The effects of syncope on serum tau protein levels in adolescents

According to the new (2009) definition, sudden, reversible, short-lasting and spontaneously resolving loss of consciousness associated with a transient, global decrease in cerebral blood flow occurs during syncope. Syncope-associated cerebral ischaemia lasts from a few to several seconds. Near infrared spectroscopy reveals decreased oxygenated haemoglobin and increased reduced haemoglobin levels. If cerebral ischaemia is due to stroke, blood–brain barrier damage and tau protein diffusion into the cerebrospinal fluid occur. Cerebrospinal fluid tau levels can be both, a useful biomarker in the assessment of ischaemic extent and a prognostic factor. The aim of the study was to evaluate whether there is an increase in serum tau protein levels during syncope, which could correspond to a stroke model of brain injury. Material and methods: The study group included 32 patients, and the control group included 38 patients (mean age for both groups was 15 years). Syncope was induced by tilt table testing. The test was performed according to the Westminster protocol. Three blood samples were collected (at baseline as well as 6 and 24 hours afterwards) to measure tau levels. Results: No differences in tau levels were demonstrated between the study group and controls (p > 0.05). Conclusions: The extent of brain injury in adolescents with syncope is insufficient to induce significantly increased serum tau levels. However, the study should be continued to assess the levels of this marker in different types of syncope

Preoperative single ventricle function determines early outcome after second-stage palliation of single ventricle heart

Abstract Background Second-stage palliation with hemi-Fontan or bidirectional Glenn procedures has improved the outcomes of patients treated for single-ventricle heart disease. The aim of this study was to retrospectively analyze risk factors for death after second-stage palliation of single-ventricle heart and to compare therapeutic results achieved with the hemi-Fontan and bidirectional Glenn procedures. Material and methods We analyzed 60 patients who had undergone second-stage palliation for single-ventricle heart. Group HF consisted of 23 (38.3%) children who had been operated with the hemi-Fontan method; Group BDG consisted of 37 (61.7%) who had been operated with the bidirectional Glenn method. The analysis focused on 30-day postoperative mortality rates, clinical and echocardiographic data, and early complications. Results The patients’ ages at the time of repair was 33 ± 11.2 weeks; weight was 6.7 ± 1.2 kg. The most common anatomic subtype was hypoplastic left heart syndrome, in 36 (60%) patients. The early mortality rate was 13.3%. Significant preoperative atrioventricular valve regurgitation, single-ventricle heart dysfunction, pneumonia/sepsis, and arrhythmias were associated with higher mortality rates after second-stage palliation. Multivariate analysis identified significant preoperative single-ventricle heart dysfunction as an independent predictor of early death after second-stage palliation. No differences were found in the analyzed variables after bidirectional Glenn compared with hemi-Fontan procedures. Conclusion Significant preoperative atrioventricular valve regurgitation, arrhythmias and pneumonia/sepsis are closely correlated with mortality in patients with single-ventricle heart after second-stage palliation. Preoperative significant single-ventricle heart dysfunction is an independent mortality predictor in this group of patients. There are no differences in clinical, echocardiographic data, or outcomes in patients treated with the hemi-Fontan compared with bidirectional Glenn procedures

Wczesne wyniki rekonstrukcji łuku aorty z bandingami tętnic płucnych w leczeniu zespołu niedorozwoju lewego serca: modyfikacja operacji Norwooda

Background: In the period from 2003 to the end of 2015, 96 Norwood I procedures were performed in the Paediatric Heart Surgery Department in Katowice, Poland, in children with hypoplastic left heart syndrome (HLHS). Aim: This paper presents a retrospective analysis of early surgical results. Methods: The patients consisted of two groups: group I included 59 children operated on in the years 2003–2012, in whom the stage I Norwood procedure with the Sano modification was performed with the aortic arch reconstructed by use of a ho-mogenous pulmonary artery patch or a bovine pericardial patch. Group II included 37 children after our modification of the Norwood I procedure, in which the aortic arch was reconstructed with an extracellular matrix patch and bilateral pulmonary artery banding was done. Results: Aortic cross-clamping time was significantly shorter in group II (mean 52; range 38–62 min) than in group I (mean 57; range 39–72 min; p &lt; 0.009). Eighteen (30.5%) children in group I and six (16.2%) in group II died. Although this dif-ference did not reach statistical significance (p = 0.12), it suggested that improved outcomes with the modified procedure are possible. The cause of death in group I was significantly more frequently due to massive postoperative bleeding (n = 6; 33.3%) than in group II (n = 1; 16.7%; p = 0.046). Conclusions: The introduction of this new surgical technique reduced postoperative bleeding rates, shortened the operation time, and might improve the mortality rate in the first-stage surgical treatment of children with HLHS.Wstęp: W latach 2003–2015 na Oddziale Kardiochirurgii Dziecięcej w Katowicach było leczonych 96 noworodków z zespołem niedorozwoju lewego serca. Cel: W niniejszej pracy przedstawiono wynik chirurgicznego leczenia wady oraz retrospektywną analizę wczesnego okresu pooperacyjnego leczonych dzieci. Metody: Pacjentów podzielono na dwie grupy: grupa I — 59 dzieci operowanych w latach 2003–2012, u których wykonano operację Norwood I z modyfikacją Sano, z rekonstrukcją łuku aorty za pomocą łaty z homogennej tętnicy płucnej lub z bydlęcego osierdzia; grupa II — 37 dzieci, u których wykonano operację Norwood I z autorską modyfikacją — z rekonstrukcją łuku aorty za pomocą łaty z CorMatrix I bandingami tętnic płucnych. Wyniki: Czas zaklemowania aorty był krótszy w grupie II (średnio 52; zakres 38–62 min) niż w grupie I (średnio 57; zakres 39–72 min; p < 0,009). Osiemnaścioro (30,5%) dzieci w grupie I i sześcioro (16,2%) w grupie II zmarło. Widoczna różnica w śmiertelności sugeruje, że modyfikacja miała wpływ na znaczną poprawę w wynikach leczenia operacyjnego jednak różnica ta nie była istotna statystycznie (p = 0,12). Statystycznie częstszą przyczyną zgonów w grupie I (6 = 33,3%) było masywne krwawienie pooperacyjne, w porównaniu z grupą II (1 = 16,7%; p = 0,046). Wnioski: Wprowadzenie autorskiej modyfikacji operacji Norwood I pozwoliło istotnie zredukować krwawienie pooperacyjne i obniżyć śmiertelność pooperacyjną, a w rezultacie znacznie poprawić wyniki pierwszego etapu leczenia operacyjnego dzieci z zespołem niedorozwoju lewego serca