhou People's Hospital Ganzhou 341000, Jiangxi Province, China
| | - Xinghua Peng
- Department of Cardiac Surgery, Ganzhou People's Hospital Ganzhou 341000, Jiangxi Province, China
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Farias JS, Villarreal EG, Dhargalkar J, Kleinhans A, Flores S, Loomba RS. C-reactive protein and procalcitonin after congenital heart surgery utilizing cardiopulmonary bypass: When should we be worried? J Card Surg 2021; 36:4301-4307. [PMID: 34455653 DOI: 10.1111/jocs.15952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/22/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION To assess the efficacy of C-reactive protein (CRP) and procalcitonin (PCT) at identifying infection in children after congenital heart surgery (CHS) with cardiopulmonary bypass (CPB). MATERIALS AND METHODS Systematic review of the literature was conducted to identify studies with data regarding CRP and/or PCT after CHS with CPB. The primary variables identified to be characterized were CRP and PCT at different timepoints. The main inclusion criteria were children who underwent CHS with CPB. Subset analyses for those with and without documented infection were conducted in similar fashion. A p value of less than .05 was considered statistically significant. RESULTS A total of 21 studies were included for CRP with 1655 patients and a total of 9 studies were included for PCT with 882 patients. CRP peaked on postoperative Day 2. A significant difference was noted in those with infection only on postoperative Day 4 with a level of 53.60 mg/L in those with documented infection versus 29.68 mg/L in those without. PCT peaked on postoperative Day 2. A significant difference was noted in those with infection on postoperative Days 1, 2, and 3 with a level of 12.9 ng/ml in those with documented infection versus 5.6 ng/ml in those without. CONCLUSIONS Both CRP and PCT increase after CHS with CPB and peak on postoperative day 2. PCT has a greater statistically significant difference in those with documented infection when compared to CRP and a PCT of greater than 5.6 ng/ml should raise suspicion for infection.
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Affiliation(s)
- Juan S Farias
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
| | - Enrique G Villarreal
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
| | - Janhavi Dhargalkar
- Department of Pediatrics, Chicago Medical School/Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Alicia Kleinhans
- Section of Critical Care and Cardiology, Texas Children's Hospital, Houston, Texas, USA.,Department of Pediatrics, Baylor School of Medicine, Houston, Texas, USA
| | - Saul Flores
- Section of Critical Care and Cardiology, Texas Children's Hospital, Houston, Texas, USA.,Department of Pediatrics, Baylor School of Medicine, Houston, Texas, USA
| | - Rohit S Loomba
- Department of Pediatrics, Chicago Medical School/Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA.,Department of Pediatric Critical Care, Advocate Children's Hospital, Oak Lawn, Illinois, USA
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Wang A, Cui C, Fan Y, Zi J, Zhang J, Wang G, Wang F, Wang J, Tan Q. Prophylactic use of levosimendan in pediatric patients undergoing cardiac surgery: a prospective randomized controlled trial. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:428. [PMID: 31888711 PMCID: PMC6937718 DOI: 10.1186/s13054-019-2704-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 12/13/2019] [Indexed: 12/15/2022]
Abstract
Background The administration of levosimendan prophylactically to patients undergoing cardiac surgery remains a controversial practice, and few studies have specifically assessed the value of this approach in pediatric patients. This study therefore sought to explore the safety and efficacy of prophylactic levosimendan administration to pediatric patients as a means of preventing low cardiac output syndrome (LCOS) based upon hemodynamic, biomarker, and pharmacokinetic readouts. Methods This was a single-center, double-blind, randomized, placebo-controlled trial. Patients ≤ 48 months old were enrolled between July 2018 and April 2019 and were randomly assigned to groups that received either placebo or levosimendan infusions for 48 h post-surgery, along with all other standard methods of care. LCOS incidence was the primary outcome of this study. Results A total of 187 patients were enrolled, of whom 94 and 93 received levosimendan and placebo, respectively. LCOS incidence did not differ significantly between the levosimendan and placebo groups (10 [10.6%] versus 18 [19.4%] patients, respectively; 95% confidence interval [CI] 0.19–1.13; p = 0.090) nor did 90-day mortality (3 [3.2%] versus 4 [4.3%] patients, CI 0.14–3.69, p = 0.693), duration of mechanical ventilation (median, 47.5 h and 39.5 h, respectively; p = 0.532), ICU stay (median, 114.5 h and 118 h, respectively; p = 0.442), and hospital stay (median, 20 days and 20 days, respectively; p = 0.806). The incidence of hypotension and cardiac arrhythmia did not differ significantly between the groups. Levels of levosimendan fell rapidly without any plateau in plasma concentrations during infusion. A multiple logistic regression indicated that randomization to the levosimendan group was a predictor of LCOS. Conclusions Prophylactic levosimendan administration was safe in pediatric patients and had some benefit to postoperative hemodynamic parameters, but failed to provide significant benefit with respect to LCOS or 90-day mortality relative to placebo. Trial registration Name of the registry: Safety evaluation and therapeutic effect of levosimendan on the low cardiac output syndrome in patients after cardiopulmonary bypass. Trial registration number: ChiCTR1800016594. Date of registration: 11 June 2018. URL of trial registry record: http://www.chictr.org.cn/index.aspx
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Affiliation(s)
- Anbiao Wang
- Intensive Care Unit (ICU), Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No. 9677 Jingshi Road, Jinan, 250021, China
| | - Chaomei Cui
- Intensive Care Unit (ICU), Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No. 9677 Jingshi Road, Jinan, 250021, China
| | - Yiou Fan
- Department of Toxicological and Functional Test, Centers for Disease Control and Prevention of Shandong, Jinan, 250014, China
| | - Jie Zi
- Intensive Care Unit (ICU), Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No. 9677 Jingshi Road, Jinan, 250021, China
| | - Jie Zhang
- Intensive Care Unit (ICU), Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No. 9677 Jingshi Road, Jinan, 250021, China
| | - Guanglai Wang
- Intensive Care Unit (ICU), Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No. 9677 Jingshi Road, Jinan, 250021, China
| | - Fang Wang
- Intensive Care Unit (ICU), Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No. 9677 Jingshi Road, Jinan, 250021, China
| | - Jun Wang
- Department of Pharmacy, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, 250021, China
| | - Qi Tan
- Intensive Care Unit (ICU), Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong University, No. 9677 Jingshi Road, Jinan, 250021, China. .,Intensive Care Unit (ICU), Department of Cardiac Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China.
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