Michał Buczyński

A Transient Ischemic Attack (TIA) in children results from a temporary interruption of blood flow to the brain, leading to brief neurological symptoms. The most common causes of pediatric TIA include congenital heart defects and vascular anomalies. We present a 10-year-old girl with neurological symptoms due to subclavian steal syndrome. Physical examination revealed an asymmetry in blood pressure measurements between the upper limbs, exceeding 30 mmHg. Echocardiography revealed a right-sided aortic arch (RAA) with an atypical configuration of the cephalic vessels. Ultrasound of the vertebral arteries demonstrated reversed flow direction in the left vertebral artery. CT angiography confirmed RAA and an atypical branching pattern. The left subclavian artery was narrower with critical stenosis in its proximal segment, adjacent to the origin of the ductus arteriosus. The girl was qualified to surgical intervention to correct the incomplete vascular ring associated with a RAA and an aberrant left subclavian artery.

Introduction: Netrin-1 (NTN-1) is an anti-inflammatory protein secreted by proximal tubule epithelial cells in reaction to hypoxic or toxic injury. We determined the utility of urinary NTN-1 as an early marker for detecting AKI in patients after cardiac surgery.Material and methods: Our study included 40 children at age 1-36 months and 20 healthy controls. We measured serum creatinine and urinary NTN-1 in patients, who underwent cardiac surgery in cardiopulmonary bypass (CPB).Results: Urinary NTN-1 was higher in the study group than in the control group. The detection ratio of urinary NTN-1 was higher pre-surgery than 6 and 24 hours after (55%, 27.5%, and 32.5%, respectively). We found no correlations between NTN-1 at any point ΔeGFR, decline eGFR, AKI after 48 h. The initial NTN-1/creatinine ratio negatively correlated with ΔGFR (r=-0.36, p=0.031), NTN-1/creatinine ratio after 24 h did not correlate with aortic clamping time, CPB time, ΔGFR. In our study, AKI occurred in 12.5% of patients and none required RRT. The occurrence of AKI correlated with CPB time (r=0.35, p=0.027) and aortic clamping time (r=0.44, p=0.005). NTN-1 concentration and NTN-1/creatinine ratio in the AKI group were not significantly higher preoperatively and 24 hours post-surgery than in patients without AKI.Conclusions: The role of urinary NTN-1 in children after cardiac surgery as an early marker of AKI was not confirmed. No factors affecting the NTN-1/creatinine ratio were found in the study group. Patients who have longer CPB time and aortic clamping time belong to the high-risk group of AKI after surgery.