[en] Objectives: To examine whether preoperative heart failure end cardiac surgery influence nitric oxide production and atrial natriuretic peptide (ANP) biological activity in infants and whether nitric oxide and ANP participate in the control of postoperative pulmonary vascular tone. Design: Prospective, clinical study. Setting: Tertiary pediatric cardiac intensive care unit in a referral cardiosurgical center. Patients: Nineteen infants (median age 4 months) undergoing cardiac surgery: 13 infants with ventricular or atrioventricular septal defect associated with heart failure and pulmonary hypertension (group 1); and six infants with tetralogy of Fallot, without heart failure (group 2). Interventions: Blood samples obtained from indwelling catheters or bypass circuit outlets. Measurements and Main Results: Nitrite and nitrate blood concentrations (as a marker for nitric oxide synthesis) and the molar ratio of cyclic guanosine 3',5'-monophosphate (cGMP) to ANP (as a marker for ANP biological activity) were determined before, during, and up to 24 hrs after cardiopulmonary bypass (CPB). In group 1 patients, these biological parameters were related to postoperative pulmonary arterial pressure. Preoperative nitrite and nitrate concentrations were higher in group 1 patients than in group 2 patients (p < .02), and this difference persisted during CPB. Nitrite and nitrate concentrations 24 hrs postoperatively were lower than preoperative values in group 1 patients (p < .05) end were unchanged in group 2 patients. An inverse correlation was observed postoperatively between nitrite and nitrate concentrations and systolic pulmonary arterial pressure (r2 = 0.4, p < .05). Group 1 patients had a lower preoperative cGMP/ANP ratio than group 2 patients (p < .05), despite higher ANP levels (p < .005). The cGMP/ANP ratio decreased during CPB in both groups (p < .0001), and in group 2 patients, cGMP and ANP values remained below preoperative values ≤24 hrs postoperatively. A correlation was observed between ANP levels and systolic pulmonary arterial pressure 2 and 4 hrs postoperatively (r2 = .4, p < .05, respectively), but no correlation was observed between ANP biological activity and postoperative pulmonary arterial pressure. Conclusions: Infants with heart failure and pulmonary hypertension have increased nitric oxide synthesis and decreased ANP biological activity; both phenomena may be involved in the pathophysiology of this clinical condition. CPB has no detectable effect on nitric oxide production but does decrease ANP biological activity. In patients with preoperative heart failure and pulmonary hypertension, endogenous nitric oxide appears to play a role in the control of postoperative pulmonary vascular tone.
Disciplines :
Pediatrics Cardiovascular & respiratory systems
Author, co-author :
Seghaye, Marie-Christine ; Université de Liège - ULiège > Département des sciences cliniques > Pédiatrie cardiologique et pneumologique
Duchateau, J.; Department of Immunology, University Hospitals Brugmann and St Pierre, Free University of Brussels, Brussels, Belgium
Bruniaux, J.; Department of Pediatric Intensive Care, Centre Chirurgical Marie-Lannelongue, Paris, France
Demontoux, S.; Department of Pediatric Intensive Care, Centre Chirurgical Marie-Lannelongue, Paris, France
Détruit, H.; Laboratory of Experimental Surgery, Centre Chirurgical Marie-Lannelongue, Paris, France
Bosson, C.; Department of Pediatric Intensive Care, Centre Chirurgical Marie-Lannelongue, Paris, France
Lecronier, G.; Department of Pediatric Intensive Care, Centre Chirurgical Marie-Lannelongue, Paris, France
Mokhfi, E.; Department of Pediatric Intensive Care, Centre Chirurgical Marie-Lannelongue, Paris, France
Serraf, A.; Department of Pediatric Cardiac Surgery, Centre Chirurgical Marie-Lannelongue, Paris, France
Planché, C.; Department of Pediatric Cardiac Surgery, Centre Chirurgical Marie-Lannelongue, Paris, France
Language :
English
Title :
Endogenous nitric oxide production and atrial natriuretic peptide biological activity in infants undergoing cardiac operations
Publication date :
June 1997
Journal title :
Critical Care Medicine
ISSN :
0090-3493
eISSN :
1530-0293
Publisher :
Lippincott Williams & Wilkins, United States - Pennsylvania
Seghaye MC, Duchateau J, Grabitz RG, et al: Complement activation during cardiopulmonary bypass in infants and children. Relation to postoperative multiple system organ failure. J Thorac Cardiovasc Surg 1993; 106:978-985
Seghaye MC, Duchateau J, Bruniaux J, et al: Interleukin-10 release related to cardiopulmonary bypass in infants undergoing cardiac operations. J Thorac Cardiovasc Surg 1996; 111: 545-553
Kirshbom PM, Jacobs MT, Tsui SSL, et al: Effect of cardiopulmonary bypass and circulatory arrest on endothelium-dependent vasodilatation in the lung. J Thorac Cardiovasc Surg 1996; 111: 1248-1256
Downing SW, Edmunds LH Jr: Release of vasoactive substances during cardiopulmonary bypass. Ann Thorac Surg 1992; 54:1236-1243
Wessel DL, Adatia I, Giglia TM, et al: Use of inhaled nitric oxide and acetylcholine in the evaluation of pulmonary hypertension and endothelial function after cardiopulmonary bypass. Circulation 1993; 88:2128-2138
Burch M, Lum L, Eliott M, et al: Influence of cardiopulmonary bypass on water balance hormones in children. Br Heart J 1992; 68:309-312
Celermajer DS, Dollery C, Burch M, et al: Role of endothelium in the maintenance of low pulmonary vascular tone in normal children. Circulation 1994; 89:2041-2044
Haywood GA, Tsao PS, von der Leyden H, et al: Expression of inducible nitric oxide synthase in human heart failure. Circulation 1996; 93:1087-1094
Bhagat K, Vallance P: Inducible nitric oxide synthase in the cardiovascular system. Heart 1996; 75:218-220
de Bold AJ: Atrial natriuretic factor: A hormone produced by the heart. Science 1985; 230:767-770
Westendorp RGJ, Meinders AE: Atrial natriuretic peptide modulates pulmonary pathophysiology. In: Yearbook of Intensive Care and Emergency Medicine. Vincent J-L (Ed). Berlin, Heidelberg, Springer-Verlag, 1994, pp 374-383
Maack T: Receptors of atrial natriuretic factor. Annu Rev Physiol 1992:54:11-27
Roy LF, Ogilvie RI, Larochelle P, et al: Cardiac and vascular effects of atrial natriuretic peptide and sodium nitroprusside in healthy men. Circulation 1989; 79:383-392
Cusson JR, Hamet P, Gutkowska J, et al: Effects of atrial natriuretic factor on natriuresis and cGMP in patients with essential hypertension. J Hypertension 1987; 5:435-443
Westendorp RGJ, Roos AN, Walma ST, et al: Preexisting cardiopulmonary disease attenuating the atrial natriuretic peptide response. Results in patients with acute respiratory failure. Chest 1992; 102:1758-1763
Tsutamoto T, Kanamori T, Wada A, et al: Uncoupling of atrial natriuretic peptide extraction and cyclic guanosine monophosphate production in the pulmonary circulation in patients with severe heart failure. J Am Coll Cardiol 1992; 20:541-546
Edwards BS, Ackermann DM, Lee ME, et al: Identification of atrial natriuretic factor within ventricular tissue in hamsters and humans with congestive heart failure. J Clin Invest 1988; 81:82-86
Raine AEG, Phil D, Erne P, et al: Atrial natriuretic peptide and atrial pressure in patients with congestive heart failure. N Engl J Med 1986; 315:533-537
Weil J, Bidlingmaier F, Döhlemann C, et al: Comparison of plasma atrial natriuretic peptide levels in healthy children from birth to adolescence and in children with cardiac diseases. Pediatr Res 1986; 20:1328-1331
Matsuoka S, Kurahashi Y, Tomimatsu H, et al: Plasma atrial natriuretic peptide levels in patients with ventricular septal defect. J Pediatr 1987; 110: 578-580
Kikuchi K, Nishioka K, Ueda T, et al: Relationship between plasma atrial natriuretic polypeptide concentration and hemodynamic measurements in children with congenital heart diseases. J Pediatr 1987; 111:335-342
Green LC, Wagner DA, Glogowski J, et al: Analysis of nitrate, nitrite, and [15 N] nitrate in biological fluids. Anal Biochem 1982; 126:131-138
Wong HR, Carcillo JA, Burckart G, et al: Increased serum nitrite and nitrate concentrations in children with the sepsis syndrome. Crit Care Med 1995; 23:835-842
Doughty LA, Kaplan S, Carcillo JA: Inflammatory cytokine and nitric oxide responses in pediatric sepsis and organ failure. Crit Care Med 1996; 24: 1137-1143
Ashab I, Peer G, Blum M, et al: Oral administration of L-arginine and captopril in rats prevents chronic renal failure by nitric oxide production. Kidney Int 1995; 47:1515-1521
Neilly IJ, Copland M, Haj M, et al: Plasma nitrate concentrations in neutropenic and non-neutropenic patients with suspected septicaemia. Br J Haematol 1995; 89:199-202
Winlaw DS, Smythe GA, Keogh AM, et al: Increased nitric oxide production in heart failure. Lancet 1994; 344:373-374
De Beider AJ, Radomski MW, Why HJF, et al: Nitric oxide synthase activities in human myocardium. Lancet 1993; 341:84-85
Mohan P, Brutsaert DL, Paulus WJ, et al: Myocardial contractile response to nitric oxide and cGMP. Circulation 1996; 93:1223-1229
Dutka DP, Elborn JS, Dclamere F, et al: Tumor necrosis factor alpha in severe congestive cardiac failure. Br Heart J 1993; 70:141-143
Hennein HA, Ebba H, Rodriguez JL, et al: Relationship of the proinflammatory cytokines to myocardial ischemia and dysfunction after uncomplicated coronary revascularization. J Thorac Cardiovasc Surg 1994; 108:626-635
Ruvolo G, Speziale G, Greco E, et al: Nitric oxide release during hypothermic versus normothermic cardiopulmonary bypass. Eur J Cardiothorac Surg 1995; 9:651-654
Finkel MS, Oddis CV, Jacob TD, et al: Negative inotropic effects of cytokines on the heart mediated by nitric oxide. Science 1992; 257:387-389
Morise T, Takeuchi Y, Okamoto S, et al: Stimulation of atrial natriuretic peptide secretion and synthesis by Na-K-ATPase inhibitors. Biochem Biophys Res Commun 1991; 176:875-881
Sagnella GA, Markandu ND, Buckley MG, et al: Atrial natriuretic peptide-cyclic GMP relationships in normal humans: Effects of dietary sodium intake. Clin Sci 1993; 85:13-17
Edwards BS, Zimmerman RS, Schwab TR, et al: Atrial stretch, not pressure, is the principal determinant controlling the acute release of atrial natriuretic factor. Circ Res 1988; 62:191-195
Hung JS, Fu M, Cherng WJ, et al: Rapid fall in elevated plasma atrial natriuretic peptide levels after successful catheter balloon valvuloplasty of mitral stenosis. Am Heart J 1989:117:381-384
Koh GY, Nussenzveig DR, Okolicany J, et al: Dynamics of atrial natriuretic factor-guanylate cyclase receptor and receptor-ligand complexes in cultured mesangial and renomedullary interstitial cells. J Biol Chem 1992; 267: 11987-11994
Baertschi AJ, Jiao JH, Carlson DE, et al: Neural control of ANF release in hypoxia and pulmonary hypertension. Am J Physiol 1990; 259:H737-H744