Effect of cardiopulmonary bypass on urea cycle intermediates and nitric oxide levels after congenital heart surgery

Objective To test the hypothesis that cardiopulmonary bypass used for repair of ventricular septal defects and atrioventricular septal defects would decrease availability of urea cycle intermediates including arginine and subsequent nitric oxide availability. Study design Consecutive infants (n = 26...

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Bibliographic Details
Published in:The Journal of pediatrics 2003-01, Vol.142 (1), p.26-30
Main Authors: Barr, Frederick E., Beverley, Heidi, VanHook, Kristin, Cermak, Emma, Christian, Karla, Drinkwater, Davis, Dyer, Karrie, Raggio, Noel T., Moore, Jason H., Christman, Brian, Summar, Marshall
Format: Article
Language:English
Subjects:
Arginine - blood
Biological and medical sciences
Blood Urea Nitrogen
Cardiopulmonary Bypass
Citrulline - blood
Female
Heart Defects, Congenital - blood
Heart Defects, Congenital - surgery
Humans
Infant
Infant, Newborn
Male
Medical sciences
Nitric Oxide - blood
Ornithine - blood
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the heart
Urea - blood
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Summary:Objective To test the hypothesis that cardiopulmonary bypass used for repair of ventricular septal defects and atrioventricular septal defects would decrease availability of urea cycle intermediates including arginine and subsequent nitric oxide availability. Study design Consecutive infants (n = 26) undergoing cardiopulmonary bypass for repair of an unrestrictive ventricular septal defect or atrioventricular septal defect were studied. Blood samples were collected immediately before surgery, immediately after surgery, and 12 hours, 24 hours, and 48 hours after surgery. Urea cycle intermediates, including citrulline, arginine, and ornithine, were measured by amino acid analysis. Nitric oxide metabolites were measured by means of the modified Griess reaction. Results Cardiopulmonary bypass caused a significant decrease in the urea cycle intermediates arginine, citrulline, and ornithine at all postoperative time points compared with preoperative levels. The ratio of ornithine to citrulline, a marker of urea cycle function, was elevated at all postoperative time points compared with preoperative values, indicating decreased urea cycle function. Nitric oxide metabolites were significantly decreased at all postoperative time points except for 48 hours, compared with preoperative levels. Conclusions Cardiopulmonary bypass significantly decreases availability of arginine, citrulline, and nitric oxide metabolites in the postoperative period. Decreased availability of nitric oxide precursors may contribute to the increased risk of postoperative pulmonary hypertension. (J Pediatr 2003;142:26-30)
ISSN:0022-3476
1097-6833
DOI:10.1067/mpd.2003.mpd0311