losartan-potassium and Transposition-of-Great-Vessels

Blood transfusion-free complex congenital cardiac surgery in a neonate remains a challenge for multidisciplinary cardiac teams. At our institution, a 3.5 kg neonate, born to a family of Jehovah's Witnesses and postnatally diagnosed with dextro-transposition of the great arteries (d-TGA) and a small muscular ventricular septal defect, underwent a successful arterial switch operation without blood or platelet transfusion. Key points that contributed to success were optimal preoperative haematopoetic conditioning using erythropoietin and iron, a miniaturized cardiopulmonary bypass circuit including a low prime volume oxygenator and crystalloid cardioplegia, and a well-coordinated multidisciplinary team. We report an overview of the literature regarding blood transfusion-free complex congenital cardiac surgery.

Topics: Biomarkers; Blood Transfusion, Autologous; Bloodless Medical and Surgical Procedures; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Drug Administration Schedule; Erythropoietin; Health Knowledge, Attitudes, Practice; Heart Arrest, Induced; Hematinics; Hematocrit; Hemoglobins; Humans; Infant, Newborn; Iron; Jehovah's Witnesses; Male; Operative Blood Salvage; Religion and Medicine; Time Factors; Transposition of Great Vessels; Treatment Outcome

Topics: Erythropoiesis; Erythropoietin; Humans; Infant; Infant, Newborn; Transposition of Great Vessels

In the present study, hematocrit, pO2 in the capillary blood, reticulocyte count, erythropoietin activity in plasma and activity of the erythropoiesis inhibition factor in 24-h collective urine were determined in newborns and infants with cyanotic malformations of the heart (transpositions of the big arteries). The plasma of the healthy newborns shows immediately after birth an erythropoietin activity below 1%, as measured by the 59Fe incorporation. The erythropoietin activity of the plasma of infants with cyanotic malformations of the heart is enhanced up to the 14th day of life. In the period of day 14--30 it corresponds to the values of healthy newborns despite the persistence of hypoxia. After the 30th day of life there is again demonstrable an increased erythropoietin activity in the plasma of infants with cyanotic malformations of the heart. Obviously, the low values of 59Fe incorporation from day 14--30 are due to the occurrence of the erythropoiesis inhibition factor. In the urine of infants with cyanotic malformations of the heart there could be demonstrated distinct inhibitions of the stimulated erythropoiesis of the polycythemic mouse. The present studies suggest that the erythropoiesis inhibition factor occurs in postnatal development irrespectively of the degrees of O2-supply of the tissue, and is possibly dependent on the gestational age.

Topics: Aging; Animals; Biological Assay; Blood Proteins; Capillaries; Erythrocyte Count; Erythropoietin; Hematocrit; Humans; Infant; Infant, Newborn; Mice; Oxygen; Partial Pressure; Reticulocytes; Transposition of Great Vessels

In 22 healthy newborns and in 31 newborns with transposition of the major arterial vessels (TMAV) erythropoietin and erythropoiesis inhibitor was studied on a model of polycythemic mice. Erythropoietin was not detected, whereas erythropoiesis inhibitor was revealed in the plasma and urine of 5--7-day-old healthy newborns. The newborns with TMAV displayed a rise of erythropoietin level up to the 14th day and its reduction during the period of from 14th to the 56th days. Erythropoiesis inhibitor was also found in the urine concentrates of the newborn with TMAV during the period of 3--4 weeks. The role of erythropoiesis inhibitor as a physiological regulator appearing in the blood of healthy and hypoxic newborns to normalize the erythropoiesis in the course of the initial weeks after birth is discussed.

Topics: Erythropoietin; Humans; Hypoxia; Infant; Infant, Newborn; Transposition of Great Vessels

Topics: Biological Assay; Erythroblastosis, Fetal; Erythrocytes; Erythropoiesis; Erythropoietin; Female; Fetus; Humans; Hypoxia; Infant, Newborn; Iron; Iron Isotopes; Pregnancy; Transposition of Great Vessels; Umbilical Cord