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Plasma exchange for the patients with dilated cardiomyopathy in children is safe and effective in improving both cardiac function and daily activities

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Abstract

Autoantibodies against cardiac proteins play an important role in the development of dilated cardiomyopathy (DCM). The efficacy and safety of apheresis such as immunoadsorption (IA) or plasma exchange (PE) to remove such antibodies have been reported in adult DCM patients. However, apheresis for pediatric DCM has not been performed because of technical difficulty due to relatively low blood volume and instability of hemodynamics. As we have experiences of preforming apheresis on hemodynamically unstable children, we have preformed ten courses of PE on seven child DCM patients including both patients in chronic and acute phase to assess the safety and efficacy to PE. Under general anesthesia, the patients were administered PE three times during 3 days as 1 course. Simultaneously, continuous hemodiafiltration (CHDF) was performed in series with the PE circuit to stabilize hemodynamic status and to minimize the adverse effects of PE. The changes in LVEF, CTR, mBP, the dosage of furosemide and NYHA were assessed before and after the procedure of PE. There were no severe adverse effects such as systemic bleeding or refractory hypotension due to apheresis. Echocardiography showed that mean baseline LVEF was 24.3 ± 7.8%. Mean LVEF significantly increased 1 week after PE to 30.5 ± 12.5%. CTR significantly decreased after PE. Mean BP significantly increased 1 month after PE (54.5 ± 10.7 to 60.7 ± 9.8 mmHg). NYHA improved after PE significantly (NYHA; 3.4 ± 1.1 to 2.5 ± 1.1). PE is safe and effective in improving both cardiac function and daily activities.

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Acknowledgements

I appreciate prof. Kanji Sugita, M.D., Ph.D., Takako Toda MD (University of Yamanashi School of Medicine, Department of Pediatrics) for conducting the present study. I appreciate Brittany Davis and Andrew Taylor for an act of proofreading. This study is supported by Yamanashi University research endowment program.

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Authors and Affiliations

  1. Department of Emergency and Critical Care Medicine, University of Yamanashi School of Medicine, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan

    Takeshi Moriguchi, Kenichi Matsuda, Norikazu Harii, Junko Goto, Daiki Harada & Hisanori Sugawara

  2. Department of Pediatrics, University of Yamanashi School of Medicine, Chuo, Japan

    Keiichi Koizumi, Minako Hoshiai & Hiroaki Kise

  3. Department of Cardiology, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Japan

    Akiyasu Baba

Authors
  1. Takeshi Moriguchi
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  2. Keiichi Koizumi
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  3. Kenichi Matsuda
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  4. Norikazu Harii
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  5. Junko Goto
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  7. Hisanori Sugawara
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  9. Hiroaki Kise
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  10. Akiyasu Baba
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Correspondence to Takeshi Moriguchi.

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Moriguchi, T., Koizumi, K., Matsuda, K. et al. Plasma exchange for the patients with dilated cardiomyopathy in children is safe and effective in improving both cardiac function and daily activities. J Artif Organs 20, 236–243 (2017). https://doi.org/10.1007/s10047-017-0956-7

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  • DOI: https://doi.org/10.1007/s10047-017-0956-7

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