M-C Seghaye

Neurodevelopmental outcome related to cerebral risk factors in children after neonatal arterial switch operation

BACKGROUND Neurodevelopmental outcome after neonatal arterial switch operation for complete transposition of the great arteries is an important topic needing prospective assessment. METHODS A group of 33 unselected children (3.0 to 4.6 years) operated on as neonates with combined deep hypothermic circulatory arrest and low flow cardiopulmonary bypass and a control group of 32 age-matched healthy children (3.0 to 4.8 years) underwent evaluation of socioeconomic and clinical neurological status and a standardized test comprising all areas of child development. Results of patients were related to those of the control group, to population norms, and to preoperative, perioperative, and postoperative cerebral risk factors. RESULTS Clinical neurological status was normal in 26 patients (78.8%) and reduced in 7 (21.2%). Complete developmental score and the subscores for motor function, visual perception, learning and memory, cognitive function, language, and socioemotional functions were not different compared to population norms. Compared to the patients, the children of the control group scored higher on tests of complete development, cognition, and language, but also on socioeconomic status. Complete developmental score and the scores for motor, cognitive, and language functions were weakly inversely related to the duration of circulatory arrest, but not to the duration of bypass. Cerebral risk factors such as serum levels of the neuron-specific enolase, perinatal acidosis, perinatal asphyxia, peri- and postoperative cardiocirculatory insufficiency, or clinical seizures were not correlated to the test results. CONCLUSIONS Neonatal arterial switch operation with combined circulatory arrest and low flow bypass is associated with neurological impairment, but not with reduced development as assessed by formal testing of motor, cognitive, language, and behavioral functions. Perioperative serum level of the neuron-specific enolase is not a valid marker for later developmental impairment.

The effect of temperature during extracorporeal circulation on ultrastructure of cardiomyocytes

Previous studies have suggested that mild hypothermia (28°C) during extracorporeal circulation (ECC) confers organ protection. The study was conducted to examine whether temperature during ECC influences cardiomyocyte ultrastructure.

Myocardial cell damage related to arterial switch operation in neonates with transposition of the great arteries

It was of objective of this study to investigate clinical and laboratory risk factors for myocardial dysfunction (MD) in neonates after arterial switch operation for transposition of the great arteries.

High oxygen treatment during preparation of children for open-heart surgery leads to a decrease in total antioxidant capacity

Children who undergo cardiac surgery with cardiopulmonary bypass (CPB) often suffer myocardial damage after the operation. It has been hypothesized that this damage is enhanced by mechanisms that involve increased oxidative stress. This oxidative stress damage could be caused by ischaemia-reperfusion injury, which could be intensified by the high oxygen treatment that is used during CPB and by inflammatory activity. To verify this, we assessed the antioxidant capacity in plasma samples collected at a number of time points before, during and after CPB, from children undergoing open-heart surgery.

Evaluation of myocardial cell damage in cardiac lymph during cardiopulmonary bypass.

Cardiac lymph is a medium which reflects the myocardial interstitial space. The purpose of our study was to evaluate the inflammatory response marker TNFα (tumor necrosis factor-α) and myocardial injury marker Troponin I during cardiopulmonary bypass (CPB) in cardiac lymph and to compare them with blood values taken from the coronary sinus (SC).