[Coagulation and fibrinolysis system in pediatric cardiopulmonary bypass].
Coagulation and fibrinolysis system was evaluated during and after pediatric cardiopulmonary bypass (CPB. Twenty-two atrial septal defect (ASD) patients were surgically repaired under CPB and aortic cross-clamp through right thoracotomy. Drainage was established by gravity, CPB flow was kept 2.4 l/min/m2 and ACT was controlled over 400 seconds. HCT, PLT, fibrinogen, AT-III, D-dimer, thrombin-antithrombin complex (TAT), alpha2 plasmin inhibitor-plasmin complex (PIC), and plasminogen activator inhibitor (PAI-1) were measured at 6 points [after induction of anesthesia, 10 minutes after initiating CPB, end of CPB, on the entrance of intensive care unit (ICU), postoperative day (POD) 1, and at outpatient division]. Both fibrinogen and AT-III showed low values during CPB (121.9 +/- 22.0 mg/dl, 57.6 +/- 10.6%). D-dimer increased at 1 week postoperatively in all patients (5.57 +/- 3.45 microg/ml). There were significantly positive correlations between CPB duration and TAT value at the end of CPB (r = 0.88, p < 0.01), on the entrance of ICU (r = 0.71, p < 0.01). There was also a positive correlation between CPB duration and PIC value on the entrance of ICU (r = 0.53, p < 0.01). Five patients showed high PAI-1 value on the entrance of ICU, which remained high in 2 of them on POD 1. The outcomes from the current study suggest that there is a potential of coagulation-dominant disseminated intravascular coagulation (DIC) during pediatric CPB even in ASD patients who do not need long CPB. Longer CPB and severe hemodilution might become risk factors.
Sakamoto
Takahiko
T
Division of Cardiovascular Surgery, Kanagawa Children's Medical Center, Yokohama, Japan.
Asou
T
T
Takeda
Y
Y
Date
K
K
Nanaumi
M
M
Nagafuchi
H
H
Koga
N
N
Ohmiya
A
A
Chiba
S
S
D001777:Blood Coagulation; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004211:Disseminated Intravascular Coagulation / Q000209:etiology*; D005342:Fibrinolysis; D006344:Heart Septal Defects, Atrial / Q000601:surgery; D006438:Hemodilution / Q000009:adverse effects; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology*; D013997:Time Factors