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The Journal of Thoracic and Cardiovascular Surgery, Vol 106, 473-478, Copyright © 1993 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
H Komai, IT Adatia, MJ Elliott, MR de Leval and SG Haworth
The plasma level of the potent vasoconstrictor endothelin-1 was measured in
children who underwent cardiac operations. Forty-five patients were divided
into two groups, those with a high pulmonary blood flow (HF group; n = 23)
and those with a normal or low flow (NF group; n = 22). Seven blood samples
were taken: immediately before cardiopulmonary bypass, immediately after
removing the aortic cross- clamps, immediately after discontinuing bypass,
and at 20 minutes and 3, 6, and 24 hours after termination of bypass. The
plasma levels of endothelin-1 were similar in both groups before bypass.
From the time the aortic crossclamps were removed, the plasma endothelin-1
levels in both groups increased significantly, to reach a peak level at 3
to 6 hours. The increase was significantly greater in the HF than in the NF
group, and the maximum values in the two groups were 12.6 +/- 1.1 and 9.6
+/- 0.8 fmol/ml, respectively (mean +/- standard error of the mean, p <
0.05). The value 20 minutes after bypass showed a positive correlation with
the mean pulmonary arterial pressure measured at the preoperative cardiac
catheterization study (r = 0.41, p < 0.05). In addition, a significant
positive correlation was obtained between endothelin-1 3 hours after bypass
and the maximum pulmonary/systemic arterial pressure ratio during the first
12 hours after operation (r = 0.86, p < 0.05). These results suggest
that cardiopulmonary bypass is associated with an immediate postoperative
increase in circulating endothelin and that patients who had a high
pulmonary blood flow before the operation are particularly vulnerable,
bypass having a more injurious effect on a lung with preexisting
endothelial dysfunction. A high level of circulating endothelin may
predispose to pulmonary vascular lability and pulmonary hypertensive crises
in the postoperative period.
ARTICLES
Increased plasma levels of endothelin-1 after cardiopulmonary bypass in patients with pulmonary hypertension and congenital heart disease
Vascular Biology and Pharmacology Unit, Institute of Child Health, London, England.
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