ABSTRACT
ABSTRACT Introduction: The current recommendation for systemic to pulmonary artery shunt (SPS) patients requiring extracorporeal life support (ECLS) is to keep the shunt open, maintaining a higher pump flow. The practice in our center is to totally occlude the shunt while on ECLS, and we are presenting the outcome of this strategy. Methods: This is a retrospective analysis of patients who underwent SPS for cyanotic congenital heart disease with decreased pulmonary blood flow and required postoperative ECLS between January 2016 and December 2020. ECLS indication was excessive pulmonary blood flow, leading to either refractory low cardiac output syndrome (LCOS) or cardiac arrest. All patients had their shunts totally occluded soon after ECLS establishment. Results: Of the 27 SPS patients who needed postoperative ECLS (13 refractory LCOS, 14 extracorporeal cardiopulmonary resuscitation), wherein the strategy of occluding the shunt on ECLS initiation was followed, 16 (59.3 %) survived ECLS weaning and eight (29.6%) survived to discharge. Conclusion: Increased flow to maintain systemic circulation for a SPS patient while on ECLS is an accepted strategy, but it should not be applied universally. A large subset of SPS patients, who require ECLS either due to cardiac arrest or refractory LCOS due to excessive pulmonary flow, might benefit from complete occlusion of the shunt soon after commencement of ECLS, especially in cases with frank pulmonary edema or haemorrhage in the pre-ECLS period. A prospective randomized trial could be ethically justified for the subset of patients receiving ECLS for the indication of excessive pulmonary blood flow.
ABSTRACT
Coconut oil and sesame oil are commonly used in South India for frying foods. On heating, edible oils form hazardous chemicals. This study explores the effect of consumption of unheated and thermally-altered sesame and coconut oils on coronary artery disease (CAD) risk factors in Wistar rats. Thirty Wistar albino rats were randomly divided into five groups (n=6/group). Group I (Control) was fed only chow, Group II: chow + unheated sesame oil, Group III: chow + heated sesame oil, Group IV: Chow + unheated coconut oil, Group V: chow + heated coconut oil. After eight weeks of treatment, serum lipid profile, hs-CRP, leptin, glucose, insulin, HOMA-IR, TNF-α, IL-6 and plasma homocysteine and fibrinogen levels were estimated. Rats in Group II showed a significant decrease in serum cholesterol, LDL-c, TNF-α, hs-CRP, insulin, and HOMA-IR but a significant increase in HDL-c, Group III showed opposite effects on these parameters, except that it decreased serum triglycerides level. Group IV and V did not show any significant effect on stated parameters. We conclude that consumption of unheated sesame oil gives protective effects against the CAD. Thermally altered sesame oil increases the CAD risk. Unheated and thermally altered coconut oil did not show any significant effect. Hence, we recommend that sesame oil better be used for dressing the food and coconut oil for frying.