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This article is part of the supplement: International Symposium on the Pathophysiology of Cardiopulmonary Bypass

Meeting abstract

L-arginine and substance P reverse the pulmonary endothelial dysfunction caused by congenital heart surgery

I Schulze-Neick1, DJ Penny1, ML Rigby1, C Morgan2, A Kelleher2, P Collins3, J Li1, A Bush1, EA Shinebourne1 and AN Redington1

Author Affiliations

1 Department of Paediatrics, The Royal Brompton and Harefield NHS Trust, and The National Heart and Lung Institute (Imperial College of Science, Technology and Medicine), London, UK

2 Department of Anaesthesiology, The Royal Brompton and Harefield NHS Trust, and The National Heart and Lung Institute (Imperial College of Science, Technology and Medicine), London, UK

3 Department of Cardiology, The Royal Brompton and Harefield NHS Trust, and The National Heart and Lung Institute (Imperial College of Science, Technology and Medicine), London, UK

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Critical Care 1999, 3(Suppl A):P14-P8  doi:10.1186/cc325

The electronic version of this article is the complete one and can be found online at: http://ccforum.com/content/3/SA/P14


Published:2 March 1999

© 1999 Current Science Ltd

Objectives

The increase in pulmonary vascular resistance (PVR) seen in children after cardiopulmonary bypass has been attributed to transient pulmonary endothelial dysfunction (PED). We therefore examined PED in children with congenital heart disease by assessing the L-arginine-nitric-oxide (NO) pathway in terms of substrate supplementation (L-arginine [L-Arg]), stimulation of endogenous nitric oxide release (substance P [Sub-P]), and end-product provision (inhaled NO) before and after open heart surgery.

Methods

Ten unoperated patients (0.62 ± 0.27 years) with pulmonary hypertension undergoing cardiac catheterisation, and 10 patients (0.64 ± 0.73 years) early after cardiopulmonary bypass were examined. All were sedated, paralysed and received positive pressure ventilation. Blood samples and pressure measurements were taken from catheters in the pulmonary artery and the pulmonary vein or left atrium. Respiratory mass spectrometry was used to measure oxygen uptake, and cardiac output was determined by the direct Fick method. PVR was calculated during steady state at ventilation with room air, during FiO2 = 0.65, and then during additional intravenous infusion of L-Arg (15 mg/kg/min), Sub-P (1 pmol/kg/min), and finally inhalation of NO (20 parts per million).

Results

In both patient groups, oxygen supplementation was the most potent pulmonary vasodilator. In preoperative patients, the lack of a further significant change with L-Arg, Sub-P and inhaled NO suggests little pre-existing PED. Postoperative PVR was higher with an additional endothelial contribution that was restorable with L-Arg and Sub-P. (see Figure)

Conclusion

Postoperatively, the rise in PVR suggested pulmonary endothelial dysfunction restorable by L-Arg and Sub-P with no additional effect of inhaled NO. These results may indicate important new treatment strategies for these patients.