Time course of endothelin-1 and adrenomedullin after the Fontan procedure
Time course of endothelin-1 and adrenomedullin after the Fontan procedure
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DOI：
10.1016/s0003-4975(99)00374-4
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发表时间：
1999-07-01
影响因子：
4.6
通讯作者：
Nakazawa, M
中科院分区：
文献类型：
--
作者：
Hiramatsu, T;Imai, Y;Nakazawa, M
背景。内皮源性血管收缩剂内皮素 (ET)-1 可能有助于血流调节的生理学并在心血管疾病中发挥作用。肾上腺髓质素 (AM) 是一种有效的血管舒张肽，对心血管功能有重大影响，并具有涉及心血管稳态的多种生物学效应。尽管已知肺血管阻力是确定Fontan手术适应症的最重要因素之一，但Fontan手术前后血浆细胞因子的时间进程尚不清楚。 16 名患者被分为两组，8 名患者（1 至 14 岁）接受了 Fontan 手术（房肺连接），8 名年龄匹配的对照组接受了双心室修复术，中心静脉压正常。在体外循环之前、体外循环之后立即以及体外循环之后6和24小时测量两组的血浆ET-1和肾上腺髓质素水平。术中插入热稀释导管，测量平均肺动脉压、肺楔压、心输出量，并计算同一时间点的肺血管阻力。在 Fontan 组中获得了血浆 ET-1 水平与肺血管阻力数据之间的相关性。结果。 Fontan组术后血浆ET-1水平升高，体外循环后6小时和24小时血浆ET-1水平高于对照组。体外循环后 6 小时和 24 小时，Fontan 组的血浆肾上腺髓质素低于对照组。血浆ET-1与肺血管阻力数据呈显着正相关(r=0.475)。结论。 Fontan 手术中体外循环后增加的 ET-1 与相对减少的肾上腺髓质素之间的不平衡可能会导致 ET-1 的主导效应，这可能会在 Fontan 手术后引起血管收缩。 ET-1 可能在 Fontan 手术后维持血管收缩方面发挥重要作用。 (C) 1999 年，胸外科医师协会。
Background. The endothelium-derived vasoconstrictor endothelin (ET)-1 might contribute to the physiology of blood flow regulation and play a role in cardiovascular disease. Adrenomedullin (AM) is a potent vasodilator peptide that has major effects on cardiovascular function and has multiple biologic effects involved in cardiovascular homeostasis. Although pulmonary vascular resistance is known to be one of the most important factors to determine the indications for a Fontan procedure, the time course of the plasma cytokine before and after the Fontan procedure is not known.Methods. Sixteen patients were divided into two groups, 8 patients (1 to 14 years) who had the Fontan procedure (atriopulmonary connection) and 8 age-matched controls who had biventricular repair with normal central venous pressure. Plasma ET-1 and adrenomedullin levels were measured in both groups immediately before cardiopulmonary bypass, immediately after cardiopulmonary bypass, and 6 and 24 hours after cardiopulmonary bypass. A thermodilution catheter was inserted during the operation, and mean pulmonary arterial pressure, pulmonary wedge pressure, and cardiac output were measured, and pulmonary vascular resistance was calculated at the same time points. Correlation between the plasma ET-1 levels and pulmonary vascular resistance data were obtained in the Fontan group.Results. Plasma ET-1 levels in the Fontan group were elevated after operation and were higher than the control group at 6 and 24 hours after cardiopulmonary bypass. Plasma adrenomedullin in the Fontan group was lower than in the control group at 6 and 24 hours after cardiopulmonary bypass. A significant positive correlation was obtained between the plasma ET-1 and pulmonary vascular resistance data (r = 0.475).Conclusions. Imbalance between increased ET-1 and relatively decreased adrenomedullin after cardiopulmonary bypass in the Fontan procedure could contribute to dominant effects of ET-1, which might induce vasoconstriction after the Fontan procedure. ET-1 might play an important role in maintaining vasoconstriction after the Fontan procedure. (C) 1999 by The Society of Thoracic Surgeons.