[en] Tumor necrosis factor-α production and products of mast cell, basophil, and eosinophil degranulation (prostaglandin D2, histamine, and eosinophil cationic protein) were prospectively studied in 26 children undergoing cardiac operations. The relationship between inflammatory response to cardiopulmonary bypass and transient postoperative arrhythmias was analyzed. Cardiopulmonary bypass was conducted with circulatory arrest and deep hypothermia in 10 patients and with continuous low-flow and moderate hypothermia in 16 patients. Transient postoperative arrhythmias diagnosed on standard or atrial electrocardiograms (or both) were seen in eight of the 26 examined children: accelerated junctional rhythm (n = 3), junctional ectopic tachycardia (n = 3), second-degree atrioventricular block (n = 1), and third- degree atrioventricular block (n = 1). Children with transient postoperative arrhythmias were younger than those without (p < 0.05). Compared with baseline values, there was in all patients a significant release of histamine and eosinophil cationic protein (p < 0.05) related to cardiopulmonary bypass, reaching peak values 4 hours after the operation. In contrast, tumor necrosis factor-α production and prostaglandin D2 release were not significant. This suggests that activated basophils but not mast cells are the major sources of histamine liberated during and after cardiopulmonary bypass. Histamine release but not eosinophil cationic protein release correlated with circulatory arrest and deep hypothermia (p < 0.05), suggesting the participation of physicochemical alterations of circulating basophils leading to histamine liberation. Four hours after the operation, patients with transient postoperative arrhythmias had significantly higher blood concentrations of histamine (p < 0.02) and eosinophil cationic protein (p < 0.05) than did those without transient postoperative arrhythmias. On the first postoperative day, four of the eight patients with transient postoperative arrhythmias had persisting elevated histamine levels, whereas in patients without transient postoperative arrhythmias histamine reached baseline values. The multivariate analysis retained histamine release and eosinophil cationic protein variations related to cardiopulmonary bypass for the emerging model to predict transient postoperative arrhythmias. The results of this study show significant histamine release related to cardiopulmonary bypass. Furthermore, they document a possible relationship between circulating histamine and transient postoperative arrhythmias. The latter may therefore be suspected among the consequences of the inflammatory response to cardiopulmonary bypass.
Disciplines :
Cardiovascular & respiratory systems Pediatrics
Author, co-author :
Seghaye, Marie-Christine ; Université de Liège - ULiège > Département des sciences cliniques > Pédiatrie cardiologique et pneumologique
Duchateau, J.; Department of Pediatric Cardiology, Aachen University of Technology, Pauwelsstrasse 30, D-52057 Aachen, Germany
Grabitz, R. G.; Department of Pediatric Cardiology, Aachen University of Technology, Pauwelsstrasse 30, D-52057 Aachen, Germany
Mertes, J.; Department of Pediatric Cardiology, Aachen University of Technology, Pauwelsstrasse 30, D-52057 Aachen, Germany
Marcus, C.; Department of Pediatric Cardiology, Aachen University of Technology, Pauwelsstrasse 30, D-52057 Aachen, Germany
Buro, K.; Department of Pediatric Cardiology, Aachen University of Technology, Pauwelsstrasse 30, D-52057 Aachen, Germany
Messmer, B. J.; Department of Pediatric Cardiology, Aachen University of Technology, Pauwelsstrasse 30, D-52057 Aachen, Germany
Von Bernuth, G.; Department of Pediatric Cardiology, Aachen University of Technology, Pauwelsstrasse 30, D-52057 Aachen, Germany
Language :
English
Title :
Histamine liberation related to cardiopulmonary bypass in children: Possible relation to transient postoperative arrhythmias
DE Chenoweth SW Cooper TE Hugli RW Stewart EH Blackstone JW. Kirklin Complement activation during cardiopulmonary bypass: evidence for generation of C3a and C5a anaphylatoxins N Engl J Med 304 1981 497 503
JK Kirklin S Westaby EH Blackstone JW Kirklin DE Chenoweth AD. Pacifico Complement and the damaging effects of cardiopulmonary bypass J Thorac Cardiovasc Surg 86 1983 845 857
MC Seghaye J Duchateau RG Grabitz Complement activation during cardiopulmonary bypass in infants and children: relation to postoperative multiple system organ failure J Thorac Cardiovasc Surg 106 1993 978 987
ME Faymonville J Pincemail J Duchateau Myeloperoxidase and elastase as markers of leukocyte activation during cardiopulmonary bypass in humans J Thorac Cardiovasc Surg 102 1991 309 317
NC Cavarocchi MD England HV Schaff Oxygen free radical generation during cardiopulmonary bypass: correlation with complement activation Circulation 74 Suppl 1986 III130 III133
JB Steinberg DP Kapelanski JD Olson JM. Weiler Cytokine and complement levels in patients undergoing cardiopulmonary bypass J Thorac Cardiovasc Surg 106 1993 1008 1016
AP Kaplan S Reddigari M Baeza P. Kuna Histamine releasing factors and cytokine-dependent activation of basophils and mast cells Adv Immunol 50 1991 237 260
H Juergensen U Braam P Pult E Kownatzki W. Schmutzler Human C5a induces a substantial histamine release in human basophils but not in tissue mast cells Int Arch Allergy Immunol 85 1988 487 488
N Haeffner-Cavaillon N Rousselier O Ponzio Induction of interleukin-1 production in patients undergoing cardiopulmonary bypass J Thorac Cardiovasc Surg 98 1989 1100 1106
A Finn S Naik N Klein RJ Levinski S Strobel M. Eliott Interleukin-8 release and neutrophil degranulation after pediatric cardiopulmonary bypass J Thorac Cardiovasc Surg 105 1993 234 241
RE Kalfin RM Engelman JA Rousou Induction of interleukin-8 expression during cardiopulmonary bypass Circulation 88 1993 401 406
WF Casey GJ Hauser RS Hannallah FM Midgley WN. Khan Circulating endotoxin and tumor necrosis factor during pediatric cardiac surgery Crit Care Med 20 1992 1090 1096
J Butler R Pillai GM Rocker S Westaby D Parker DJ. Shale Effect of cardiopulmonary bypass on systemic release of neutrophil elastase and tumor necrosis factor J Thorac Cardiovasc Surg 105 1993 25 30
M Haak-Frendscho C Dinarello AP. Kaplan Recombinant human interleukin-1 beta causes histamine release from human basophils J Allergy Clin Immunol 82 1988 218 223
A Falus K Merétey Histamine: an early messenger in inflammatory and immune reactions Immunol Today 13 1992 154 156
R Levi DAA Owen J. Trzeciakowski Actions of histamine on the heart and vasculature CR Ganelli ME Parsons Pharmacology of histamine receptors 1982 John Wright and Sons Bristol 236 297
A Garson Arrhythmias A Garson P Gillette The electrocardiogram in infants and children: a systematic approach 1983 Lea & Febiger Philadelphia 195 375
A Garson The normal electrocardiogram A Garson P Gillette The electrocardiogram in infants and children: a systematic approach 1983 Lea & Febiger Philadelphia 61 82
DE Matthews VT. Farewell Binary logistic regression DE Matthews VT Farewell Using and understanding medical statistics 1985 S. Karger Basel 139 147
Meyer-Burgdorff G Seidel FJ. Schlueter Freisetzung von Histamin und Serotonin bei extracorporaler Zirkulation Anaesthesist 22 1973 212 216
DE Withington M Elliot WK. Man Histamine release during paediatric cardiopulmonary bypass Agents Actions 33 1991 200 202
DE Hammerschmidt DF Stroncek TK Bowers Complement activation and neutropenia occurring during cardiopulmonary bypass J Thorac Cardiovasc Surg 81 1981 370 377
AN Sajnani NS Ranadive HZ. Movat Redistribution of immunoglobulin receptors on human neutrophils and its relationship to the release of lysosomal enzymes Lab Invest 35 1976 143 151
AA Wolff R. Levi Histamine and cardiac arrhythmias Circ Res 58 1986 1 16
MR Bristow R Ginsburg DC. Harrison Histamine and the human heart: the other receptor system Am J Cardiol 49 1982 249 251
R Levi JR Malm FO Bowman MR. Rosen The arrhythmogenic actions of histamine on human atrial fibers Circ Res 49 1981 545 550
R Levi JH. Zavecz Acceleration of idioventricular rhythms by histamine in guinea pig heart Circ Res 44 1979 847 855
R Levi AJ. Pappano Modifications of the effects of histamine and norepinephrine on the sinoatrial node pacemaker by potassium and calcium J Pharmacol Exp Ther 204 1978 625 633
JP Trzeciakowski R. Levi Reduction of ventricular fibrillation threshold by histamine: resolution into separate H1- and H2-mediated components J Pharmacol Exp Ther 223 1982 774 783
R Levi N Capurro C-H. Lee Pharmacological characterization of cardiac histamine receptors: sensitivity to H1- and H2- receptor agonists and antagonists Eur J Pharmacol 30 1975 328 335
AL Waldo WAH. MacLean Anatomy of the specialized conduction system of the heart. Diagnosis and treatment of cardiac arrhythmias following open-heart surgery 1980 Futura Mount Kisco, New York 237 244
CJF Spry P-C Tai J. Davies The cardiotoxicity of eosinophils Postgrad Med J 59 1983 147 151
JW Grant GA Serwer BE Armstrong HN Oldham PAW. Anderson Junctional tachycardia in infants and children after open-heart surgery for congenital heart disease Am J Cardiol 59 1987 1216 1218
PC. Gillette Diagnosis and management of postoperative junctional ectopic tachycardia Am Heart J 118 1989 192 194
G Marone C Stellato P Mastronardi B. Mazzarella Mechanisms of activation of human mast cells and basophils by general anaesthetic drugs Ann Fr Anesth Reanim 12 1993 116 125
J Moss CE. Rosow Histamine release by narcotics and muscle relaxants in humans Anesthesiology 59 1983 330 339
