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J Thorac Cardiovasc Surg 2001;122:242-248
© 2001 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease (CHD)

Continuous perfusion of pulmonary arteries during total cardiopulmonary bypass favorably affects levels of circulating adhesion molecules and lung function

From the Division of Cardiovascular Surgery, Tokyo Metropolitan Children's Hospital,^a and the Department of Preventive Medicine and Public Health, School of Medicine, Kyorin University, Tokyo,^b Japan.

Supported by the clinical research fund from the Tokyo Metropolitan Government.

Received for publication Nov 7, 2000. Revisions requested Jan 4, 2001; revisions received Jan 25, 2001. Accepted for publication Jan 30, 2001. Address for reprints: Takaaki Suzuki, MD, Division of Pediatric Cardiovascular Surgery, Michigan Congenital Heart Center, University of Michigan Medical Center, F7830 Mott Children's Hospital, 1500 East Medical Center Dr, Ann Arbor, MI 48109-0223 (E-mail: suzukimd{at}blue.ocn.ne.jp).

Abstract

Objectives: Lung injury is a serious complication of cardiopulmonary bypass in infants with congenital heart disease and pulmonary hypertension. Cessation of blood flow in the pulmonary arteries during cardiopulmonary bypass is known to provoke lung dysfunction. We assessed the effect of continuous pulmonary perfusion on circulating adhesion molecules and on lung function.
Methods: Fourteen infants with congenital heart disease and pulmonary hypertension were enrolled in the study. During total cardiopulmonary bypass, 8 patients underwent continuous perfusion of the pulmonary arteries (perfusion group), and the remaining 6 patients did not (control group). Plasma levels of circulating intercellular adhesion molecule 1, soluble granule membrane protein 140, and sialyl Lewis^x and PaO₂/fraction of inspired oxygen ratios were measured before commencement and serially for 24 hours after termination of bypass.
Results: Plasma levels of circulating intercellular adhesion molecule 1 decreased significantly at the termination of bypass in both groups but returned to prebypass levels immediately in the control group, whereas in the perfusion group the values remained significantly less than those before bypass. Plasma levels of soluble granule membrane protein 140 in the control group were significantly higher at 6 and 12 hours after bypass than levels before bypass, whereas in the perfusion group the values remained at the prebypass level throughout the postbypass period. Trends of plasma levels of sialyl Lewis^x were alike in both groups. PaO₂/fraction of inspired oxygen ratios in the control group decreased significantly from 6 hours after bypass, whereas values in the perfusion group remained at the prebypass value throughout the postbypass period.
Conclusions: This study suggests that in infants having congenital heart disease and pulmonary hypertension, continuous pulmonary perfusion during total cardiopulmonary bypass minimizes ischemic insult and neutrophil-endothelial interaction mediated by adhesion molecules in the pulmonary microvessels.

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