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J Thorac Cardiovasc Surg 2004;127:1523-1525
© 2004 The American Association for Thoracic Surgery

Brief communication

Cardiopulmonary bypass elicits a prominent innate immune response in children with congenital heart disease

^a Department of Intensive Care, Royal Children's Hospital, Parkville, Victoria, Australia
^d Department of Cardiac Surgery, Royal Children's Hospital, Parkville, Victoria, Australia
^g Department of Perfusion, Royal Children's Hospital, Parkville, Victoria, Australia
^h Department of Cardiology, Royal Children's Hospital, Parkville, Victoria, Australia
^b Staph and Strep Group Murdoch Children's Research Institute, Parkville, Victoria, Australia
^e Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia
^c Department of Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia
^f Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia

Received for publication October 29, 2003; revisions received November 18, 2003; accepted for publication November 24, 2003.

^* Address for reprints: Daniel J. Penny, MD, FRCPI, Department of Cardiology, Royal Children's Hospital, Flemington Rd, Parkville, Victoria 3052 Australia
dan.penny@rch.org.au

The first 20% of the full text of this article appears below.

Systemic inflammatory response syndrome (SIRS) is common after operations for congenital heart disease (CHD).¹ SIRS is characterized by release of proinflammatory cytokines, but the mechanisms initiating this cascade remain ill defined. Recent data from septic patients and a single study in adults undergoing heart surgery suggest that activation of the innate immune response might provide this early trigger.^2,3 However, there are no other data that explore the contribution of the innate immune response in SIRS associated with cardiopulmonary bypass (CPB), specifically none in children. We have investigated, for the first time, the regulation of toll-like receptor 2 (TLR-2) and TLR-4 expression on peripheral blood monocytes of children with an inflammatory response after operations for CHD.

Methods

Nine children (median age, 6 months; weight, 5.6 kg) undergoing surgical intervention for CHD were studied. They were the first cohort to be recruited for a prospective study of moderate hypothermic versus normothermic CPB, which was approved by our institutional ethics committee. Blood samples were taken for TLR-2 and TLR-4 and the cytokines tumor necrosis . . . [Full Text of this Article]

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