부산대학교 도서관

Byline: D. Abrahamov (1), E. Erez (1), M. Tamariz (1), O. Dagan (2), E. Pearl (3), Y. Abrahamov (4), B. Gendel (1), N. Desai (5), J. Kats (6), B. Vidne (1), V. Barak (7) Keywords: KeywordsaCapillary leak syndrome; Cardiopulmonary by pass Abstract: aCapillary leak syndrome (CLS), characterized by extravascular fluid accumulation and significant organ dysfunction, is a serious complication in children undergoing cardiopulmonary bypass (CPB). We examined the relationship between plasma vascular endothelial growth factor (VEGF) levels and severity of CLS. The kinetics of VEGF in the plasma of 11 neonates and 7 older children undergoing CPB were investigated, correlating plasma VEGF levels and CLS clinical presentation. The degree of postoperative CLS was quantified by measuring parameters of extracellular volume and end-organ dysfunction. A chest-wall soft-tissue-width index (CSTWI) was designed in order to standardize the extracellular fluid accumulation. Most CLS parameters were significantly more prominent in the neonatal patients. Low plasma VEFG levels (> 35pg/ml) were found in 3 neonatal control patients and all but, sample from the older group patient. The neonates had significantly higher preoperative VEGF plasma levels (684.4+-559.1pg/ml, P=0.02), which decreased during the operation to levels below 35pg/ml and increased again 24h postoperatively to levels significantly higher than in the older patients (484+-270.3pg/ml, P=0.001). Multilinear regression analysis found preoperative VEGF levels to independently correlate with CLS as represented by CSTWI (P< 0.01, r=0.726). Both the occurrence of post-CPB CLS and plasma VEGF levels pre- and postoperatively were thus higher in neonates than in children. Plasma VEGF level is a predictor of the severity of postoperative CLS. Author Affiliation: (1) Department of Cardiothoracic Surgery, Rabin Medical Center, Tel-Aviv University, Petah-Tikva, Israel, IL (2) Pediatric Cardiac Surgery Intensive Care Unit, Schneider Medical Center, Tel-Aviv University, Petah-Tikva, Israel, IL (3) Department of Pediatrics, Schneider Medical Center, Tel-Aviv University, Petah-Tikva, Israel, IL (4) Department of Gynecology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel, IL (5) Department of Cardiovascular Surgery, Sunnybrook Health Science Center, University of Toronto, Toronto, Canada, CA (6) Department of Anesthesiology, Schneider Medical Center, Tel-Aviv University, Petah-Tikva, Israel, IL (7) The Immunology and Tumor Diagnosis Laboratory, Department of Oncology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel, IL (8) 13 Shai Agnon St., P.O.B. 4241, Jerusalem, Israel, IL Article note: Accepted: 1 March 2000