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Interleukin-10, T-lymphocytes, and cardiac output in children after ventricular septal defect repair: a pilot study
Stefan Grosek1, Janez Primozic, Alojz Ihan
1Department of Pediatric Surgery and Intensive Care, University Medical Center Ljubljana, Zaloska 7, 1525, Ljubljana, Slovenia. stefan.grosek@mf.uni-lj.si
Insights
Children undergoing ventricular septal defect surgery showed distinct inflammatory responses and T-cell changes based on cardiac index (CI). Higher interleukin-10 levels and lower T-cell counts at 24 hours post-surgery differentiated normal CI from low CI groups.
Area of Science:
- Pediatric Cardiology
- Immunology
- Critical Care Medicine
Background:
- Ventricular septal defect (VSD) surgery requires cardiopulmonary bypass (CPB), which can trigger inflammatory responses.
- Assessing the acute inflammatory response and its correlation with cardiac function post-CPB is crucial for pediatric cardiac surgery outcomes.
Purpose of the Study:
- To evaluate the acute inflammatory response, specifically interleukin-10 and tumor necrosis factor alpha levels, and cardiac output in children following VSD repair.
- To investigate the relationship between inflammatory markers, lymphocyte subsets, and cardiac index (CI) post-CPB.
Main Methods:
- Prospective observational study involving ten children undergoing open-heart surgery for VSD.
- Measurement of plasma interleukin-10 and tumor necrosis factor alpha via ELISA, and lymphocyte subsets by flow cytometry before and after CPB.
- Continuous cardiac index (CI) monitoring using pulse contour analysis, categorizing patients into normal and low CI groups.
Main Results:
- Children with normal CI maintained significantly higher relative interleukin-10 levels 24 hours post-CPB compared to those with low CI.
- The normal CI group showed a greater than threefold decrease in T-lymphocytes (T-cells, T-helper, cytotoxic T-cells) 24 hours post-CPB, unlike the low CI group.
- Relative values of tumor necrosis factor alpha also differed between the normal and low CI groups post-CPB.
Conclusions:
- Pediatric VSD repair patients exhibit either normal or low cardiac index post-CPB.
- Elevated interleukin-10 and reduced T-lymphocyte counts at 24 hours post-CPB are key indicators differentiating normal from low CI groups.
- These findings highlight potential biomarkers for assessing post-cardiac surgery recovery in children.
Objective:
To evaluate the acute inflammatory response and cardiac output in children after surgery for ventricular septal defect.
Design And Setting:
Prospective, observational study in a level III multidisciplinary neonatal and pediatric intensive care unit.
Patients:
Ten children undergoing open-heart surgery for ventricular septal defect.
Interventions:
All children received methylprednisolone (30 mg/kg) in cardiopulmonary bypass (CPB) prime.
Measurements And Results:
Before and after cardiopulmonary bypass, plasma interleukin-10 and tumor necrosis factor alpha were measured by enzyme-linked immunosorbent assay, and lymphocyte subsets in peripheral blood by flow cytometry. Relative values (post-/pre-CPB) of interleukin-10 and tumor necrosis factor alpha were calculated. The cardiac index (CI) was measured continuously beat-to-beat by a pulse contour analysis (PiCCO). Children above the cutoff value (median cardiac index value 3.0 l min(-1) m(-2)) were designated as the normal CI group and those below this value as the low CI group. In the normal CI group the relative values of interleukin-10 remained almost seven times higher than pre-CPB values at 24 h while in the low CI group they decreased almost to pre-CPB values. Furthermore, the normal CI group, but not the low CI group, exhibited more than threefold decrease in T-lymphocytes (lymphocyte T-cells, T-helper cells, and cytotoxic T-cells) 24 h after CPB.
Conclusions:
Children operated on for ventricular septal defect developed either a normal or low CI. The higher relative values of interleukin-10 and lower counts of lymphocyte T-cells, T-helper and cytotoxic T-cells differentiated the normal CI group from the low CI group at 24 h after cardiopulmonary bypass.
