Time course of cranial ultrasound abnormalities after arterial switch operation in neonates.
; ; et al
in Annals of Thoracic Surgery (2001), 71(3), 877-80
BACKGROUND: The object of this study was to investigate the time course and fate of abnormal findings in cranial ultrasound after performing an arterial switch operation in neonates with transposition of ... [more ▼]
BACKGROUND: The object of this study was to investigate the time course and fate of abnormal findings in cranial ultrasound after performing an arterial switch operation in neonates with transposition of the great arteries, and to analyze the relationship to cerebral cell damage. METHODS: Cranial ultrasound was performed prospectively in 35 neonates with transposition of the great arteries before the operation as well as 4 hours, 1, 2, and 3 days, and 1 and 2 weeks postoperatively. Blood levels of neuron-specific enolase, a marker of cerebral cell damage, were determined before, during, and 4 and 24 hours postoperatively. RESULTS: In 17 of 35 neonates (49%), early postoperative cranial ultrasound revealed abnormalities indistinguishable from intraventricular hemorrhage. In 11 neonates findings were transient and were normalized 2 weeks postoperatively, whereas in the remaining 6 neonates there was evidence of resolving hemorrhage. In all neonates there was a rise in neuron-specific enolase blood concentrations during and 4 hours after extracorporal circulation without correlation to sonographic findings. CONCLUSIONS: Enhanced echogenicity of the choroid plexus or dilatation of the cerebral ventricular system is a frequent early postoperative finding that may be caused by transient plexus edema rather than intraventricular hemorrhage and is not related to cerebral cell damage. [less ▲]Detailed reference viewed: 7 (0 ULg)
Neurodevelopmental outcome related to cerebral risk factors in children after neonatal arterial switch operation.
; SEGHAYE, Marie-Christine ; et al
in Annals of Thoracic Surgery (2001), 71(3), 881-8
BACKGROUND: Neurodevelopmental outcome after neonatal arterial switch operation for complete transposition of the great arteries is an important topic needing prospective assessment. METHODS: A group of ... [more ▼]
BACKGROUND: Neurodevelopmental outcome after neonatal arterial switch operation for complete transposition of the great arteries is an important topic needing prospective assessment. METHODS: A group of 33 unselected children (3.0 to 4.6 years) operated on as neonates with combined deep hypothermic circulatory arrest and low flow cardiopulmonary bypass and a control group of 32 age-matched healthy children (3.0 to 4.8 years) underwent evaluation of socioeconomic and clinical neurological status and a standardized test comprising all areas of child development. Results of patients were related to those of the control group, to population norms, and to preoperative, perioperative, and postoperative cerebral risk factors. RESULTS: Clinical neurological status was normal in 26 patients (78.8%) and reduced in 7 (21.2%). Complete developmental score and the subscores for motor function, visual perception, learning and memory, cognitive function, language, and socioemotional functions were not different compared to population norms. Compared to the patients, the children of the control group scored higher on tests of complete development, cognition, and language, but also on socioeconomic status. Complete developmental score and the scores for motor, cognitive, and language functions were weakly inversely related to the duration of circulatory arrest, but not to the duration of bypass. Cerebral risk factors such as serum levels of the neuron-specific enolase, perinatal acidosis, perinatal asphyxia, peri- and postoperative cardiocirculatory insufficiency, or clinical seizures were not correlated to the test results. CONCLUSIONS: Neonatal arterial switch operation with combined circulatory arrest and low flow bypass is associated with neurological impairment, but not with reduced development as assessed by formal testing of motor, cognitive, language, and behavioral functions. Perioperative serum level of the neuron-specific enolase is not a valid marker for later developmental impairment. [less ▲]Detailed reference viewed: 2 (0 ULg)
Moderate hypothermia during cardiopulmonary bypass reduces myocardial cell damage and myocardial cell death related to cardiac surgery.
; ; et al
in Journal of the American College of Cardiology (2001), 38(4), 1216-23
OBJECTIVES: The goal of this study was to test the hypothesis that moderate hypothermia during cardiopulmonary bypass (CPB) provides myocardial protection by enhancing intra-myocardial anti-inflammatory ... [more ▼]
OBJECTIVES: The goal of this study was to test the hypothesis that moderate hypothermia during cardiopulmonary bypass (CPB) provides myocardial protection by enhancing intra-myocardial anti-inflammatory cytokine balance. BACKGROUND: Moderate hypothermia during experimental CPB stimulates production of interleukin-10 (IL10) and blunts release of tumor necrosis factor-alpha (TNFalpha). METHODS: Twelve young pigs were assigned to a temperature (T degrees ) regimen during CPB: moderate hypothermia (T degrees : 28 degrees C; n = 6) and normothermia (T degrees : 37 degrees C; n = 6). Intra-myocardial TNFalpha- and IL10-messenger RNA were detected by competitive reverse transcriptase polymerase chain reaction and quantification of cytokine synthesis by Western blot. Levels of cardiac troponin I (cTnI) in cardiac lymph and in arterial and coronary venous blood were examined during and after CPB. Myocardial cell damage was assessed by histologic and ultrastructural anomalies of tissue probes taken 6 h after CPB. RESULTS: Synthesis of IL10 was significantly higher, while that of TNFalpha was significantly lower, in pigs that were in moderate hypothermia during surgery than in the others. In contrast with normothermia, moderate hypothermia was also associated with significantly lower cumulative cardiac lymphatic flow during and after CPB, significantly lower lymphatic cTnI concentrations after CPB, significantly lower percentages of myocardial cell necrosis and a significantly lower score of ultrastructural anomalies of myocardial cells. While the percentage of apoptotic cells was not different between groups, the apoptosis/necrosis ratio tended to be higher in animals that were in moderate hypothermia during surgery. In all animals, TNFalpha synthesis correlated positively while IL10 production correlated negatively with necrosis and total cell death, respectively. CONCLUSIONS: Our results suggest that moderate hypothermia during CPB provides myocardial protection by enhancing intra-myocardial anti-inflammatory cytokine balance. [less ▲]Detailed reference viewed: 20 (0 ULg)
Cannulation of the cardiac lymphatic system in swine.
; SEGHAYE, Marie-Christine ; et al
in European Journal of Cardio - Thoracic Surgery (2000), 18(2), 228-32
OBJECTIVE: Cardiac lymph is the most direct medium for analyzing metabological changes in the myocardial cell. Currently, dogs are the animals used for investigation of myocardial lymphatic function ... [more ▼]
OBJECTIVE: Cardiac lymph is the most direct medium for analyzing metabological changes in the myocardial cell. Currently, dogs are the animals used for investigation of myocardial lymphatic function. However, questions arise when comparing and interpreting the human system to the experimental model, since the dog coronary anatomy is different from human anatomy and pulmonary lymph contamination is found in up to 81% of the cases. Swine, having similar coronary anatomy to humans, are a proven model for cardiovascular research. The purpose of this study was to investigate the cardiac lymphatic anatomy of the swine and to develop a reliable cannulation technique to collect the lymph. METHODS AND RESULTS: The lymphatic anatomy of 60 pigs was studied and classified and a new technique for lymphatic cannulation was developed. The cannulation success rate was 55%. In addition, no pulmonary lymph contamination was found at the cannulation site. CONCLUSION: We conclude that porcine myocardial lymphatics can be successfully cannulated for the investigation of myocardial lymphatic function. [less ▲]Detailed reference viewed: 60 (0 ULg)
Mid-term follow-up after multiple system organ failure following cardiac surgery in children.
; SEGHAYE, Marie-Christine ; et al
in Acta Paediatrica (1999), 88(11), 1238-43
Multiple system organ failure after cardiac surgery in children is a severe complication with unknown mid- and long-term sequelae. We therefore evaluated 11 children (aged 20-126 mo, median: 67 mo) having ... [more ▼]
Multiple system organ failure after cardiac surgery in children is a severe complication with unknown mid- and long-term sequelae. We therefore evaluated 11 children (aged 20-126 mo, median: 67 mo) having survived multiple system organ failure after cardiac operations for congenital cardiac defects in a cross-sectional follow-up study 12-76 mo (median: 32 mo) after surgery. Clinical and laboratory examinations included cardiac, pulmonary, renal, hepatic, neurological and psychological function tests. All patients had adequate cardiac function. Lung mechanics were abnormal in three children and glomerular renal function was abnormal in two patients. Slight elevation of gamma-glutamyl transpeptidase and coagulation factor deficiency was present in six and seven patients, respectively (five of whom had undergone the Fontan operation). Severe neurological sequelae such as diplegia (n = 1) and mental retardation (n = 1) were observed in two patients. In addition, five children presented delayed motor, graphomotor and/or speech development. Two children were found to have abnormal intelligence. We conclude that with the exception of neurological impairment, mid-term sequelae of multiple system organ failure after cardiac surgery in children are mild. However, longer follow-up using an appropriate control group is mandatory. [less ▲]Detailed reference viewed: 6 (0 ULg)
Cardiac myxoma in a 6-year-old child--constitutional symptoms mimicking rheumatic disease and the role of interleukin-6.
; SEGHAYE, Marie-Christine ; et al
in Acta Paediatrica (1999), 88(7), 786-8
A 6-y-old girl with right atrial myxoma presented with remittent fever attacks, general arthralgia and laboratory investigations mimicking rheumatic or autoimmune disease. Interleukin-6 (IL-6) serum ... [more ▼]
A 6-y-old girl with right atrial myxoma presented with remittent fever attacks, general arthralgia and laboratory investigations mimicking rheumatic or autoimmune disease. Interleukin-6 (IL-6) serum concentration was markedly elevated before and normal after tumour resection, whereas myxoma cells stained negatively for IL-6. IL-6 should be considered a myxoma marker: overproduction by myxoma cells and consecutive systemic passage are assumed to cause immunological features. [less ▲]Detailed reference viewed: 3 (0 ULg)
Growth of pulmonary artery after arterial switch operation for simple transposition of the great arteries.
; ; et al
in European Journal of Pediatrics (1998), 157(2), 95-100
This retrospective study attempts to assess the size and growth pattern of the pulmonary artery about 1 year after neonatal arterial switch operation for simple transposition of the great arteries. Sixty ... [more ▼]
This retrospective study attempts to assess the size and growth pattern of the pulmonary artery about 1 year after neonatal arterial switch operation for simple transposition of the great arteries. Sixty-seven patients underwent cardiac catheterization, including catheterization of the right and left pulmonary arteries, and right ventricular angiography an average of 13.9 months after arterial switch operation. In 34 of these patients pre-operative right ventricular angiocardiograms were available. The diameter of the main pulmonary artery and that of its proximal right and left branches were measured. The values were compared to those of normal children matched for body surface area, taken from the literature and, for the branch values, related to the degree of branch stenosis and to the corresponding values, measured on pre-operative angiocardiograms. The cross-section of the main pulmonary artery after arterial switch operation with Lecompte manoeuvre becomes oval. The branches of the pulmonary artery are sometimes underdeveloped and this finding is related to branch stenosis. The ratio of the branch gradients is inversely proportional to the growth ratio of both branches while the pre- and postoperative Nakata indices are identical. CONCLUSION: The Lecompte manoeuvre induces a flattening of the main pulmonary artery with concomitant reduction of its cross-sectional area. There is also frequently trivial or rarely moderate branch pulmonary stenosis which is accompanied by growth retardation of the concerned branch. [less ▲]Detailed reference viewed: 1 (0 ULg)
The production of pro- and anti-inflammatory cytokines in neonates assessed by stimulated whole cord blood culture and by plasma levels at birth.
SEGHAYE, Marie-Christine ; ; et al
in Biology of the Neonate (1998), 73(4), 220-7
The capability of neonates to achieve cytokine balance was evaluated. Production of the pro-inflammatory cytokines TNF alpha and IL-8, of the natural anti-inflammatory cytokine IL10 and of the regulator ... [more ▼]
The capability of neonates to achieve cytokine balance was evaluated. Production of the pro-inflammatory cytokines TNF alpha and IL-8, of the natural anti-inflammatory cytokine IL10 and of the regulator of the acute phase response IL6 was assessed after whole blood stimulation by lipopolysaccharide in cord blood (n = 10), adult volunteers serving as control (n = 17). Additionally, circulating cytokines were determined in cord and in maternal blood immediately after delivery (n = 27, respectively). Significant production of TNF alpha, IL8, IL10 and IL6 was observed in cord blood after lipopolysaccharide stimulation and was similar to cytokine production in adult blood. The plasma concentrations of TNF alpha were significantly higher in cord than in maternal blood, while plasma concentrations of IL10 and IL6 were significantly lower. Our results demonstrate fully developed capability of whole cord blood to synthesize pro- and anti-inflammatory cytokines in response to a pro-inflammatory stimulation in vitro. In vivo, however, higher circulating TNF alpha and lower IL10 and IL6 levels in cord blood suggest that the inflammatory stress associated with normal delivery does not induce detectable anti-inflammatory response in neonates at birth. [less ▲]Detailed reference viewed: 5 (0 ULg)
Pathophysiologie der durch den extrakorporalen Kreislauf bedingten entzündlichen Reaktion im Kindesalter
Thèse d’agrégation de l’enseignement supérieur (1996)Detailed reference viewed: 5 (0 ULg)
Komplementaktivierung und Aktivierung des Plasmakontaktsystems während Herz-Lungen-Maschinen Operationen beim Kind - Beziehung zum postoperativen Polyorganversagen
Doctoral thesis (1994)Detailed reference viewed: 4 (0 ULg)
Maladie de Caffey-Silverman néonatale avec thrombocytose, augmentation de la C-réactive protéine et des immunoglobulines
; SEGHAYE, Marie-Christine ; Senterre, Jacques
in Archives Françaises de Pédiatrie (1988), 45Detailed reference viewed: 18 (0 ULg)
Thrombose aortique idiopathique chez le nouveau-né à terme
SEGHAYE, Marie-Christine ; Defraigne, Jean-Olivier ; RIGO, Jacques et al
in Archives Françaises de Pédiatrie (1987), 44Detailed reference viewed: 23 (1 ULg)