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Polymers (Basel) ; 11(5)2019 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-31130638


This study looked into the synthesis and study of Dextrane Sulfate-Doxorubicin Nanoparticles (DS-Dox NP) that are sensitive to amylase and show anticoagulant properties. The particles were obtained by the method of solvent replacement. They had a size of 305 ± 58 nm, with a mass ratio of DS:Dox = 3.3:1. On heating to 37 °C, the release of Dox from the particles was equal to 24.2% of the drug contained. In the presence of amylase, this ratio had increased to 42.1%. The study of the biological activity of the particles included an assessment of the cytotoxicity and the effect on hemostasis and antitumor activity. In a study of cytotoxicity on the L929 cell culture, it was found that the synthesized particles had less toxicity, compared to free doxorubicin. However, in the presence of amylase, their cytotoxicity was higher than the traditional forms of the drug. In a study of the effect of DS-Dox NP on hemostasis, it was found that the particles had a heparin-like anticoagulant effect. Antitumor activity was studied on the model of ascitic Zaidel hepatoma in rats. The frequency of complete cure in animals treated with the DS-Dox nanoparticles was higher, compared to animals receiving the traditional form of the drug.

Eur J Cardiothorac Surg ; 55(3): 572-578, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-29315433


OBJECTIVES: This study aimed to investigate the indications for and the results of axillary arterio-venous fistula in patients with a functionally single ventricle at mid-term follow-up after bidirectional cavopulmonary connection. METHODS: From 2012 to 2017, 20 patients aged 21.1 ± 8.7 years (median 20.5) underwent axillary arterio-venous fistula after bidirectional cavopulmonary connection in our institution. The interval between bidirectional cavopulmonary connection and axillary arterio-venous fistula was 13.9 ± 7.2 years. The clinical and haemodynamic parameters of the patients were assessed before and after surgery. RESULTS: There was no in-hospital mortality. Paraesthesia of the arm persisted for 1-7 days. The mean arterial oxygen saturation increased from 72.4 ± 7.1% pre-surgery to 81.6 ± 5.5% (P < 0.001) after surgery, and was 83.8 ± 6.5% at discharge (P = 0.002 Wilcoxon matched pairs test). The haemoglobin, haematocrit, McGoon index and ejection fraction values did not change significantly. The speed and minute volume of the blood flow in the superior vena cava increased from from 21.1 ± 8.3 cm/s to 28.8 ± 14.9 cm/s (P < 0.001) and from 10.6 ± 3.7 ml/s to 12.5 ± 2.9 ml/s (P < 0.001), respectively. At the mid-term follow-up (1-5 years), 2 patients died from concomitant pathology. Stable improvement in the state and tolerance of physical activity was noted: before surgery, 17 patients were classified as New York Heart Association functional capacity (FC) III and 3 patients as FC IV; after surgery, 9 patients were FC II and 3 patients were FC III. One patient underwent a Fontan operation within 3 years. CONCLUSIONS: Axillary arterio-venous fistula can be used as the stage of surgical treatment and a bridge to Fontan and/or heart transplantation for this category of patients.

Derivação Arteriovenosa Cirúrgica , Derivação Cardíaca Direita , Coração Univentricular/cirurgia , Adolescente , Adulto , Axila , Criança , Feminino , Seguimentos , Humanos , Masculino , Fatores de Tempo , Coração Univentricular/fisiopatologia , Adulto Jovem
Eur J Cardiothorac Surg ; 48(2): 308-14; discussion 314-5, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25527172


OBJECTIVES: The influence of concomitant atrioventricular valve regurgitation on the results of Fontan operation remains disputable. The goal of this study was to compare early and late results of Fontan operation performed in patients with mild or moderate-to-severe atrioventricular valve regurgitation. METHODS: For retrospective analysis, patients with atrioventricular valve insufficiency assessed by echocardiography were divided into three groups based on the severity of regurgitation and its repair or non-repair during Fontan operation: Group 1: unrepaired regurgitation 1-2+ (n = 33); Group 2: unrepaired regurgitation 3-4+ (n = 11); Group 3: repaired regurgitation 3-4+ (n = 35). Actuarial survival was estimated by the Kaplan-Meier method, followed by the log-rank test to compare survival curves between groups. RESULTS: Hospital mortality rates in Groups 1 through 3 reached 3, 27 and 14%, respectively (P = 0.015, Group 1 vs Group 2). The frequency of non-lethal complications did not significantly differ between groups. However, patients from Group 2 required significantly more intensive inotropic support, longer mechanical ventilation and had larger pleural effusion. Predicted survival after Fontan operation was the worst in Group 2 (P = 0.016, Group 2 vs Group 1). The frequency of non-lethal late complications was also the highest in Group 2 (50 vs 17 or 11%); however, the difference did not reach statistical significance (P = 0.13 and 0.069, respectively). The severity of atrioventricular valve regurgitation during the follow-up did not significantly change when compared with discharge after the repair in Group 2 or Group 3 (P = 0.19 and 0.52, respectively), and significantly increased in Group 1 (P = 0.003). However, this increase did not have clinical significance during the reported period of follow-up. CONCLUSIONS: If unrepaired, concomitant moderate-to-severe atrioventricular valve regurgitation significantly worsens the results of the Fontan procedure. Longer observation is needed to define the strategy in patients with mild atrioventricular valve regurgitation that remained unrepaired during Fontan operation.

Técnica de Fontan/efeitos adversos , Cardiopatias Congênitas/cirurgia , Insuficiência da Valva Tricúspide/complicações , Adolescente , Criança , Pré-Escolar , Cuidados Críticos/métodos , Feminino , Técnica de Fontan/métodos , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/fisiopatologia , Hemodinâmica/fisiologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Cuidados Pós-Operatórios/métodos , Período Pós-Operatório , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/cirurgia , Ultrassonografia
Pediatr Cardiol ; 35(7): 1108-15, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24714980


Cardiopulmonary bypass (CPB) reduces coagulation factor levels through hemodilution and consumption. Differences in CPB-induced alterations of factor XIII (FXIII) levels in children with cyanotic and acyanotic congenital heart defects (CHDs) are not well characterized. FXIII activity (determined by Berichrom assay), prothrombin index, activated partial thromboplastin time, and fibrinogen were measured before open heart surgery with CPB and 5 days postoperatively for children older than 3 years with acyanotic (n = 30) and cyanotic (n = 30) CHDs. The preoperative FXIII levels did not differ significantly among the children of the compared groups. The cyanotic patients showed a significantly longer duration of CPB (111.4 ± 45.8 vs 71.5 ± 33.6 min; p = 0.026) and aortic cross-clamp (68.0 ± 27.1 vs 45.4 ± 31.4 min; p = 0.034). The drop in FXIII levels after termination of CPB was more profound for the children with cyanotic CHDs (87.1 ± 13.4 to 49.1 ± 13.2 vs 81.5 ± 12.6 to 58.6 ± 11.1 %, respectively; p = 0.018). The cyanotc patients also were restored to their baseline FXIII levels later than the children with acyanotic CHDs (at 48 vs 24 h). The post-CPB dynamics of the majority of the other coagulation parameters in the compared groups of patients were similar. The cyanotic patients experienced significantly greater postoperative blood loss than the acyanotic patients (12.6 ± 4.9 vs 5.0 ± 2.1 mL/kg; p < 0.001) and were transfused with larger volumes of red blood cells (10.4 ± 6.5 vs 4.2 ± 2.5 mL/kg; p = 0.007). The decrease in FXIII levels after CPB is more profound and lasts longer in children with cyanotic CHDs than in acyanotic patients. The rational strategy of postoperative FXIII replacement therapy for these categories of patients needs to be determined.

Coagulação Sanguínea/fisiologia , Procedimentos Cirúrgicos Cardíacos/métodos , Cianose/sangue , Fator XIII/metabolismo , Cardiopatias Congênitas/cirurgia , Adolescente , Biomarcadores/sangue , Criança , Pré-Escolar , Cianose/etiologia , Cianose/cirurgia , Feminino , Seguimentos , Cardiopatias Congênitas/sangue , Cardiopatias Congênitas/complicações , Humanos , Masculino , Período Pós-Operatório , Prognóstico , Estudos Prospectivos
Interact Cardiovasc Thorac Surg ; 12(4): 563-8, 2011 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21233261


The object of our study was to analyze the results of bidirectional cavopulmonary anastomosis (BCPA) and modified Fontan operations (MFO) in patients with a functionally single ventricle and heterotaxy syndrome and to reveal risk factors for these surgical interventions. During 1983-2010, 681 patients underwent BCPA or MFO. Thirty-nine had heterotaxy syndrome. The median follow-up period after BCPA and MFO was nine and 1.5 years, respectively. Risk factors for lethal outcomes were determined by logistic regression analysis. Hospital mortality after BCPA and MFO was 7.9% and 12.5%, respectively and did not significantly differ from patients without heterotaxy. The most frequent hospital complications were heart failure, pleural effusions, and arrhythmias. Late mortality after BCPA and MFO was 8.7% and did not significantly differ from patients without heterotaxy. Late deaths were caused by congestive heart failure or pulmonary thromboembolism. The main non-lethal complication was arrhythmia. Patients have significantly improved their functional class at follow-up. The independent risk factor for lethal outcomes after BCPA and MFO was preoperative regurgitation at atrioventricular valves (P=0.012). BCPA and MFO in patients with a functionally single ventricle and heterotaxy syndrome allow to significantly improves their quality of life. Preoperative regurgitation at atrioventricular valves worsens surgical results.

Anormalidades Múltiplas , Técnica de Fontan , Cardiopatias Congênitas/cirurgia , Ventrículos do Coração/cirurgia , Adolescente , Adulto , Análise de Variância , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Dextrocardia/complicações , Dextrocardia/mortalidade , Dextrocardia/fisiopatologia , Técnica de Fontan/efeitos adversos , Técnica de Fontan/mortalidade , Doenças Genéticas Ligadas ao Cromossomo X/complicações , Doenças Genéticas Ligadas ao Cromossomo X/mortalidade , Doenças Genéticas Ligadas ao Cromossomo X/fisiopatologia , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/mortalidade , Cardiopatias Congênitas/fisiopatologia , Ventrículos do Coração/anormalidades , Ventrículos do Coração/fisiopatologia , Síndrome de Heterotaxia , Mortalidade Hospitalar , Humanos , Lactente , Estimativa de Kaplan-Meier , Modelos Logísticos , Razão de Chances , Recuperação de Função Fisiológica , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Federação Russa , Situs Inversus/complicações , Situs Inversus/mortalidade , Situs Inversus/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
Interact Cardiovasc Thorac Surg ; 12(2): 141-5, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21109618


The purpose of this study is to analyze the immediate results of bidirectional cavopulmonary anastomosis (BCPA) and Fontan operations performed in adults, and to reveal the risk factors. During the years 1983-2010, 681 consecutive patients underwent BCPA or a Fontan operation. Fifty-three of 681 patients were more than 18 years of age. Twenty-nine adults underwent BCPA and 24 underwent a Fontan operation. Immediate results of surgical treatment were followed during the hospital period. The average number of exceeded 'operability' criteria by Choussat et al. [Choussat A, Fontan F, Besse P, Vallot F, Chauve A, Bricaud H. Selection criteria for Fontan procedure. In: Anderson RH, Shinebourne EA, editors. Pediatric Cardiology. Edinburgh: Churchhill Livingstone, 1977:559-566] was significantly higher in patients from the BCPA group compared to the Fontan group (1.3±0.8 vs. 0.9±0.7, P=0.034). Hospital mortality after BCPA in adults was 6.9% (2/29) and did not differ from children (7.1%, 19/268), P=0.634. Hospital mortality after Fontan operation in adults was 8.3% (2/24) and did not differ from children (11.9%, 43/360), P=0.419. The frequency of non-lethal hospital complications was higher in patients after a Fontan operation. Patients from the Fontan group more frequently developed arrhythmias and prolonged pleural effusions. Preoperative regurgitation at atrioventricular valves was an independent risk factor for hospital mortality and morbidity after a Fontan operation. BCPA and Fontan operations performed in adults are accompanied by good immediate results and considerably improves patients' condition.

Derivação Cardíaca Direita/métodos , Cardiopatias Congênitas/mortalidade , Cardiopatias Congênitas/cirurgia , Hemodinâmica/fisiologia , Adolescente , Adulto , Análise de Variância , Estudos de Coortes , Intervalos de Confiança , Feminino , Seguimentos , Técnica de Fontan/métodos , Técnica de Fontan/mortalidade , Derivação Cardíaca Direita/mortalidade , Cardiopatias Congênitas/diagnóstico , Mortalidade Hospitalar/tendências , Humanos , Modelos Logísticos , Masculino , Análise Multivariada , Razão de Chances , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/mortalidade , Circulação Pulmonar/fisiologia , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem