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J Thorac Cardiovasc Surg 2000;119:192-193
© 2000 Mosby, Inc.

LETTERS TO THE EDITOR

Pulmonary surfactant and cardiopulmonary bypass in infants

Section of Neonatology, Christiana Hospital, 4755 Ogletown-Stanton Rd
Newark, DE 19718

Reply to the Editor:

We thank Millar and colleagues for their interest in our article, "The Role of Cardiopulmonary Bypass and Surfactant in Pulmonary Decompensation after Surgery for Congenital Heart Disease." ¹ We concur that our data have certain limitations and must be interpreted with a degree of caution. Although we did not account for the variable recovery of epithelial lining fluid by using a marker of dilution, we made every effort to standardize the timing and technique of the lavage fluid with each procedure. Although a measurement of dilution may have been helpful, even this method has potential limitations ² and, as mentioned in the letter, our method is similar to that used in other studies in children undergoing bypass for congenital heart disease. ^3,4 Millar and colleagues also pointed out the potential limitations to using total protein as the denominator. However, as stated in our conclusions, we believe the decline in the phospholipid/protein ratio seen in infants receiving bypass is indicative of lung injury. Finally, by stating that our data support the findings of McGowan and colleagues, ³ we did not mean to imply that we found the same alteration in surfactant composition that was shown in this investigation. We were able to demonstrate a quantitative difference in surfactant, whereas McGowan and associates showed a qualitative difference, albeit in a different patient population.

References

1. Paul DA, Greenspan JS, Davis DA, Russo P, Antunes MJ. The role of cardiopulmonary bypass and surfactant in pulmonary decompensation after surgery for congenital heart disease. J Thorac Cardiovasc Surg 1999;117:1025-6.[Free Full Text]
   
2. NHLBI Workshop Summary. Assessment of lung function and dysfunction in studies of infants and children. Am Rev Respir Dis 1993;148:1105-8.[Medline]
   
3. McGowan FX, Ikegami M, Del Nido PJ, Motoyama EK, Kurland G, David PJ, et al. Cardiopulmonary bypass significantly reduces surfactant activity in children. J Thorac Cardiovasc Surg 1993;106:968-77.[Abstract]
   
4. Levine AM, Lotze A, Stanley S, Stroud C, O’Donnell R, Whitsett J, et al. Surfactant content in children with inflammatory lung disease. Crit Care Med 1996;24:1062-7.[Medline]
   

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This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Pierantonio Russo Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Paul, D. A. Articles by Antunes, M. J. Search for Related Content PubMed PubMed Citation Articles by Paul, D. A. Articles by Antunes, M. J.