Object

Title: Endothelin-1 concentration in neonates with hypoplastic left hart syndrome after the Norwooda procedure

Abstract:

Hypoplastic left heart syndrome (HLHS) is the most common congenital single-ventricle-type heart defect and the most common cause of heart-associated death in pediatric population. The Norwood procedure is the first stage of HLHS treatment, associated with a significant risk of death. The objective of the thesis is a prospective evaluation of the association between survival rates, hemodynamic and biochemical parameters, therapeutic modality and perioperative serum endothelin-1 concentration in newborns with hypoplastic left heart syndrome treated employing the Norwood procedure. The investigation included 30 neonates with hypoplastic left heart syndrome (investigated group) subjected to the Norwood procedure in cardiopulmonary bypass and deep hypothermia. The prospective analysis concentrated on dynamic changes of serum Et-1 concentration levels in arterial blood. The measurements were performed preoperatively, two times in the course of cardiopulmonary bypass, and six times in the postoperative period. The results were compared with Et-1 values obtained from neonates with transposition of the great arteries (the controls). The mean peak concentration value was noted 8 hours postoperatively, both in the investigated group and in the controls. The mean increase of Et-1 concentration between hour 2 and hour 8 postoperatively amounted to 148 % in patients with HLHS and only to ; 28 % in the controls (TGA). Children with HLHS that did not survive showed the peak concentration 6 hours after the surgery, just prior to death, and the Et-1 value achieved at this measurement proved a significant factor associated with the risk of death. The mean Et-1 concentration measured 20 hours postoperatively in children with hypoplastic left heart syndrome was still high, while in patients with transposition of the great arteries it reached its lowest value, being lower than preoperatively. Based on the results, the following conclusions were formulated: 1. In the perioperative period (the Norwood procedure), hypoplastic left heart syndrome, as a congenital heart defect of a single ventricle-type, provides hemodynamic conditions favoring high serum endothelin-1 concentration values in arterial blood. 2.Endothelin-1 may contribute to the pathomechanisms leading to circulatory failure in newborns with hypoplastic left heart syndrome in the early postoperative period. 3.The restoration of normal anatomical and hemodynamic conditions as a result of surgical treatment of congenital heart defects decreases serum Et-1 concentration values in arterial blood. 4.Cardiopulmonary bypass with deep hypothermia and extracorporeal circulation arrest are not decisive factors in generating high serum Et-1 values in arterial blood of newborns with congenital heart defects. 5.Preoper ; ative serum Et-1 concentrations in arterial blood of neonates with hypoplastic left heart syndrome seem to have no prognostic value as an indicator of survival in the early postoperative period. 6.A postoperative treatment modality affects serum Et-1 values in arterial blood of newborns with hypoplastic left heart syndrome. 7.A pharmacological modification of the perioperative endothelin system function is worthy considering in order to achieve better therapeutic results. 8.Hemodynamic disturbances resulting from congenital heart defects affect postoperative serum Et-1 concentration levels in arterial blood.

Place of publishing:

Kraków

Level of degree:

2 - studia doktoranckie

Degree discipline:

kardiochirurgia ; pediatria

Degree grantor:

Wydział Lekarski

Promoter:

Malec, Edward

Date issued:

2005

Identifier:

oai:dl.cm-uj.krakow.pl:1003

Call number:

ZB-107612

Language:

pol

Access rights:

nieograniczony

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Last modified:

Jun 26, 2023

In our library since:

Nov 21, 2012

Number of object content hits:

349

Number of object content views in PDF format

69

All available object's versions:

http://dl.cm-uj.krakow.pl:8080/publication/1003

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ZB-107612 Jun 26, 2023
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