Cardiac output values and correlation of renal injury with neutrophil gelatinase-associated lipocalin levels in off-pump coronary artery bypass patients

Abstract Objective: To investigate the correlation between cardiac output values and renal neutrophil gelatinase-associated lipocalin (NGAL) levels as a biomarker of renal ischemia. Methods: Forty patients, who underwent off-pump coronary artery bypass (OPCAB) surgery and in whom the positioning of the heart was fixed with simple suspension sutures without a mechanical stabilizer, were included in the study. Continuous cardiac output (CO) measurements were recorded using the arterial pressure waveform analysis method (FloTrac sensor system) in the perioperative period. CO was recorded every minute during non-anatomical cardiac positioning for left anterior descending artery (LAD), diagonal artery (D), circumflex artery (Cx), and right coronary artery (RCA) bypasses. Serum NGAL samples were analyzed in the preoperative, perioperative, and postoperative periods. Results: The CO values measured at various non-anatomical cardiac positions during distal anastomosis for LAD, D, Cx, and RCA were significantly lower than pre- and postoperative values measured with the heart in normal anatomical position (3.45±0.78, 2.9±0.71, 3.11±0.56, 3.19±0.81, 5.03±1.4, and 4.85±0.78, respectively, P=0.008). There was no significant difference between CO values measured at various non-anatomical cardiac positions during distal anastomosis. Although there was no significant correlation between NGAL levels and age, duration of surgery, preoperative CO, D-CO, RCA-CO, and postoperative CO measurements, there was a significant correlation between NGAL levels and LAD-CO (P=0.044) and Cx-CO (P=0.018) at the postoperative 12th hour. Conclusion: Full revascularization may be achieved by employing the OPCAB technique while using simple suspension sutures without a mechanical stabilizer and by providing safe CO levels and low risk of renal ischemia.

Éxito en el manejo no invasivo de la tromboembolia pulmonar en un niño con leucemia linfocítica aguda / The successful non-invasive management of pulmonary thromboembolism in a child with acute lymphoblastic leukemia

Durante la niñez, la tromboembolia pulmonar (TEP) es una afección poco frecuente, aunque potencialmente mortal. El mayor número de episodios de tromboemblia venosa (TEV) es resultado de complicaciones de factores de riesgo subyacentes, tales como tumores malignos, quimioterapia (L-asparaginasa) y colocación de un catéter venoso central. Presentamos el caso de un paciente con leucemia linfocítica aguda y TEP que tuvo un presíncope y fue tratado satisfactoriamente con heparina de bajo peso molecular y antagonistas del calcio.

In childhood, pulmonary thromboembolism (PTE) is an uncommonbut potentially life-threatening disease. The greater numbers of venous thromboembolism (VTE) are complications of underlying risk factors such as malignancies, chemotherapy (L-asparaginase), and central venous catheter. We report a patient with acute lymphoblastic leukemia and PTE, who presented with near-syncope, and was successfully treated with low molecular weight heparin and calcium channel blockers.