Related Experiment Video
Updated: Aug 8, 2026
Determining Intestinal Permeability Using Lucifer Yellow in an Apical-Out Enteroid Model
Published on: July 27, 2022
Gut permeability in paediatric cardiac surgery
I Malagon1, W Onkenhout, G Klok
1Department of Anaesthesia, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands. jmalagon@lumc.nl
Insights
Pediatric cardiac surgery patients exhibit increased intestinal permeability, especially those on cardiopulmonary bypass. Gut barrier function improves over time, with faster recovery in aortic coarctation repair patients.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Cardiology
Background:
- Intestinal mucosal ischemia is a risk in pediatric cardiac surgery, potentially causing necrotizing enterocolitis and mortality.
- Assessing gut permeability is crucial for understanding post-surgical complications in children.
Purpose of the Study:
- To investigate gut permeability in pediatric patients undergoing cardiac surgery.
- To evaluate the impact of cardiopulmonary bypass on intestinal barrier function.
Main Methods:
- Dual sugar permeability test using 3-O-methyl-D-glucose, D-xylose, L-rhamnose, and lactulose.
- Oral administration of saccharides at anesthesia induction, 12, and 24 hours post-surgery.
- Study included 34 pediatric patients with and without cardiopulmonary bypass.
Main Results:
- Elevated lactulose/rhamnose ratios indicated increased gut permeability in all cardiac surgery patients compared to healthy children.
- Cardiopulmonary bypass use was associated with the highest lactulose/rhamnose ratios 12 hours post-surgery.
- Patients not on cardiopulmonary bypass showed improved permeability over 24 hours; aortic coarctation repair patients recovered fastest.
Conclusions:
- Congenital heart defect patients undergoing cardiac surgery have impaired gut permeability.
- Cardiopulmonary bypass significantly affects the intestinal barrier's morphology and function.
- Intestinal permeability shows a trend towards normalization post-surgery, with varying recovery rates.
Background:
Intestinal mucosal ischaemia can occur in infants and children during and after cardiac surgery. Severe decreases in mucosal perfusion may cause complications such as necrotizing enterocolitis and postoperative mortality. We investigated gut permeability in paediatric patients undergoing cardiac surgery using the dual sugar permeability test and absorption of two other saccharides.
Methods:
Thirty-four patients undergoing palliative or corrective surgical procedures with and without cardiopulmonary bypass were investigated. Intestinal permeability was measured using 3-O-methyl-D-glucose, D-xylose, L-rhamnose and lactulose, given orally after induction of anaesthesia and 12 and 24 h later.
Results:
Lactulose/rhamnose ratios were raised from the outset [median 0.39 (confidence interval 0.07-1.8 for patients undergoing operations without cardiopulmonary bypass and 0.30 (0.02-2.6) with cardiopulmonary bypass]. The highest lactulose/rhamnose ratios were recorded 12 h after surgery 0.32 (0.07-6.9), when cardiopulmonary bypass was used. This is approximately seven times the value expected in healthy children. There was an improvement in patients not undergoing cardiopulmonary bypass: 0.22 (0.03-0.85) 12 h and 0.11 (0-0.48) 24 h after induction of anaesthesia. Patients undergoing repair of aortic coarctation showed the fastest recovery: 0.09 (0.03-0.31) 12 h and 0.07 (0.04-0.35) 24 h after induction of anaesthesia.
Conclusions:
Patients with congenital heart defects have abnormal gut permeability when compared with healthy children of similar age. Cardiopulmonary bypass seems to affect the intestinal barrier morphologically (lactulose and rhamnose absorption) and functionally (3-O-methyl-D-glucose and D-xylose absorption).
