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The syndrome of heart failure at children with congenital heart diseases and pulmonary arterial hypertension: pathophysiological, clinic-evolutive, therapeutic and prognostic particularities


Author: Palii Ina
Degree:doctor habilitat of medicine
Speciality: 14.00.09 - Pediatrics
Year:2012
Scientific consultants: Petru Stratulat
doctor habilitat, professor, Public Medical Sanitary Intitution Scientific Research Institute of Mother and Child Health Care
Eleonora Vataman
doctor habilitat, professor, Public Medico-Sanitary Institution Moldavian Institute of Cardiology
Institution: Public Medical Sanitary Intitution Scientific Research Institute of Mother and Child Health Care
Scientific council: DH 53-14.00.09
Public Medical Sanitary Intitution Scientific Research Institute of Mother and Child Health Care

Status

The thesis was presented on the 27 March, 2012
Approved by NCAA on the 23 May, 2012

Abstract

Adobe PDF document1.37 Mb / in romanian

Keywords

congenital heart diseases (CHD), chronic heart failure (CHF), pulmonary arterial hypertension (PAH), pathophysiological mechanisms, cardiac remodeling, biological markers, factors of prognosis, children

Summary

The thesis consists of 208 pages, contains introduction, 6 chapters, bibliography by 287 sources, 55 tables and 31figures. The results are published in 61 scientific works.

Domain of research: paediatric cardiology.

Aim of research: The evaluation of the pathophysiological, clinic-evolutive and therapeutics particularities of children with the syndrome of heart failure due to congenital heart disorders and pulmonary arterial hypertension.

Objectives of research: To elucidate the pathophysiological mechanisms, the clinical-evolutive and paraclinical particularities, the predictors of the severity and riskiness of the evolution of the syndrome of CHF secondary to CHD depending on the grade of PAH. To evaluate the circulated levels of CHF’s biomarkers - endothelin 1, NT-proBNP, nitric oxide; of the proinflammatory cytokines - TNF-alpha, IL-1β, IL-6 and to estimate the role of the oxidative stress in the pathophysiology, diagnosis and evolution of the syndrome. A complex clinical study of the sildenafil’s efficacy in the treatments of children with PAH and CHF as well as the elaboration of the optimised therapeutic management program.

Novelty and originality of research: For the first time the pathophysiological mechanisms (neuroendocrine activation, cytokine and oxidative stress) involved in the evolution of the CHF with the background of CHD and PAH of different grade are elucidated.

The scientific problem solved in the study: The emphasis of the respective pathophysiological mechanisms have allowed the identification of possible ways of correction of this disease aiming also a point of prognostics improvement.

Theoretical significance: It is emphasized and completed the concept of neuroendocrine, cytokine and oxidative stress activation concerning the heart failure pathogenesis.

Applied value: The proper diagnosis is favoured and correct management is elucidated with the aim to prevent severe complications and to ameliorate the quality of life of the children with CHF secondary to CHD and PAH.

Practical implementation: The study results were proven as scientific point and have been implemented in the paediatric cardiology of Mother and Child Health Protection Scientific Research Institute.