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Biomedical subjects

M A Karolczak

Publications and source records attributed to M A Karolczak.

6 recordsLinked to original sources
PubMed2006

Is hypothermia a benefit? Von Willebrand factor in pediatric cardiopulmonary bypass.

AIM: The use of cardiopulmonary bypass (CPB) is associated with the risk of development of postpump syndrome. Thrombocyte activation leads to microembolism, endothelial damage and necrosis with release of various substances, such as the von Willebrand factor (vWf). High levels of vWf increase the risk of postoperative complications and mortality. Our objective was to find a correlation between CPB and plasma levels of vWf in pediatric patients operated on for congenital heart defects. METHODS: Twenty patients with congenital heart defects (ventricular septal defect, atrial septal defect/partial anomalous pulmonary vein drainage, Bland White Garland syndrome) were operated on with the use of CPB. The arterial blood was sampled after induction of anesthesia, 5 minutes after commencing CPB, 1 hour and 3 hours after surgery. The plasma levels of vWf were measured and compared to selected clinical findings. RESULTS: There was no early mortality. There were no significant differences in CPB and aortic cross clamp times when compared in patients with various defects. vWf plasma levels were significantly elevated in all patients 1 hour and 3 hours after surgery. We found no correlation between vWf levels and type of defect, CPB duration, aortic cross clamp as well as reperfusion time. However, we were able to demonstrate that the observed elevation of vWf levels was almost 4-fold higher in patients cooled down to lower temperatures (15 patients; mean rectal value 27.64+/-0.7 degrees C) than in 5 patients (mean rectal temperature 30.74+/-1.56 degrees C) where only slight elevation was found. There were no differences in the postoperative course of these patients. All patients were discharged from hospital 10+/-3 days after operation (mean value 9 days). CONCLUSIONS: vWf plasma levels are significantly elevated after pediatric hypothermic CPB. It seems that the augmentation of vWf values could be independently associated with rate of hypothermia.

Adolescent↗
PubMed1989

Right-sided intrathoracic bypass graft for complex or recurrent coarctation of the aorta.

A simple technique is described for the interposition of a tube graft between the ascending and descending aorta in the right chest. Directing the graft posteriorly preserves the integrity of the pericardium and avoids potential damage to the prosthesis at a subsequent sternotomy for open heart surgery. This procedure was used successfully and without complication in an 18-month-old boy who had undergone two previous operations for coarctation of the aorta, and in a 20-year-old girl with William's syndrome and diffuse hypoplasia of the distal aortic arch.

Adult↗
PubMedDate not supplied

Anomalous origin of the left coronary artery (LCA) from pulmonary trunk (Bland-White-Garland syndrome) with systemic collateral supply to LCA.

We present the case of 15-year-old asymptomatic girl referred to our institution with the diagnosis of mitral valve prolapse and a suspicion of coronary artery fistula. Detailed diagnostics revealed Bland-White-Garland syndrome (B-W-G) with tortuous aneurysmatic right coronary artery (9 mm in diameter). In addition, on surgery, multiple collateral vessels between the right and left coronary arteries were found crossing over the pulmonary trunk and right ventricle. Because of fragile and calcified anterior walls of the main pulmonary artery we had to elect Hamilton rather than Takeuchi technique. The procedure was aggravated by continuous blood outflow from enlarged LCA ostium suggesting systemic collateral supply. Weaning from cardiopulmonary bypass and postoperative period was uneventful. There are only two published reports on systemic collateral supply to LCA in patients with BWG.

Adolescent↗