Levosimendan in a neonate with severe coarctation of aorta and low cardiac output syndrome.

We report successful use of levosimendan after failed balloon angioplasty in a critically ill neonate with coarctation of aorta (CoA) and severe low cardiac output syndrome (LCOS). Treatment with levosimendan improved left heart function, and decreased lactate and brain natriuretic peptide levels. To our knowledge, this is the first report on the safe and successful use of levosimendan in the management of LCOS due to severe CoA in a neonate awaiting surgical repair.

Diferencia veno-arterial de dióxido de carbono como predictor de gasto cardiaco disminuido en modelo pediátrico experimental / Veno-arterial difference of carbondioxide as a predictor of low cardiac output in an experimental pediatric model

Background: Cardiac output (CO) measurement is not a standard of care for critically ill children, but it can be estimated by indirect methods such as veno-arterial pCO2 difference (ΔVACO2). Aim: To determine the correlation between CO and ΔVACO2 and evaluate the usefulness of ΔVACO2 in the diagnosis of low CO in an experimental pediatric model. Materials and Methods: Thirty piglets weighing 4.8 ± 0.35 kg were anesthetized and monitored with transpulmonary thermodilution. Lung injury was induced with tracheal instillation of Tween 20®. Serial measurements of central venous and arterial blood gases, as well as CO, were obtained at baseline, 1, 2 and 4 h after lung injury induction. Low cardiac output (LCO) was defined as CO lower than 2.5 Llminlm². Results: There was an inverse correlation between CO and ΔVACO2 (r = -0.36, p < 0.01). ΔVACO2 was 14 ± 8 mmHg in LCO state and 8 ± 6 mmHg when this condition was not present (p < 0.01). Area under the receiver operating characteristic (ROC) curves of ΔVACO2 and LCO state was 0.78 (0.68-0.86). The best cut-point was 8.9 mmHg to determine LCO with a sensibility 0.78, specificity 0.7, positive predictive value 0.27 and negative predictive value 0.96. Conclusions: In this model there was an inverse correlation between ΔVACO2 and CO. The best cutoff value to discard LCO was ΔVACO2 of 8.9 mmHg, indicating that under this value the presence of LCO is very unlikely.

Correlação entre gasometria atrial direita e índice cardíaco no pós-operatório de cirurgia cardíaca / Correlation between right atrial venous blood gasometry and cardiac index in cardiac surgery postoperative period

OBJETIVO: Determinar a confiabilidade em se correlacionar o índice cardíaco com os dados fornecidos pela gasometria do sangue venoso atrial direito em pacientes submetidos à cirurgia cardíaca, durante o período pós-operatório. MÉTODOS: A partir das amostras de sangue arterial e venoso do átrio direito, colhidas no pós-operatório de cirurgia cardíaca, foram determinados os parâmetros de oxigênio do sangue venoso do átrio direito. Estes parâmetros foram então comparados com o índice cardíaco determinado pela termodiluição. RESULTADOS: Houve boa correlação entre a saturação de oxigênio do sangue venoso do átrio direito (SvO2), diferença artério-venosa do conteúdo de oxigênio do sangue colhido no átrio direito e o índice cardíaco aferido pela termodiluição, com boa sensibilidade e especificidade e alto valor preditivo positivo e negativo. A pressão do sangue do átrio direito (PvO2) apresentou baixa sensibilidade na estimativa de baixo débito cardíaco. CONCLUSÃO: No pós-operatório de cirurgia cardíaca, a SvO2e a diferença artério-venosa do conteúdo de oxigênio (C(av)O2) apresentaram-se como parâmetros confiáveis correlacionados a baixo débito cardíaco. A PvO2 foi pouco sensível no diagnóstico de baixo débito no pós-operatório de cirurgia cardíaca.

OBJECTIVE: To determine, even during postoperative period, the confiability of the cardiac index correlate with the data data given by a central atrial venous blood gasometry in patients who underwent cardiac surgery. METHODS: From the sample of arterial and venous blood of right atrium gathered in postoperative of cardiac surgery, it was determinated the hemoglobin concentration and the gasometric study through what was observed of the venous oxygen saturation (SvO2) and the partial pressure of oxygen from venous blood gathered in right atrium (PvO2), add to the calculation of artery-venous difference of the oxygen content - radial artery / right atrium (C( a-v )O2). Afterwards, these parameters were compared with the cardiac index determined by thermodilution. RESULTS: There was good correlation between SvO2, C(av)O2 of the venous right atrial blood and cardiac index meansured by termodiluition method, with sensibility and especificity good and high positive predict value and negative predict value. The PvO2 demonstrated poor sensibility in the estimative of low output. CONCLUSION: In cardiac surgery postoperative, the SvO2and the C(a-v)O2 were safe parameters correlated with low cardiac output. The PvO2 demonstrated poor sensibility in the estimative of low output in postoperative cardiac surgery.

Serum tumour necrosis factor-alpha and chronic heart failure

Serum tumor necrosis factor-alpha [TNF-alpha] was studied in 84 patients with cachectic chronic heart failure [46 males and 38 females] in addition to 13 healthy volunteers served as controls. The weight, the height, the body mass index, the median circumference, the skin fold thickness and the body fat percentage were used as parameters for the degree of cachexia. Patients were categorized according to underlying etiology of heart failure into group I including 24 patients with rheumatic heart disease [RHD], group II including 20 patients with ischemic heart disease [IHD], group III including 20 patients with cardiomyopathic heart disease and group IV including 20 patients with decompensated corpulmonale. Serum TNF- alpha was significantly higher in all patients [mean +/- SE 125.73 +/- 16.90 pg/ml] than the control group [mean +/- SE 15.94 +/- 2.00 pg/ml], the same level of significance was observed in comparing each group of patients and the control group. When groups of patients were compared with each other, TNF-alpha was statistically higher in group II than group I and group IV. The body fat content percentage was significantly lower in all patients [mean +/- SE 18.2 +/- 0.70] compared with control group [mean +/- SE 22.77 +/- 1.11%]. The findings suggested that the raised level of TNF may play a role in the pathogenesis of cardiac cachexia in patients with chronic heart failure irrespective of their etiology

Serotonergic mechanisms in heart failure.

A total of 29 subjects were studied which included 18 heart failure and 11 matched control cases. The underlying heart disease in heart failure cases was mostly chronic rheumatic valvular disease. The diagnosis of heart disease and heart failure was made on the basis of clinical examination, supplemented by electrocardiography, chest skiagram and echo cardiography. The serotonin status was assessed by measuring platelet serotonin uptake, intraplatelet serotonin content and whole blood 5-hydroxytryptamine (5-HT) levels. Blood platelet count was also done. In heart failure cases, platelet count were significantly less, the platelet 5-HT uptake and blood 5-HT levels remain unaltered. These findings indicate that platelet pool of serotonin does not contribute to raised serotonin blood levels in heart failure. The high blood serotonin levels may be due to either clearance defect or enhanced secretion from the gut or both. The altered serotonin kinetics in platelets also indicate a state of platelet activation in heart failure.