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Byline: Luca Dello Strologo (1), Francesco Parisi (2), Antonia Legato (1), Claudia Pontesilli (1), Anna Pastore (3), Lucilla Rava (4), Alberto E. Tozzi (4), Gianfranco Rizzoni (1) Keywords: Heart transplantation; Cyclosporin A; Renal function; Children; Nephrotoxicity Abstract: Renal function deterioration is a reason of concern in heart transplantation. Our aim was to evaluate long-term renal function in heart transplant children on cyclosporine (CsA) treatment and to investigate the effect of several variables possibly involved in renal function deterioration. Creatinine clearances were retrospectively reviewed in 50 children (median follow 99.7 months after heart transplant). Gender, age, and body weight at transplant, rejection episodes, CsA cumulative dose, and trough levels were analyzed. After an initial increase of the glomerular filtration rate (GFR), renal function worsened in most patients 28% of the children developed renal insufficiency (defined as GFR &lt 80 ml/min per 1.73 m.sup.2), which was already evident in the first 3 years. Neither CsA dose, trough levels, nor other patient characteristics were found to be associated with renal function deterioration. In this study renal failure occurred in one-third of the patients. The lack of association of CsA with renal insufficiency may be explained by several reasons, including the limitations of the retrospective design of the study. However, it is possible that the nephrotoxic effect of CsA is more likely to occur in a set of predisposed patients. These must be soon identified to evaluate early a calcineurin inhibitor-sparing strategy. Author Affiliation: (1) Division of Nephrology and Dialysis, Bambino Gesu Children's Hospital and Research Institute, Piazza S. Onofrio 4, 00165, Rome, Italy (2) Cardiac Transplant, Bambino Gesu Children's Hospital and Research Institute, Rome, Italy (3) Clinical Biochemistry, Bambino Gesu Children's Hospital and Research Institute, Rome, Italy (4) Epidemiology Unit, Bambino Gesu Children's Hospital and Research Institute, Rome, Italy Article History: Registration Date: 13/01/2006 Received Date: 30/11/2004 Accepted Date: 16/11/2005 Online Date: 21/02/2006

The efficacy and safety of pretreating vein grafts is assessed with edifoligide for patients undergoing coronary artery bypass graft (CABG) surgery. Results reveal that while failure of at least 1 vein graft is quite common within 12 to 18 months after CABG surgery, edifoligide is no ore effective than placebo in preventing these events.

The vascular endothelium is a crucial regulator of vascular function and homeostasis. Nitric oxide (NO) is an important paracrine substance released by the endothelium to regulate vasomotor tone. Risk factors for atherosclerosis, as well as atherosclerosis per se, are associated with endothelial dysfunction and decreased bioavailablilty of NO. Indeed, endothelial dysfunction is integral to the pathogenesis of atherosclerosis and other cardiovascular diseases. Moreover, endothelial dysfunction relates to an increased risk of adverse cardiovascular outcomes. L-Arginine is an essential amino acid required by the constitutive enzyme, endothelial NO oxide synthase (eNOS), to produce NO. Administration of L-arginine improves endothelial function in animal models and in humans with hypercholesterolemia and with atherosclerosis. Clinical trials to date support potential clinical applications of L-arginine in the treatment of coronary artery disease and peripheral arterial disease, as well as in the prevention of in-stent restenosis. The mechanism of benefit of L-arginine on endothelial function is unclear, because intracellular concentrations of L-arginine far exceed that required by eNOS. One potential explanation of this 'arginine paradox' is that L-arginine restores endothelial function in atherosclerotic patients, in whom there are elevated levels of asymmetric dimethylarginine, an endogenous inhibitor of eNOS. Given the promising findings of early studies of L-arginine as a potential therapy for cardiovascular disorders, large-scale clinical trials are warranted. KEY WORDS: * endothelium * arginine * nitric oxide * cardiovascular disease

Byline: C. Aufricht (1), F. Votava (1), M. Marx (1), K. Frenzel (1), G. Simbruner (2) Keywords: Key words Topical furosemide; Lung mechanics; Plasma levels Abstract: Objective: Recent studies have suggested direct pulmonary effects of furosemide in asthmatics and infants with bronchopulmo- nary dysplasia. We tested the hypothesis that intratracheally administered furosemide also increases respiratory compliance in children after cardiac surgery, and investigated whether furosemide has a topical and/or systemic action. Study design: Prospective study with intra-individual control. In twelve infants and toddlers (age: 10 +- 8 months, weight: 6.9 +- 3 kg) mechanically ventilated for compromised lung mechanics after cardiac surgery, 0.5 mg/kg furosemide was intratracheally administered to the lungs. Lung mechanics were serially assessed using a computerised system (Sensormedics 2600) during a 2 h control and 2 h intervention period. Urine output was measured by an indwelling bladder catheter and levels of furosemide were determined in blood and tracheal aspirates. Results: Static compliance improved within 30 min in all patients, reached a maximum of 44 (20--85) % above baseline and remained improved throughout the study (p &lt 0.05). An immediate, short and significant diuretic effect of intratracheally applied furosemide was observed. Furosemide levels 1 h after intervention were 795 ng/ml in the blood and 431 ug/ml (i. e. 1000-fold higher) in the tracheal aspirate. Changes in compliance were correlated only to urine output values over the 2 h (r = 0.82, p = 0.044, n = 9) after furosemide administration. Conclusion: We conclude that intratracheally applied furosemide improves static compliance in infants and toddlers with compromised lung mechanics after cardiac surgery. We demonstrated that furosemide is absorbed from the lung and has a systemic effect within 15 min after its intratracheal instillation. Author Affiliation: (1) Universitats-Kinderklinik, University of Vienna, Vienna, Austria, AT (2) Universitats-Kinderklinik Dr. v. Haunersches Kinderspital, Lindwurmstrasse 4, D-80337 Munich, Germany FAX: + 49 (89) 5160 4419, DE Article note: Received: 14 February 1997 Accepted: 15 May 1997

Byline: J. M. Klinge (1), J. Scharf (1), M. Hofbeck (1), S. Gerling (1), S. Bonakdar (1), H. Singer (1) Keywords: Key words Furosemide; Infusion vs intermittent injection; Urine output; Cardiac surgery; Intensive care; Pediatrics Abstract: Objective: To compare the amount of furosemide needed to fulfil defined criteria for renal output if given intermittently or as a continuous infusion and to compare the effect of these two regimens on hemodynamic variables and urine electrolyte concentrations. Design: Prospective randomized study of postoperative hemodynamically stable pediatric cardiac patients. The patients were given furosemide according to the urine output, either as an intermittent bolus injection or as a continuous infusion. Setting: Pediatric intensive care unit in a university hospital Patients: The patients were randomly assigned before admission to either the intermittent i. v. or the continuous furosemide i. v. infusion group. Measurements and results: Demographic and hemodynamic data were recorded for a maximum of 72 h, as were furosemide dose, urine output, and fluid and inotropic drug requirements. Forty-six patients completed the study. Maximal hourly urine output was significantly higher in the intermittent group. A significantly lower dose of furosemide in the intermittent group produced the same 24-h urine volume as in the continuous infusion group. Conclusions: Intermittent furosemide administration may be recommended in hemodynamically stable postoperative pediatric cardiac patients because of less drug requirement. However, the high maximal urine output may cause hemodynamic problems in patients who depend on high inotropic support. Author Affiliation: (1) University of Erlangen-Nuremberg, Hospital for Children and Adolescents, Erlangen, Germany, DE Article note: Received: 16 April 1996 Accepted: 31 January 1997

Byline: J. M. Simsic (1), V. S. Reddy (2), K. R. Kanter (2), P. M. Kirshbom (2), J. M. Forbess (2) Keywords: Congenital heart disease; Postoperative care; Nesiritide Abstract: We report the use of nesiritide in two infants following cardiac surgery. Both infants had increased intracardiac filling pressures postoperatively, despite traditional afterload reduction and diuretics. Both infants demonstrated clinical improvement with nesiritide therapy. There is currently limited data available describing the use of nesiritide in infants. Author Affiliation: (1) Sibley Heart Center Cardiology, Children's Healthcare of Atlanta, Emory University, Atlanta, GA 30329, USA (2) Division of Pediatric Cardiothoracic Surgery, Emory University, Atlanta, GA 30329, USA Article History: Registration Date: 01/01/2003 Online Date: 04/06/2004