Haemodynamic changes in children with portal hypertension during the postoperative period.

The cardiovascular changes following portosystemic shunt surgery (PSSS) in 33 children with extrahepatic portal hypertension (EPH) were studied to determine if portosystemic shunt surgery had any influence on the cardiovascular state. Haemodynamic data were obtained using two-dimensional and M-mode echocardiography, pulsed-wave Doppler and direct invasive techniques. Postoperatively all patients developed a hyperdynamic state, associated with an increase in cardiac index (CI), heart rate (HR) and a decrease in systemic vascular resistance index (SVRI). In 16 patients (group I), who preoperatively exhibited a hyperdynamic state accompanied by pulmonary hypertension, postoperative studies found an increase in acceleration time to ejection time ratio (AT/ET) in the pulmonary artery from 0.32 +/- 0.05 (mean +/- SEM) to 0.43 +/- 0.01; P < 0.01. Nine patients (group II) who were normodynamic preoperatively developed pulmonary hypertension and right ventricular (RV) dysfunction postoperatively: decrease in AT/ET from 0.42 +/- 0.02 (mean +/- SEM) to 0.32 +/- 0.01; P < 0.01 and an increase in maximal peak pulmonary artery velocity to acceleration time ratio (Vmax/AT) from 702.56 +/- 69.10 (mean +/- SEM) to 1127 +/- 105.30 cm.sec-2; P < 0.01. In eight patients (group III) who were normodynamic preoperatively and were treated with dobutamine infusions at a rate of 5 micrograms.kg-1.min-1 postoperatively, the CI was found to increase from 5.28 +/- 1.1 (mean +/- SEM) to 7.97 +/- 1.64 L.min-1.m-2; P < 0.01, left ventricular ejection fraction (LVEF) from 69.0 +/- 4.1 (mean +/- SEM) to 81.0 +/- 2.9%; P < 0.01 and AT/ET from 0.37 +/- 0.04 (mean +/- SEM) to 0.44 +/- 0.03; P < 0.01.(ABSTRACT TRUNCATED AT 250 WORDS)

[Value of dobutamine in children surgically treated for portal hypertension. Apropos of 23 cases]. / Intérêt de la dobutamine chez l'enfant opéré d'hypertension portale. A propos de 23 cas.

In children undergoing mesenterico-caval or distal spleno-renal shunting for extrahepatic portal hypertension, dobutamin (3-5 micrograms.kg-1.min-1 for 24 hr postoperatively) prevents right ventricle dysfunction and pulmonary hypertension resulting from suddenly increased blood return to the heart by the inferior vena cava, thus improving cardiac output and myocardial contractility. Twelve 1-15 yr children benefitted from this inotropic therapy without any adverse side effect.

[Portal hypertension in children: venous shunting in the early childhood]. / Portalnaia gipertenziia u detei: opyt venoznogo shuntirovaniia v rannem detskom vozraste.

Operations were carried out on 98 children with extrahepatic portal hypertension and on 6 with intrahepatic block and no signs of hepatocellular insufficiency. Mesenterico-caval H-shunt was formed in 78 children with the use of the internal jugular vein as the insert. The remaining children underwent formation of mesocaval anastomosis (8), distal spleno-renal shunt (4), portocaval anastomosis (1), Sugiura's operation (7). Among the operations 68 were planned, 12 emergency, and 18 preventive. The average age of the children was 6.5 years; 31 were under the age of 5 years and 19 under 3 years of age. The youngest child was aged 10 months, the H-shunt was successful. The results of the operation: thrombosis of the shunt 0%, portosystem encephalopathy 0%, recurrent hemorrhage 0%, lethality 1%. This is evidence of the expediency of performing shunting operations in early childhood.

[Disorders of hemodynamics and their correction in children with nonhepatic portal hypertension during the course of surgical treatment]. / Narusheniia gemodinamiki i ikh korrektsiia u detei s vnepechenochnoi portal'noi gipertenziei na étapakh khirurgicheskogo lecheniia.

Twenty children with the extrahepatic portal hypertension syndrome were examined; echo- and doppler-cardiography were employed to assess the central hemodynamic status before and after mesenterial-caval H-shunting, making use of a vascular insert from the internal jugular vein. The status of the circulatory system varied in the patients prior to surgery, and a risk group was distinguished with the maximal deviations of the hemodynamic parameters from the age-specific norms. 70% of the patients developed within 3 h after surgery pulmonary hypertension and right-ventricular dysfunction in the presence of a drastic rise of venous reflux to the right heart. Later an attempt was made at correction of the circulatory disorders by dopamine infusion at the rate of 3-6 micrograms/(kg.min) (19 patients). The authors emphasize that directly after shunting inotropic dopamine maintenance is necessary to prevent the development of hemodynamic disorders.

[The epidemiological surveillance of poliomyelitis in the Ukraine]. / Epidemiologicheskii nadzor za poliomielitom na Ukraine.

Correlation has been revealed between the circulation of polioviruses among the population and environmental objects. A rise in the circulation of polioviruses, type I, was caused by a decrease in collective immunity to this virus type. Water supply and sewage system purification was found ineffective with respect to enteroviral contamination. Vaccinal prophylaxis, carried out for many years, did not lead to the elimination of poliovirus strains, genetically different from vaccine ones.