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J Thorac Cardiovasc Surg 2009;137:730-735
© 2009 The American Association for Thoracic Surgery

Cardiopulmonary Support

Removal of prostaglandin E₂ and increased intraoperative blood pressure during modified ultrafiltration in pediatric cardiac surgery

^a Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine, Tsu, Japan
^b Department of Pediatrics, Mie University Graduate School of Medicine, Tsu, Japan
^c Medical Engineer Room, Mie University Graduate School of Medicine, Tsu, Japan

Received for publication March 25, 2008; revisions received August 1, 2008; accepted for publication September 4, 2008.

^_* Address for reprints: Shin Takabayashi, MD, PhD, Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine, 2-174, Edobashi, Tsu, Mie 514-8507, Japan. (Email: shin1111{at}clin.medic.mie-u.ac.jp).

Objective: We investigated the relationship between serum prostaglandin E₂ and intraoperative blood pressure in pediatric cardiac surgery with modified ultrafiltration.

Methods: In 35 consecutive patients (31.6 ± 26.8 months, 0.4–111 months, 10.9 ± 5.5 kg, 2.9–23.8 kg) who underwent cardiac surgery with modified ultrafiltration, we measured intraoperative serum prostaglandin E₂ changes and effluent prostaglandin E₂, assessed the relationship between serum prostaglandin E₂ and intraoperative hemodynamic parameters, and performed subset analyses to compare patients with low (<10 kg, n = 18) and high (>10 kg, n = 10) weights.

Results: During cardiopulmonary bypass, systolic blood pressure decreased from 80.8 ± 15.2 to 60.5 ± 11.3 mm Hg (P = .00000002979) and serum prostaglandin E₂ increased from 16.6 ± 8.7 to 58.8 ± 53.3 pg/mL (P = .002). During modified ultrafiltration, although central venous pressure and catecholamine dosage transited at the same levels, systolic blood pressure increased from 60.5 ± 11.3 to 83.4 ± 14.1 mm Hg (P = .00000002979) and serum prostaglandin E₂ decreased from 58.8 ± 53.3 to 21.1 ± 11.6 pg/mL (P = .001), with negative correlation between serum prostaglandin E₂ and systolic blood pressure (R = –0.392, P = .0000277723) and 15,700 ± 10,700 pg (1790 ± 2230 pg/kg) prostaglandin E₂ removed during modified ultrafiltration. Decrease in serum prostaglandin E₂ was significantly higher in low-weight patients (51.8 ± 58.4 pg/mL) than in high-weight patients (15.7 ± 30.1 pg/mL).

Conclusion: Removal of prostaglandin E₂ is one reason for increased blood pressure during modified ultrafiltration, with the effect more marked in low-weight patients.