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Thul J, Pruett TL, Teigen LM. CT-derived psoas muscle area and density are associated with length of stay and discharge disposition after liver transplantation. Clin Nutr ESPEN 2023; 55:434-439. [PMID: 37202080 DOI: 10.1016/j.clnesp.2023.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND & AIMS Prolonged length of stay (LOS) and discharge disposition following liver transplantation are associated with postoperative complications and increased healthcare utilization. This study evaluated the relationship between CT-derived psoas muscle measurements and hospital LOS, intensive care unit (ICU) LOS, and discharge disposition after liver transplant. The psoas muscle was chosen given its ease of measurement with any radiological software. A secondary analysis assessed the relationship between the American Society for Parenteral and Enteral Nutrition and the Academy of Nutrition and Dietetics (ASPEN/AND) malnutrition diagnosis criteria and CT-derived psoas muscle measures. METHODS CT-derived measures of psoas muscle density (mHU) and cross-sectional area at the level of the third lumbar vertebrae were obtained from preoperative CT scans of liver transplant recipients. Cross-sectional area measures were corrected for body size to generate a psoas area index variable (cm2/m2; PAI). RESULTS Each 1-unit increase in PAI was associated with a reduced hospital LOS of 4 days (R2 = 0.07). Each 5-unit increase in mean Hounsfield units (mHU) was associated with a reduced hospital and ICU LOS of 5 and 1.6 days, respectively (R2 = 0.22 and 0.14, respectively). Mean PAI and mHU were higher in patients who discharged to home. PAI was reasonably identified through ASPEN/AND malnutrition criteria, but there was no difference in mHU between those with and without malnutrition. CONCLUSION Measures of psoas density were associated with both hospital and ICU LOS and discharge disposition. PAI was associated with hospital LOS and discharge disposition. CT-derived measures of psoas density may be a valuable complement to preoperative liver transplant nutrition assessment using traditional ASPEN/AND malnutrition criteria.
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Affiliation(s)
- Jessica Thul
- MHealth Fairview, University of Minnesota Medical Center, Minneapolis, MN, 55455, USA.
| | - Timothy L Pruett
- Department of Surgery, University of Minnesota, Minneapolis, MN, 55455, USA.
| | - Levi M Teigen
- Department of Food Science and Nutrition, University of Minnesota, St. Paul, MN, 55108, USA.
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Brunner CF, Harres E, Yörüker U, Sen-Hild B, Valeske K, Müller M, Thul J, Hahn A, Pons-Kühnemann J, Schranz D, Jux C, Akintürk H. Neurological Outcome of Aortic Arch Reconstruction Using Selective Cerebral Perfusion Compared to Standard Open-Heart Surgery in Pediatric Patients: A Prospective Single-Center Study. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - E. Harres
- Pediatric Heart Center, Giessen, Deutschland
| | - U. Yörüker
- Pediatric Heart Center, Giessen, Deutschland
| | - B. Sen-Hild
- Pediatric Heart Center, Giessen, Deutschland
| | - K. Valeske
- Pediatric Heart Center, Giessen, Deutschland
| | - M. Müller
- Pediatric Heart Center, Giessen, Deutschland
| | - J. Thul
- Pediatric Heart Center, Giessen, Deutschland
| | - A. Hahn
- Kinderneurologie Gießen, Gießen, Deutschland
| | - J. Pons-Kühnemann
- Institute for Medical Statistics, University of Giessen, Gießen, Deutschland
| | - D. Schranz
- Goethe University Frankfurt, Frankfurt, Deutschland
| | - C. Jux
- Pediatric Heart Center, Giessen, Deutschland
| | - H. Akintürk
- Pediatric Heart Center, Giessen, Deutschland
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Steinbrenner B, Recla S, Thul J, Jux C, Akintürk H, Schranz D. Pulmonary Infections are Common in Patients with PAB in LV-DCM. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Rüblinger L, Behrje J, Thul J, Jux C, Khalil M. Treatment of a Severe Arterial Thrombosis of a Healthy Premature Neonatal Infant. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Zschirnt M, Thul J, Hahn A, Mazhari N, Schranz D, Skrzypek S, Müller M, Akintürk H, Jux C, Rupp S. 30-Year Long-Term Outcome of Heart Transplanted Children with Cardiomyopathy. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Yörüker U, Valeske K, Müller M, Schmidt D, Thul J, Jux C, Schranz D, Akintürk H. Aortic Valve Repair for Pediatric and Grown-Up Congenital Heart Disease Patients: 16 Years Single-Center Experience with 106 Cases. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- U. Yörüker
- Pediatric Heart Center, Justus Liebig University, Giessen, Germany
| | - K. Valeske
- Pediatric Heart Center, Justus Liebig University, Giessen, Germany
| | - M. Müller
- Pediatric Heart Center, Justus Liebig University, Giessen, Germany
| | - D. Schmidt
- Pediatric Heart Center, Justus Liebig University, Giessen, Germany
| | - J. Thul
- Pediatric Heart Center, Justus Liebig University, Giessen, Germany
| | - C. Jux
- Pediatric Heart Center, Justus Liebig University, Giessen, Germany
| | - D. Schranz
- Pediatric Heart Center, Justus Liebig University, Giessen, Germany
| | - H. Akintürk
- Pediatric Heart Center, Justus Liebig University, Giessen, Germany
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Sen-Hild B, Yörüker U, Sprengel A, Müller M, Thul J, Schranz D, Jux C, Akintürk H. Outcomes of Biventricular Surgical Treatment for Interrupted Aortic Arch with/without Associated Complex Cardiac Anomalies: A Single-Center Experience in 16 Years. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- B. Sen-Hild
- Pediatric Heart Center, Justus Liebig University, Giessen, Germany
| | - U. Yörüker
- Pediatric Heart Center, Justus Liebig University, Giessen, Germany
| | - A. Sprengel
- Pediatric Heart Center, Justus Liebig University, Giessen, Germany
| | - M. Müller
- Pediatric Heart Center, Justus Liebig University, Giessen, Germany
| | - J. Thul
- Pediatric Heart Center, Justus Liebig University, Giessen, Germany
| | - D. Schranz
- Pediatric Heart Center, Justus Liebig University, Giessen, Germany
| | - C. Jux
- Pediatric Heart Center, Justus Liebig University, Giessen, Germany
| | - H. Akintürk
- Pediatric Heart Center, Justus Liebig University, Giessen, Germany
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Krieg K, Hahn A, Rommel F, Thul J, Müller M, Mann V, Jux C, Akintürk H. Neurological and Cognitive Development of School-Aged and Young Patients Who Received Aortic Arch Surgery Using Antegrade Selective Cerebral Perfusion in Neonatal and Infancy Period. Thorac Cardiovasc Surg 2019. [DOI: 10.1055/s-0039-1678785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- K. Krieg
- Pediatric Heart Center, Justus Liebig University, Gießen, Germany
| | - A. Hahn
- Department of Pediatric Neurology, Justus Liebig University, Gießen, Germany
| | - F. Rommel
- Department of Pediatric Neurology, Justus Liebig University, Gießen, Germany
| | - J. Thul
- Pediatric Heart Center, Justus Liebig University, Gießen, Germany
| | - M. Müller
- Pediatric Heart Center, Justus Liebig University, Gießen, Germany
| | - V. Mann
- Pediatric Heart Center, Justus Liebig University, Gießen, Germany
| | - C. Jux
- Pediatric Heart Center, Justus Liebig University, Gießen, Germany
| | - H. Akintürk
- Pediatric Heart Center, Justus Liebig University, Gießen, Germany
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Akintürk H, Sen-Hild B, Yörüker U, Müller M, Thul J, Jux C, Schranz D. Reverse Potts-Shunt for Bridging to Transplant, Recovery or Long-term Palliation. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1627868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- H. Akintürk
- Kinderherzzentrum, Kinderherzchirurgie und Angeborene Herzfehler, Justus Liebig Universität, Giessen, Germany
| | - B. Sen-Hild
- Kinderherzzentrum, Kinderherzchirurgie und Angeborene Herzfehler, Justus Liebig Universität, Giessen, Germany
| | - U. Yörüker
- Kinderherzzentrum, Kinderherzchirurgie und Angeborene Herzfehler, Justus Liebig Universität, Giessen, Germany
| | - M. Müller
- Kinderherzzentrum, Kinderherzanästhesie, Justus Liebig Universität, Giessen, Germany
| | - J. Thul
- Kinderherzzentrum, Kinderherzchirurgie und Angeborene Herzfehler, Justus Liebig Universität, Giessen, Germany
| | - C. Jux
- Kinderherzzentrum, Kinderkardiologie, Justus Liebig Universität, Giessen, Germany
| | - D. Schranz
- Kinderkardiologie, JW Goethe University Frankfurt, Frankfurt am Main, Germany
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Miera O, Schmitt K, Menon A, Ersel S, Reiprich A, Akintürk H, Thul J, Karimova A, Cesnjevar R, Reinhardt Z, Goldwasser R, Heineking B, Schramm R, Romlin B, Kansy A, Maruszewski B, Sandica E, Pawlak S, Sliwka J, Schweiger M, Huebler M, Stiller B, Fleck T, Hoerer J, Boet A, Medrano C, Guereta L, Amodeo A. (733)Current Practice of Anticoagulation for Pediatric VAD Therapy - A Multi-Institutional European Survey of the EXCOR Pediatric Investigator Group (EEPIG). J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Yörüker U, Valeske K, Elmontaser H, Müller M, Thul J, Schranz D, Akintürk H. Mid-Term Results of Fontan Completion after Hybrid Norwood Stage I and Comprehensive Stage II Operation for Hypoplastic Left Heart Syndrome. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- U. Yörüker
- Justus-Liebig-Universität Giessen, Kinderherzzentrum, Giessen, Germany
| | - K. Valeske
- Justus-Liebig-Universität Giessen, Kinderherzzentrum, Giessen, Germany
| | - H. Elmontaser
- Justus-Liebig-Universität Giessen, Kinderherzzentrum, Giessen, Germany
| | - M. Müller
- Justus-Liebig-Universität Giessen, Kinderherzzentrum, Giessen, Germany
| | - J. Thul
- Justus-Liebig-Universität Giessen, Kinderherzzentrum, Giessen, Germany
| | - D. Schranz
- Justus-Liebig-Universität Giessen, Kinderherzzentrum, Giessen, Germany
| | - H. Akintürk
- Justus-Liebig-Universität Giessen, Kinderherzzentrum, Giessen, Germany
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Latus H, Hachmann P, Voges I, Sarikouch S, Peters B, Mazhari N, Behnke-Hall K, Akintuerk H, Apitz C, Thul J, Bauer J, Schranz D. Impaired Cardiac Dimensions and Function in Children and Adolescents after Heart Transplantation Assessed by Cardiac Magnetic Resonance. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1599016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- H. Latus
- Pediatric Heart Centre Giessen, Giessen, Germany
| | - P. Hachmann
- Pediatric Heart Centre Giessen, Giessen, Germany
| | - I. Voges
- Pediatric Heart Centre Giessen, Giessen, Germany
| | - S. Sarikouch
- Department of Cardiothoracic Surgery, Hannover Medical School, Hannover, Germany
| | - B. Peters
- German Competence Network for Congenital Heart Defects, Berlin, Germany
| | - N. Mazhari
- Pediatric Heart Centre Giessen, Giessen, Germany
| | | | - H. Akintuerk
- Pediatric Heart Centre Giessen, Giessen, Germany
| | - C. Apitz
- Pediatric Heart Centre Giessen, Giessen, Germany
| | - J. Thul
- Pediatric Heart Centre Giessen, Giessen, Germany
| | - J. Bauer
- Pediatric Heart Centre Giessen, Giessen, Germany
| | - D. Schranz
- Pediatric Heart Centre Giessen, Giessen, Germany
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Valeske K, Mazhari N, Yerebakan C, Müller M, Thul J, Schranz D, Akintürk H. Future Perspectives of a Childrens' Heart Center after More Than 200 Pediatric Heart Transplantations. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Yerebakan C, Yörüker U, Valeske K, Elmontaser H, Müller M, Thul J, Schranz D, Akintürk H. Biventricular Correction of Aortic Atresia/ Severe Aortic Valve Hypoplasia with Ventricular Septal Defect Using “Norwood-Rastelli Operation” after Hybrid Palliation. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Schneck E, Mann V, Körner C, Jost A, Thul J, Engel JB, Müller MF. [Patient with a Fontan circulation undergoing caesarean section: Anesthesiological management]. Anaesthesist 2015; 64:532-9. [PMID: 26159666 DOI: 10.1007/s00101-015-0047-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 05/07/2015] [Accepted: 05/12/2015] [Indexed: 11/29/2022]
Abstract
Adults suffering from congenital heart diseases (CHD) represent a challenge to anesthesiologists because of the diverse pathologies, complex pathophysiology and special treatment strategies. Due to improved therapeutic options for CHD, patient quality of life and life expectancy is increasing, leaving them as a growing population including pregnant patients with CHD. This article presents the main principles of the pathophysiology and anesthesiological management of pregnant patients living with a Fontan circulation based on a case report, which was complicated by an aortic coarctation and atonic uterine hemorrhage.
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Affiliation(s)
- E Schneck
- Klinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum Gießen und Marburg, Standort Gießen, Sektion Kinderherzzentrum, Rudolf-Buchheim-Str. 7, 35392, Gießen, Deutschland,
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Mazhari N, Valeske K, Behnke-Hall K, Thul J, Bauer J, Akintürk H, Müller M, Schranz D. Herztransplantation bei Patienten nach einer univentrikulären Palliation, Erfahrungen eines Zentrums. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1555967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Thul J, Müller M, Mazhari N, Behnke-Hall K, Akintürk H. Die Implementierung der Blutgruppen - inkompatiblen Herztransplantation (ABOi-HTx) an einem Zentrum. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1555966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Yerebakan C, Valeske K, Elmontaser H, Thul J, Müller M, Mann V, Bauer J, Schranz D, Akintürk H. Role of the Hybrid Strategy in the Biventricular Correction of Hypoplastic Left Heart Syndrome and Variants. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Yerebakan C, Latus H, Valeske K, Elmontaser H, Thul J, Müller M, Schranz D, Akintürk H. Back to Fetal Physiology - An Option for the Palliation of Severe Postcapillary Pulmonary Hypertension in Shone´s Complex? Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Yerebakan C, Baumann S, Valeske K, Elmontaser H, Thul J, Müller M, Mann V, Schranz D, Akintürk H. Anomalous Left Coronary Artery from the Pulmonary Artery - Single Center Experience of Sixteen Years. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Recla S, Steinbrenner B, Logeswaran T, Rüblinger L, Schmidt D, Bauer J, Apitz C, Thul J, Schranz D. Modern chronic heart failure therapy in context of pulmonary banding to avoid heart transplantation. Mol Cell Pediatr 2015. [PMCID: PMC4715068 DOI: 10.1186/2194-7791-2-s1-a16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Khalil M, Recla S, Steinbrenner B, Moysich A, Kerst G, Latus H, Gummel K, Schmidt D, Apitz C, Bauer J, Thul J, Valeske K, Akintürk H, Schranz D. Reversible Pulmonary Artery Banding for Left Ventricular-DCM with preserved RV function: feasibility of percutaneous PA-debanding. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1393987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Heckmann M, d'Uscio CH, Steckel H, Neuhaeuser C, Bödeker RH, Thul J, Schranz D, Frey BM. Reduction in cortisol inactivation is part of the adrenal stress response to cardiac and noncardiac pediatric surgery: a prospective study using gas chromatography-mass spectrometry analysis. Horm Metab Res 2014; 46:677-84. [PMID: 24867134 DOI: 10.1055/s-0034-1375650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
UNLABELLED We examined the hypothesis that major cardiac surgery triggers a more intense adrenal stress response than less intensive noncardiac surgery, which then alters cortisol inactivation. Urinary excretion rates of glucocorticoid metabolites were determined before and after surgery using gas chromatography-mass spectrometry in 29 children undergoing scheduled major cardiac surgery and 17 control children undergoing conventional noncardiac surgery in a prospective observational study. Excretion rates of glucocorticoid metabolites were summed and corrected for creatinine excretion to calculate cortisol production rates (mg/mmol creatinine/m(2) body surface area). Precursor/product ratios from individual metabolites were calculated to characterize cortisol inactivation (11β-hydroxysteroid dehydrogenase). Postoperatively, median cortisol production rates increased in both groups ( MCS from 2.7 to 9.3; controls: from 2.7 to 5.8; p<0.001) with no significant difference between groups (p=0.12). Ratios of cortisol to cortisone metabolites, indicating the overall activity of 11β-hydroxysteroid dehydrogenase, increased postoperatively in both groups (p<0.001). In conclusion, surgery resulted in a distinct postoperative increase in cortisol production. In contrast to our hypothesis, children undergoing major cardiac surgery did not show an increased adrenal stress response compared to children undergoing conventional surgery. Furthermore, the reduction in cortisol inactivation appears to be an essential part of the stress response to pediatric surgery in general.
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Affiliation(s)
- M Heckmann
- Departments of General Pediatrics & Neonatology, Justus Liebig University, Giessen, Germany
| | - C H d'Uscio
- Departments of Nephrology & Hypertension, University Hospital Bern, Bern, Switzerland
| | - H Steckel
- Departments of General Pediatrics & Neonatology, Justus Liebig University, Giessen, Germany
| | - C Neuhaeuser
- Departments of General Pediatrics & Neonatology, Justus Liebig University, Giessen, Germany
| | - R-H Bödeker
- Institute of Medical Statistics, Justus Liebig University, Giessen, Germany
| | - J Thul
- Department of Pediatric Cardiology, Justus Liebig University, Giessen, Germany
| | - D Schranz
- Department of Pediatric Cardiology, Justus Liebig University, Giessen, Germany
| | - B M Frey
- Departments of Nephrology & Hypertension, University Hospital Bern, Bern, Switzerland
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Yerebakan C, Valeske K, Elmontaser H, Thul J, Schranz D, Akintürk H. Prolonged left ventricular mechanical support in a seven-year-old patient following extensive myocardial infarction enabling myocardial recovery. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Elmontaser H, Yerebakan C, Valeske K, Müller M, Thul J, Schranz D, Akintürk H. Surgical treatment of thoracic and partial ectopia cordis - A case presentation. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Valeske K, Müller M, Elmontaser H, Thul J, Yerebakan C, Bauer J, Schranz D, Akintürk H. 15 years of Giessen hybrid approach to the hypoplastic left heart. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Yerebakan C, Valeske K, Elmontaser H, Müller M, Thul J, Schranz D, Akintürk H. Urgent implantation of the Berlin Heart Excor biventricular assist device as a total artificial heart in a patient with single ventricle circulation. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Behnke-Hall K, Bauer J, Thul J, Mazhari N, Schranz D. Long-Term Outcome of Renal Function with Everolimus Treatment in a Pediatric Center. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Valeske K, Thul J, Müller M, Bauer J, Hijjeh N, Schranz D, Akintürk H. Mechanical circulatory support in pediatric patients – a review of 15 years. Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Apitz C, Hijjeh N, Bauer J, Thul J, Akintürk H, Schranz D. Hybrid-OP zum Verschluss eines großen Vorhofseptumdefektes bei einem Kleinkind mit chronischer Lungenerkrankung und pulmonaler Hypertonie. Klin Padiatr 2011. [DOI: 10.1055/s-0031-1273792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Akintürk H, Hijjeh N, Müller M, Valeske K, Thul J, Bauer J, Schranz D. Comprehensive stage II Norwood palliation under beating heart conditions – is it possible? Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1246875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Behnke-Hall K, Wagner HJ, Bauer J, Thul J, Mandy H, Reiter A, Schranz D. 523: Diagnosis, Treatment and Outcome of Hodgkin Like Post-Transplant Lymphoproliferative Disease after Pediatric Heart Transplantation: A Single Center Experience. J Heart Lung Transplant 2010. [DOI: 10.1016/j.healun.2009.11.540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Valeske K, Sprengel A, Müller M, Thul J, Bauer J, Schranz D, Akintürk H. 20 years experience with arterial switch operation – a single center review of 212 patients. Thorac Cardiovasc Surg 2009. [DOI: 10.1055/s-0029-1191429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Valeske K, Müller M, Hijjeh N, Bauer J, Thul J, Böning A, Schranz D, Akintürk H. Different methods of RVOT reconstruction: A 16 year follow-up. Thorac Cardiovasc Surg 2008. [DOI: 10.1055/s-2008-1037721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Valeske K, Bauer J, Müller M, Michel-Behnke I, Thul J, Schranz D, Akintürk H. Interrupted aortic arch. A ten year analysis of conventional and alternative therapy. Thorac Cardiovasc Surg 2007. [DOI: 10.1055/s-2007-967299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Akintürk H, Valeske K, Müller M, Bauer J, Thul J, Michel-Behnke I, Hagel KJ, Schranz D. Biventricular repair in children with hypoplastic left heart complex. Thorac Cardiovasc Surg 2007. [DOI: 10.1055/s-2007-967267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bartram U, Thul J, Bauer J, Wössmann W, Schranz D. Systemic Sarcoidosis After Cardiac Transplantation in a 9-year-old Child. J Heart Lung Transplant 2006; 25:1263-7. [PMID: 17045940 DOI: 10.1016/j.healun.2006.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2006] [Revised: 05/09/2006] [Accepted: 06/26/2006] [Indexed: 11/22/2022] Open
Abstract
Sarcoidosis is a granulomatous disease of unknown etiology and is only rarely seen in infants and children. We present the case of a 9-year-old boy who developed sarcoidosis with multi-organ involvement 9 years after cardiac transplantation for Shone complex. The patient was on immunosuppressive therapy with tacrolimus and mycophenolate mofetil. He presented with severe respiratory distress due to marked mediastinal lymphadenopathy and bilateral pulmonary infiltrates in association with fatigue, low-grade fever, hepatosplenomegaly and generalized lymphadenopathy. Lymph node histology showed non-caseating epitheloid cell granulomas and giant cells. Initialization of therapy with prednisolone resulted in prompt clinical recovery and resolution of all symptoms except for the development of mild pulmonary fibrosis. Tapering of the steroids led to recurrence of mediastinal lymphadenopathy 5 months after the initial disease, which responded to an increase in steroid dose. The clinical course, the medical management, and the possible role of immunosuppression in the etiology of the disease are discussed.
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Affiliation(s)
- U Bartram
- Department of Pediatric Cardiology, University Children's Hospital Giessen, Giessen, Germany.
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Bauer J, Valeske K, Thul J, Müller M, Michel-Behnke I, Gehron J, Schranz D, Akintürk H. ECMO support after complex cardiac surgery in congenital heart disease. Thorac Cardiovasc Surg 2006. [DOI: 10.1055/s-2006-925681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bauer J, Thul J, Valeske K, Müller M, Michel-Behnke I, Gehron J, Schranz D, Akintürk H. Perioperative Management in Pediatric Heart Transplantation. Thorac Cardiovasc Surg 2005; 53 Suppl 2:S155-8. [PMID: 15704040 DOI: 10.1055/s-2004-830470] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Peri- and early postoperative mortality significantly influences the probability of survival following heart transplantation in children. Main causes of death early after transplantation are rejection, non specific graft failure and RV failure due to pulmonary hypertension. Optimal therapy of pulmonary hypertension and aggressive use of assist devices as a bridge to recovery will substantially improve survival in the early period after transplantation. Furthermore, the use of marginal donor organs will be more acceptable because transient myocardial insufficiency may recover during extracorporeal life support.
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Affiliation(s)
- J Bauer
- Pediatric Heart Center, Justus-Liebig-University Giessen, Giessen, Germany.
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Akintürk H, Valeske K, Müller M, Orhan C, Bauer J, Thul J, Scholz S, Schranz D. Early biventricular correction of hypoplastic left heart complex in infants. Thorac Cardiovasc Surg 2005. [DOI: 10.1055/s-2005-862148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Valeske K, Orhan C, Müller M, Bauer J, Scholz S, Thul J, Schranz D, Akintürk H. Early correction of congenital left ventricular outflow tract obstruction with hypoplastic aortic valve. Thorac Cardiovasc Surg 2005. [DOI: 10.1055/s-2005-861913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Hilgendorff A, Reiss I, Thul J, Alzen G, Gortner L. [Wilson-Mikity syndrome as a cause of respiratory insufficiency of prematurity]. Klin Padiatr 2003; 212:318-9. [PMID: 14582512 DOI: 10.1055/s-2000-9608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The Wilson-Mikity syndrome is a differential diagnosis of chronic lung disease in the neonate and primarily related to immaturity. It is characterized by the absence of typical clinical and radiological findings of the respiratory distress syndrome (RDS). Infectious causes are being discussed.
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Affiliation(s)
- A Hilgendorff
- Zentrum für Kinderheilkunde und jugendmedizin, Abt. Allgemeine Pädiatrie und Neonatologie, Justus-Lieb-Universität, Giessen
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Michel-Behnke I, Akintuerk H, Marquardt I, Mueller M, Thul J, Bauer J, Hagel KJ, Kreuder J, Vogt P, Schranz D. Stenting of the ductus arteriosus and banding of the pulmonary arteries: basis for various surgical strategies in newborns with multiple left heart obstructive lesions. Heart 2003; 89:645-50. [PMID: 12748222 PMCID: PMC1767699 DOI: 10.1136/heart.89.6.645] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To present an institutional experience with stent placement in the arterial duct combined with bilateral banding of the pulmonary artery branches as a basis for various surgical strategies in newborns with hypoplastic left heart obstructive lesions. DESIGN Observational study. SETTING Paediatric heart centre in a university hospital. PATIENTS 20 newborns with various forms of left heart obstructive lesions and duct dependent systemic blood flow. INTERVENTIONS Patients underwent percutaneous ductal stenting and surgical bilateral pulmonary artery banding. Atrial septotomy by balloon dilatation was performed as required, in one premature baby by the transhepatic approach. MAIN OUTCOME MEASURES Survival; numbers of and reasons for palliative and corrective cardiac surgery. RESULTS One patient died immediately after percutaneous ductal stenting. One patient died in connection with the surgical approach of bilateral pulmonary banding. Stent and ductal patency were achieved for up to 331 days. Two patients underwent heart transplantation and two patients died on the waiting list. Ten patients had a palliative one stage procedure with reconstruction of the aortic arch and bidirectional cavopulmonary connection at the age of 3.5-6 months. There was one death. One patient is still awaiting this approach. Two patients received biventricular repair. In one, biventricular repair will soon be provided. CONCLUSIONS Stenting the arterial duct combined with bilateral pulmonary artery banding in newborns with hypoplastic left heart or multiple left heart obstructive lesions allows a broad variation of surgical strategies depending on morphological findings, postnatal clinical conditions, and potential ventricular growth.
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Affiliation(s)
- I Michel-Behnke
- Paediatric Heart Centre, Justus-Liebig University Giessen, Giessen, Germany. Ina.Michel-Behnke.@paediat.med.uni-giessen.de
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Abstract
Acute rejection of the donor heart is a major cause of mortality in infant heart transplant recipients. The early diagnosis of acute cardiac rejection (ACR) is crucial. Non-invasive methods have shown poor sensitivity in detecting rejection when compared to endomyocardial biopsies (EMB). We assessed troponin I as a new marker to diagnose cardiac rejection. Serum cardiac troponin I (cTNI) levels were retrospectively analysed in 25 heart transplant patients (ages, 2 wk to 13 yr; mean age, 3 months) presenting 36 acute rejections. In early post-operative rejection and initially elevated cTNI levels, rejection was associated with a second increase of serum cTNI concentrations in 21% of the patients (p = 0.15). If cTNI levels were in normal range before ACR an elevation was monitored in 59% of the rejection periods (p < 0.05). In 25% of the cases (n = 9) cTNI levels remained in normal range during the rejection episode (<0.6 ng/mL), in 22% (n = 8) cTNI levels did not exceed pathological values from 0.6 to 1.5 ng/mL and in 53% (n = 19) the measured levels went beyond 1.5 ng/mL. Maximum concentrations of cTNI were measured mostly 12 d from the moment rejection was suspected (day 1) in patients (median day 3). However, cTNI levels were elevated for 2-43 d after ACR was diagnosed (median 10 d). Twenty per cent of the patients with grade 3 rejection (ISHLT) and 75% of the patients with grade 4 rejection had a corresponding elevated cTNI level (p = 0.013). No false-positive elevations of cTNI were documented. The present data demonstrate that cTNI is a not a sensitive but a specific marker of ACR in children.
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Affiliation(s)
- J Siaplaouras
- Kinderklinik der Justus-Liebig-Universität Giessen, Kinderherzzentrum, Giessen, Germany
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Thul J, Friedrich B, Günther R, Reiss I, Schranz D, Gortner L. Crit Care 2003; 7:6. [DOI: 10.1186/cc2152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Bauer J, Thul J, Krämer U, Hagel KJ, Akintürk H, Valeske K, Schindler E, Bohle RM, Schranz D. Heart transplantation in children and infants: short-term outcome and long-term follow-up. Pediatr Transplant 2001; 5:457-62. [PMID: 11737772 DOI: 10.1034/j.1399-3046.2001.00023.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Since 1988, 82 heart transplants have been performed in 80 infants and children. Diagnoses pretransplant were: hypoplastic left heart syndrome (HLHS) (n = 43); cardiomyopathy (n = 19); endocardial fibroelastosis (n = 6); and other complex congenital heart diseases (n = 12). Age at transplantation was < 1 yr in 61 patients. Overall survival rate was 79% at 1 yr and 73% at 5 and 10 yr. To date, 20 patients have died after transplantation. Causes of death were: rejection (eight patients); right ventricular failure (four patients); transplant coronary artery disease (TCAD) (two patients); and other causes (six patients). In the majority of patients somatic growth is not impaired, and renal function is reduced (but stable) in all patients. Two patients developed post-transplant lymphoproliferative disease, which was treated successfully. Major long-term morbidity is neurologic deficit - severe in three patients and minor in six. TCAD was present or suspected in six surviving patients. We conclude that heart transplantation in infants and children can be performed with good early and late results. Quality of life is excellent in most patients. TCAD, however, will become an increasing problem in the long term.
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Affiliation(s)
- J Bauer
- Department of Pediatric Cardiology, University Giessen, Giessen, Germany.
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Wozniak G, Noll T, Akintürk H, Thul J, Müller M. Factor XIII prevents development of myocardial edema in children undergoing surgery for congenital heart disease. Ann N Y Acad Sci 2001; 936:617-20. [PMID: 11460520 DOI: 10.1111/j.1749-6632.2001.tb03549.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In a prospective investigation of perioperative cardiac edema formation requiring a delayed sternal closure, we identified thrombin increase combined with a simultaneous decrease of factor XIII as a probable cause. After experimental studies additionally revealed that factor XIII could protect endothelial barrier function, we did another prospective randomized trial in which factor XIII or placebo was preoperatively substituted. The substitution finally showed distinct effects minimizing the incidence of myocardial swelling. Therefore, the clinical application of factor XIII may have a valuable therapeutic benefit in cases of leakage syndrome during extracorporeal circulation in congenital heart surgery.
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Affiliation(s)
- G Wozniak
- Department of Cardiovascular Surgery, Justus-Liebig-University Giessen, Rudolf-Buchheim-Str. 7, D-35392 Giessen, Germany.
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Siaplaouras J, Thul J, Will JC, Bauer J, Kreuder J, Valeske K, Akintürk H, Schranz D. [Cardiac troponin I after heart surgery corrective operation in infancy and childhood]. Z Kardiol 2001; 90:408-13. [PMID: 11486575 DOI: 10.1007/s003920170150] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Perioperative myocardial damage is an important determinant for postoperative cardiac function and recovery. Cardiac troponin I (cTNI) is a specific marker for myocardial damage. The aim of our study was to evaluate pre- and postoperative cTNI levels, the pattern of elevation in the first four postoperative days and the prognostic value after pediatric cardiac operation. METHODS Cardiac troponin I levels were measured in 115 children mean age 36 +/- 45 months (range 4 days to 189 months) undergoing elective operation of a congenital heart defect. Routine measurements were made preoperatively, immediately after cardiopulmonary bypass and serially 8, 18, 42, 90, 138 hours thereafter. Data from 13 patients undergoing surgery without cardiopulmonary bypass served as controls. Postoperative cTNI levels were correlated with intra- and postoperative parameters (such as duration of aortic crossclamping, cardiopulmonary bypass time and need for postoperative inotropic support). RESULTS All preoperative cTNI levels were in the normal range. Postoperatively, the highest median cTNI levels were found in patients after repair of tetralogy of Fallot (TOF), atrioventricular septal defect (AVSD) and implantation of a homo- or xenograft. Postoperative cTNI levels correlated significantly with duration of cardiopulmonary bypass and aortic crossclamping, operative approach (ventriculotomy versus atriotomy) and inotropic support (p < 0.0001). Peak cTNI levels were found immediately after surgery in 77.4% of our patients, 8 hours postoperative in 13.9% and at 18 hours after the surgery in 5.2% of the patients. In three children cTNI continued to increase; a secondary increase was found in one patient. Two of these children died, two had a prolonged postoperative recovery. CONCLUSION The postoperative level of cardiac troponin I could be used as a marker of perioperative myocardial injury caused by ischemia and operative trauma. Peak levels usually could be obtained immediately after surgery, but a further increase of cTNI during the following 18 hours may occur and is not necessarily related to impaired recovery. However still increasing cTNI levels after 18 hours postoperatively and a secondary increase as well may be used as indicators of poor outcome.
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Affiliation(s)
- J Siaplaouras
- Zentrum für Kinderheilkunde der Justus-Liebig-Universität Giessen Feulgenstrasse 12 35385 Giessen, Germany
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Affiliation(s)
- I Michel-Behnke
- Department of Pediatric Cardiology, Justus Liebig University, Giessen, Germany
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Bauer J, Dapper F, Thul J, Kroll J, Michel-Behnke I, Hagel KJ, Schranz D. Prospektive Behandlungs- strategie bei Neugeborenen mit hypoplastischem Linksherz. Monatsschr Kinderheilkd 1998. [DOI: 10.1007/s001120050284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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