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Hyperamylasemia after cardiac surgery in infants and children
T Tikanoja1, P Rautiainen, M Leijala
1Department of Pediatrics, Kuopio, University Hospital, Finland.
Insights
Hyperamylasemia, elevated amylase levels, is common in pediatric patients after cardiac surgery. Differentiating amylase types is crucial for accurate diagnosis and treatment decisions in these young patients.
Area of Science:
- Pediatric Cardiology
- Clinical Chemistry
Background:
- Cardiac surgery in infants and children can lead to significant physiological changes.
- Postoperative hyperamylasemia is a recognized complication, but its incidence and implications require further clarification.
Purpose of the Study:
- To determine the incidence of hyperamylasemia in pediatric patients undergoing cardiac surgery.
- To investigate the role of amylase isoenzyme measurements in clinical decision-making.
Main Methods:
- A prospective study involving 186 infants and children undergoing cardiac surgery.
- Serum samples were collected preoperatively and for three days post-surgery, as well as before discharge.
- Amylase levels were measured using two distinct assays to differentiate between total amylase and pancreatic isoenzymes.
Main Results:
- Postoperative hyperamylasemia was observed in 34% of patients, with 12% showing abnormalities across all assays.
- A tenfold increase in pancreatic amylase, suggestive of pancreatitis, occurred in 8% of patients, associated with a higher mortality rate (21%).
- Hyperamylasemia was more prevalent in children over one year of age and after open-heart procedures, including homograft implantation and cardiac transplantation.
Conclusions:
- Hyperamylasemia is a frequent occurrence following cardiac surgery in pediatric populations.
- Distinguishing between amylase isoenzymes is essential for appropriate clinical management.
- Establishing age-specific reference values for amylase is critical for accurate interpretation of results.
Objective:
This study was conducted to clarify the incidence of hyperamylasemia after cardiac surgery in infants and children.
Design And Patients:
186 infants and children operated on at Children's Hospital. Helsinki, during an 11-month period were enrolled in the study. Serum samples were taken before and on 3 consecutive days after cardiac surgery at the intensive care unit and before discharge from the hospital.
Measurements:
We measured serum total amylase and serum pancreatic amylase with two different assays (1) reduction of salivary amylase from total amylase activity and (2) measurement of mass concentration with monoclonal antibodies.
Results:
Preoperative values for both total amylase and pancreatic isoenzymes were strongly age-related. At least one of the three tests showed postoperative hyperamylasemia (> +/- 2 SD above starting values of the age group and maximal value > 3 times the individual starting value) in 64/186 (34%) patients. 22/186 (12%) patients had abnormal results in all assays. A more than tenfold rise in pancreatic amylase, suggesting pancreatitis, was found in 14 patients (8%). Mortality was 21% in this subgroup, but 5% in the rest of the patients. Hyperamylasemia was more common after 1 year of age, and after open-heart surgery, especially homograft implantation or cardiac transplantation.
Conclusions:
Hyperamylasemia is a common finding after cardiac surgery in pediatric patients. Amylase isoenzyme measurements are needed for clinical decision making. Age-group-related reference values are mandatory for the right interpretation of amylase values.