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Changes in plasma fibronectin in children after elective repair of congenital heart defects
R Hackbarth1, A P Sarnaik, K Meert
1Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit 48201.
Insights
Children undergoing heart surgery experience significant plasma fibronectin depletion, a key protein for capillary integrity. This depletion worsens with more complex procedures, suggesting children are more vulnerable than adults.
Area of Science:
- Biochemistry
- Pediatric Surgery
- Critical Care Medicine
Background:
- Plasma fibronectin is vital for capillary integrity and host defense.
- Depletion occurs in adults after critical illness (sepsis, trauma, burns) and surgery.
- Previous studies suggest a link between low fibronectin and increased capillary permeability.
Purpose of the Study:
- To measure plasma fibronectin levels in children post-cardiac surgery.
- To compare postoperative levels with preoperative values.
- To investigate the association between fibronectin depletion and surgical complexity.
Main Methods:
- Immunoturbidometric assay used to measure plasma fibronectin.
- 20 children (6 months–12 years) undergoing congenital heart defect repair were studied.
- Levels were measured immediately post-operation and daily for 5 days.
Main Results:
- Significant plasma fibronectin decline observed on postoperative days 1-5 (p < 0.05).
- Nadir (lowest point) reached on day 3, with gradual recovery.
- Greater fibronectin depletion in patients with higher therapeutic intervention scores (p < 0.005).
Conclusions:
- Children experience significant, prolonged plasma fibronectin depletion after cardiovascular operations.
- Postoperative depletion correlates with surgical complexity.
- Children may be more susceptible due to reduced synthesis and more extensive surgeries.
Abstract:
Plasma fibronectin is an attachment protein important for maintaining capillary integrity and host defense mechanisms. Depletion of plasma fibronectin has been shown to occur in adults after septic shock, major trauma, and burns. Limited laboratory and clinical studies suggest a correlation between decreased plasma fibronectin levels and increased pulmonary capillary permeability and tissue perfusion. Mild and transient plasma fibronectin depletion has been observed in adults after cardiovascular operations. We measured plasma fibronectin by immunoturbidometric assay in 20 children (age 6 months to 12 years) undergoing repair of congenital heart defects. Plasma fibronectin levels immediately after operations and daily thereafter were compared with the preoperative values. Plasma fibronectin declined on postoperative days 1, 2, 3, 4, and 5 (p < 0.05). A nadir was reached on day 3 with a tendency toward recovery thereafter. Patients with a therapeutic intervention score of more than 35 had greater magnitude of plasma fibronectin decline than those with a score of less than 35 at 24 hours after the operation (p < 0.005). We conclude that (1) significant and prolonged plasma fibronectin depletion occurs after cardiovascular operations in children; and (2) postoperative plasma fibronectin depletion is associated with increasingly complex surgical intervention. Reduced plasma fibronectin synthesis and more extensive operations for congenital heart defects are likely reasons for children being more susceptible than adults to plasma fibronectin depletion after cardiovascular operations.