title: Perturbation of the microvascular glycocalyx and perfusion in infants after cardiopulmonary bypass.
abstract: OBJECTIVE
  Perturbation of the endothelial glycocalyx is discussed in the pathogenesis of complications related to cardiopulmonary bypass. We evaluated the effects of cardiopulmonary bypass on the microcirculation and the microvascular endothelial glycocalyx of infants undergoing surgery for congenital cardiac defects.
  
  
  METHODS
  The microcirculation was visualized at the ear conch using Sidestream dark field imaging before surgery (T0), after admission to the intensive care unit (T1), 24 hours postsurgery (T2), and 7 days postsurgery (T3). Glycocalyx thickness was assessed by measurement of the perfused boundary region. Microcirculatory parameters included total and perfused vessel density, vessel diameters, and microcirculatory flow index.
  
  
  RESULTS
  A total of 40 infants undergoing cardiac surgery (36 with cardiopulmonary bypass, 4 without cardiopulmonary bypass) were examined. As controls, measurements before and after cardiac catheterization (n = 6) and before and after surgery for cleft palate (n = 9) were performed. After surgery with cardiopulmonary bypass, the perfused boundary region was significantly increased, indicating reduced glycocalyx thickness at T1 compared with preoperative values with a stepwise return to baseline by T3. In the control groups, no significant perfused boundary region changes were noted. Furthermore, after cardiopulmonary bypass, a transient, significant reduction of the microcirculatory flow index and the perfused vessel density was seen at T1. Similar changes were observed after cardiac surgery without cardiopulmonary bypass, but not in the other controls.
  
  
  CONCLUSIONS
  Our study reveals for the first time local perturbations of the endothelial glycocalyx and microvascular perfusion in infants after surgery with cardiopulmonary bypass. Microcirculatory monitoring might be a useful tool to evaluate interventions aiming at reduction of bypass-related complications.
authors.affiliation: Division of Neonatology, Campus Innenstadt, Dr von Hauner Children's University Hospital Munich, Munich, Germany; Department of Pediatric Cardiology and Intensive Care Medicine, Dr von Hauner Children's University Hospital Munich, Munich, Germany. Electronic address: claudia.nussbaum@med.uni-muenchen.de.
authors.forename: Claudia
authors.initials: C
authors.lastname: Nussbaum
authors.affiliation: Division of Neonatology, Campus Innenstadt, Dr von Hauner Children's University Hospital Munich, Munich, Germany.
authors.forename: Amelie
authors.initials: A
authors.lastname: Haberer
authors.affiliation: Division of Neonatology, Campus Innenstadt, Dr von Hauner Children's University Hospital Munich, Munich, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Tiefenthaller
authors.affiliation: Department of Cardiac Surgery, University of Münster, Albert-Schweitzer-Campus 1, Münster, Germany.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Januszewska
authors.affiliation: Department of Anesthesiology, University Hospital of Munich, Munich, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Chappell
authors.affiliation: Department of Anesthesiology, University Hospital of Munich, Munich, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Brettner
authors.affiliation: Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-University Munich, Munich, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Mayer
authors.affiliation: Department of Pediatric Cardiology and Intensive Care Medicine, Dr von Hauner Children's University Hospital Munich, Munich, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Dalla Pozza
authors.affiliation: Division of Neonatology, Campus Innenstadt, Dr von Hauner Children's University Hospital Munich, Munich, Germany.
authors.forename: Orsolya
authors.initials: O
authors.lastname: Genzel-Boroviczény
mesh_terms: D000293:Adolescent; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D002972:Cleft Palate / Q000601:surgery; D004431:Ear, External / Q000098:blood supply; D005260:Female; D019276:Glycocalyx; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000502:physiology*; D016896:Treatment Outcome
keywords: SDF; cardiopulmonary bypass; congenital cardiac defects; endothelial glycocalyx; infants; microcirculation