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J Thorac Cardiovasc Surg 1997;114:1053-1060
© 1997 Mosby, Inc.

SURGERY FOR CONGENITAL HEART DISEASE

NITROGEN BALANCE, 3-METHYLHISTIDINE EXCRETION, AND PLASMA AMINO ACID PROFILE IN INFANTS AFTER CARDIAC OPERATIONS FOR CONGENITAL HEART DEFECTS: THE EFFECT OF EARLY NUTRITIONAL SUPPORT

Václav Chaloupeck , MD^a, Bohumil Huín , MD^a, Tomá Tláskal , MD^a, Martin Kostelka , MD^a, Vladimír Kucera , MD^a, Jan Janouek , MD^a, Jan kovránek , MD^a, Ludek prongl, Ing ^b

Supported by the Grant Agency of the Czech Ministry of Health, grant No. 2043-3.

Received for publication July 31, 1996 Revisions requested Sept. 16, 1996 Revisions received June 10, 1997 Accepted for publication June 12, 1997 Address for reprints: Václav Chaloupeck, MD, Kardiocentrum, University Hospital Motol, Vúvalu 84, 150 06 Prague 5, Czech Republic.

Abstract

Objective: The objective of this study was to evaluate the effect of nutritional support on proteolysis and plasma amino acid profile in infants early after cardiac operations for congenital heart defects. Methods: Thirty-seven patients, 2 to 12 months old, were randomized on postoperative day 1 for 24-hour isocaloric metabolic study. Group STANDARD (18 patients) received glucose as the maintenance fluid, and group PN (19 patients) received glucose and crystalloid amino acid solution at a dosage of 0.8 ± 0.1 gm/kg per day. The nonprotein caloric intake in the two groups was 25 ± 15 and 33 ± 9 kcal/kg, respectively (p = not significant). Results: The nitrogen balance was markedly less negative in group PN than in group STANDARD (–114 ± 81 vs –244 ± 86 mg/kg, respectively, p = 0.001). There was a highly significant inverse correlation between the nitrogen balance and urinary 3-methylhistidine excretion in both groups, but the muscle proteolysis was blunted more effectively in patients receiving amino acids. Concentrations of the plasmatic branched-chain amino acids, alanine, glycine, and proline, decreased significantly in group STANDARD but not in group PN on postoperative day 2. Glutamine and threonine levels declined significantly on postoperative day 2 in both groups. Low levels of arginine were observed in our patients before operation and in the early postoperative period. The amino acid concentrations normalized on postoperative day 7 in all patients. Conclusion: Significant proteolysis and hypoaminoacidemia were observed in infants early after cardiac operations. This hypercatabolic response was blunted by parenteral nutritional support.