Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Прогностическое значение исходных нарушений ликвородинамики в развитии мозговой дисфункции после коррекции врожденных пороков сердца в условиях искусственного кровообращения

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Link: Clinical Physiology of Blood Circulaiton. 2012; (): -

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Abstract

The aim of the study was to evaluate the risk of the development of neurological complications after the operation with cardiopulmonary bypass in children with burdened premorbid background. To study the role of B-type natriuretic peptides in pathogenesis hypertension-hydrocephalic syndrome and arguments to support preoperative pharmacological correction of liquor hypertension. Material and methods. 62 patients of an early age were included into the study. They underwent CHD correction under the conditions of CPB. The study design was «case-control». The diagnosis for hypertension - hydrocephalic syndrome was established anamnestically, clinically and supported by the results of neurosonography. The level of B-type natriuretic peptides was established in all children by enzymelinked immunoassay. Results. The highest frequency of neurological complications in patients of the major group under conditions of comparability of other complications was detected with the analysis of early postoperative period. It predetermined more need in artificial lung ventilation, increase of length stay in intensive care unit and duration of hospital stay. The level of B-type natriuretic peptides was significantly higher in patients with initial disturbances of cerebrospinal fluid circulation and it had high predictive value of the development of neurological complications after the operation with cardiopulmonary bypass (area under the ROC curve was 0.815). Conclusion. The presence of nonocclusive form of disturbances in cerebrospinal fluid circulation is the predictor of acute neurological complications of postoperative period in children with congenital heart defects. The age from 1 to 3 is more endangered for acute liquorodynamic decompensation development. Intracranial hypertension is characterized by more high initial level of B-type natriuretic peptides. Its level is more than 135 pg/ml and characterized by high risk of injured nervous system after interventions under conditions of cardiopulmonary bypass. Dynamic marker can be the measure of adequacy for dehydratation. Tropic dehydration therapy is reasonable measure in preoperative and early postoperative period, including preventively.

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