Störungen der Balance zwischen vasodilatativen und vasokonstriktiven Mediatoren während des extrakorporalen Kreislaufs bei Neugeborenen

This work has analysed the influence of heart surgery with extracorporeal perfusion on a group of 27 neonates. The patients suffered from variable congenital heart defects which required open heart surgery in the neonatal period. The patients perioperative clinical condition was documented and the plasmalevels of nitrate/nitrite and vasopressin were determined by using a colorimetric assay and an ELISA respectively. It was studied whether neonates would respond to open heart surgery with extracorporeal perfusion by the changing of the synthesis and the release of nitric oxide and vasopressin, whether it came to a shift in the balance of these vasoactive agents, and whether there were any correlations to clinical complications. After the initiation of the extracorporeal perfusion the nitrate-/nitriteplasmalevels fell significantly and even one day postoperative, they were still significantly lower than the preoperative values. However vasopressinplasmalevels rose highly with the beginning of the extracorporeal perfusion but declined to levels just over preoperative values at 24 hours postoperative. This shift in balance seems to be an adaptation of the neonates to the hemodynamic stress caused by the extracorporeal perfusion. In addition there are interactions between those two vasoactive agents which amplify the existing imbalance. The higher vasopressin- and lower nitric oxidelevels could sustain the cardiovascular system by enhancing the cardiac output and by optimizing the peripheral vascular resistance. Preoperatively high vasopressinplasmalevels appear to affect the clinical situation beneficially. However there is also evidence for a negative influence on the renal function and for an amplification of thromboembolic events. These relations should be investigated more deeply in further studies. Summing up, longer times of extracorporeal perfusion and of aortic cross-clamping as well as the performance of a circulatory arrest, involved amplified complications. Deeper hypothermia however has an advantageous effect. These observations though seem to be only partly based on the changed plasmalevels of nitric oxide and vasopressin.

Grantor dc:publisher

Publikationsserver der RWTH Aachen University

Year dc:date

2009

Author dc:creator

• Marcinkowski, Verena

Contributors dc:contributor

• Seghaye, Marie-Christine

• info:eu-repo/classification/ddc/610
• Extrakorporaler Kreislauf
• Arginin-Vasopressin
• Vasopressin
• Stickstoffmonoxid
• Neugeborenes
• Hypothermie
• Herz-Lungen-Maschine
• Herzoperation
• Offene Herzoperation
• Vasodilatation
• Vasokonstriktion
• Allgemeine Entzündungsreaktion
• Medizin
• Nitrat
• Nitrit
• capillary leak syndrome
• heart surgery
• extracorporeal perfusion
• nitric oxide
• nitrate

Statement dc:rights

• info:eu-repo/semantics/openAccess

Language dc:language

ger

Identifier

https://publications.rwth-aachen.de/search?p=id:%22RWTH-CONV-112960%22

OAI record oai:identifier

https://publications.rwth-aachen.de/oai2d?verb=GetRecord&metadataPrefix=oai_dc&identifier=oai%3Apublications.rwth-aachen.de%3A50414