H Komai1, S G Haworth. 1. Vascular Biology and Pharmacology Unit, Institute of Child Health, London, England.
Abstract
BACKGROUND: Thrombomodulin and angiotensin-converting enzyme are endothelial glycoproteins. The metabolism of these substances is altered when endothelial cells are damaged. METHODS: Serum thrombomodulin level was assayed in 56 children and angiotensin-converting enzyme activity determined in 27 children with congenital heart disease before, during, and after open heart operations. RESULTS: The thrombomodulin level was significantly higher in children with a high pulmonary blood flow who had pulmonary hypertension than in those with a normal pressure (p < 0.01), and although all patients showed an increase in serum thrombomodulin after coming off cardiopulmonary bypass, the increase was greater in those with preoperative pulmonary hypertension (p < 0.05). Serum angiotensin-converting enzyme activity was normal preoperatively in all children, irrespective of pulmonary arterial pressure, and decreased in all after coming off cardiopulmonary bypass but decreased to a significantly greater extent in those who had pulmonary hypertension preoperatively (p < 0.05). CONCLUSIONS: These findings are compatible with the presence of pulmonary endothelial cell injury and dysfunction before intracardiac repair, which is exacerbated by cardiopulmonary bypass.
BACKGROUND:Thrombomodulin and angiotensin-converting enzyme are endothelial glycoproteins. The metabolism of these substances is altered when endothelial cells are damaged. METHODS: Serum thrombomodulin level was assayed in 56 children and angiotensin-converting enzyme activity determined in 27 children with congenital heart disease before, during, and after open heart operations. RESULTS: The thrombomodulin level was significantly higher in children with a high pulmonary blood flow who had pulmonary hypertension than in those with a normal pressure (p < 0.01), and although all patients showed an increase in serum thrombomodulin after coming off cardiopulmonary bypass, the increase was greater in those with preoperative pulmonary hypertension (p < 0.05). Serum angiotensin-converting enzyme activity was normal preoperatively in all children, irrespective of pulmonary arterial pressure, and decreased in all after coming off cardiopulmonary bypass but decreased to a significantly greater extent in those who had pulmonary hypertension preoperatively (p < 0.05). CONCLUSIONS: These findings are compatible with the presence of pulmonary endothelial cell injury and dysfunction before intracardiac repair, which is exacerbated by cardiopulmonary bypass.
Authors: Richard W Pierce; Riad Abou Zahr; Sarah Kandil; E Vincent S Faustino; Jordan S Pober Journal: Pediatr Crit Care Med Date: 2018-07 Impact factor: 3.624