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[Plasma aminogram in infants operated on complex congenital heart disease]
J M Moreno Villares1, L Oliveros Leal, I Sánchez Díaz
1Unidad de Nutrición Clínica, Hospital Universitario 12 de Octubre, Madrid, España. jmoreno.hdoc@salud.madrid.org
Insights
Congenital heart surgery in infants causes a temporary drop in plasma amino acids, particularly glutamine. Levels tend to normalize post-surgery, but further study is needed to understand the clinical significance.
Area of Science:
- Biochemistry
- Pediatric Cardiology
- Surgical Outcomes
Context:
- Post-surgical morbidity remains high in infants undergoing congenital heart disease surgery.
- Protein metabolism and its impact on clinical outcomes in these young patients are not well understood.
- Pre-surgical malnutrition and systemic response to surgery, including extracorporeal circulation, contribute to morbidity.
Purpose:
- To assess the effect of heart surgery on the plasma aminogram of infants with complex congenital heart disease.
- To investigate changes in amino acid profiles following early-age cardiac operations.
Summary:
- Plasma amino acid levels in infants with congenital heart disease were within normal ranges pre-surgery, regardless of nutritional status.
- A significant decrease in most plasma amino acids was observed one day post-surgery, with levels remaining low at day +3 for several amino acids, including glutamine.
- Glutamine levels showed a slower trend toward normalization by day +7.
Impact:
- The study reveals a transient but significant alteration in amino acid metabolism following early-life congenital heart surgery.
- Findings highlight the need for further research into the clinical implications of these metabolic changes.
- Understanding these post-surgical amino acid dynamics may inform future nutritional support strategies for pediatric cardiac patients.
Unlabelled:
Post-surgical morbidity of congenital heart disease operated at early ages still is high. Both pre-surgical malnourishment and the repercussions of the systemic response to the aggression, including extracorporeal circulation contribute to it. The metabolism of proteins has been little studied in these infants and toddlers, as well as its repercussion on clinical outcomes. The aim of this study was to assess the effect of the surgery on the plasma aminogram of infants early operated for complex congenital heart disease.
Patients And Methods:
We prospectively gathered the anthropometrical and analytical data of 55 children < 3 years of age submitted to elective heart surgery at the day of intervention and at days +1 (n = 53), +3 (n = 39), and +7 (n = 19). The data are presented as mean and standard deviation. The comparison between the variables through time was done by one-tailed analysis of variance for repeated samples. It was considered to be statistically significant with a p value < 0.05.
Results:
Mean age at the time of surgery was 5.5+/-7.2 months (range 3 days-3 years). The z score for weight before the surgery was -1.24+/-1.14 and for height -0.73+/-1.53. 86.7% of the patients had hypo-prealbuminemia at day 0. The average plasma levels for all the amino acids were within the normal ranges. The evolution of the aminogram showed a general decrease as compared to the levels prior to surgery at day +1 (p < 0.005), which were kept low at +3 for isoleucine, alanine, arginine, glycine, threonine and glutamine (p < 0.005) and only for glutamine at day +7.
Conclusions:
1. The plasma aminogram in infants with congenital heart disease was within the normal range before the surgery, irrespective of the nutritional status. 2. After the surgery, a significant decrease is observed for plasma levels of most of the amino acids, with a trend towards normalization, which is slower for certain branched amino acids, particularly for glutamine. 3. The clinical significance of these findings deserves further studies.
