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The role of plasma endothelin in the Fontan circulation
M Yamagishi1, H Kurosawa, K Hashimoto
1Department of Pediatric Cardiovascular Surgery, Children's Research Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan. myama@koto.kpu-m.ac.jp
Insights
Elevated endothelin-1 (ET-1) levels after the Fontan operation correlate with increased central venous pressure, suggesting ET-1 impacts pulmonary circulation. This highlights potential implications for Fontan circulation management.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Vascular Physiology
Background:
- Cardiopulmonary bypass releases vasoactive substances that can impair pulmonary circulation post-Fontan operation.
- The specific effects of plasma endothelin-1 (ET-1), a potent vasoconstrictor, on Fontan circulation remain uninvestigated.
Purpose of the Study:
- To investigate the role of plasma endothelin-1 (ET-1) in the pulmonary circulation following the Fontan operation.
Main Methods:
- Compared plasma ET-1 levels in patients undergoing modified Fontan operation (group F) versus biventricular repair (group C).
- Measured ET-1 concentrations on postoperative days (Early I, Early II) and during late cardiac catheterization.
- Correlated ET-1 levels with central venous pressure, a marker of pulmonary circulatory status.
Main Results:
- Plasma ET-1 concentrations significantly increased in group F post-operation compared to baseline.
- Elevated ET-1 levels showed a significant positive correlation with central venous pressure in the early postoperative period.
- This correlation between ET-1 and central venous pressure persisted even as ET-1 levels decreased in the late postoperative phase.
Conclusions:
- Increased endothelin-1 (ET-1) following the Fontan operation may contribute to pulmonary vasoconstriction.
- These findings suggest ET-1 has significant implications for managing Fontan circulation.
- Further research into ET-1's role could inform therapeutic strategies for Fontan patients.
Background:
Various vasoactive substances are released during cardiopulmonary bypass. They may deteriorate pulmonary circulation after the Fontan operation. Effects of plasma endothelin-1 (ET-1), a vasoconstricting peptide, on the Fontan circulation have not been investigated.
Methods:
Eleven patients (aged 11.1+/-7.5 years) who underwent the modified Fontan operation (group F) and seven patients (aged 9.9+/-6.0 years) who underwent the biventricular repair (group C) were studied. Plasma samples were obtained for measuring ET-1 on the first postoperative day (Early I), on returning to floor care from the intensive care unit (Early II), and during postoperative cardiac catheterization (Late).
Results:
Plasma concentrations of ET-1 increased in group F (Early I, 4.37+/-1.78 pg/ml; Early II, 4.07+/-1.90 pg/ml) as compared with the basal value of 1.0+/-0.5 pg/ml. The central venous pressure, which reflects the pulmonary circulatory state, soon after the Fontan operation correlated significantly with the increased ET-1 concentration (y=1.809 x+6.484; r=0.809; p=0.0026). Although the Late ET-1 concentrations in group F were significantly decreased, the central venous pressure and the ET-1 concentrations demonstrated a significant correlation (y=3.074 x +5.427; r=0.740; p=0.0227).
Conclusions:
The increased humoral vasoactive substances such as ET-1, which induces pulmonary vasoconstriction following the Fontan operation, may have important implications for the Fontan circulation.