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The Journal of Cardiovascular Surgery 2002 December;43(6):793-7

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

The role of plasma endothelin in the Fontan circulation

Yamagishi M. 1, Kurosawa H. 2, Hashimoto K. 2, Nomura K. 2, Kitamura N. 1

1 Department of Pediatric Cardiovascular Surgery Children’s Research Hospital Kyoto Prefectural University of Medicine, Kyoto, Japan 2 Department of Cardiovascular Surgery Jikei University School of Medicine Tokyo, Japan


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Background. Various vasoac­tive sub­stanc­es are ­released dur­ing car­di­o­pul­mo­nary ­bypass. They may dete­ri­orate pul­mo­nary cir­cu­la­tion ­after the Fontan oper­a­tion. Effects of plas­ma endo­the­lin-1 (ET-1), a vas­o­con­strict­ing pep­tide, on the Fontan cir­cu­la­tion ­have not ­been inves­ti­gat­ed.
Methods. Eleven ­patients (­aged 11.1±7.5 ­years) who under­went the mod­i­fied Fontan oper­a­tion (­group F) and sev­en ­patients (­aged 9.9±6.0 ­years) who under­went the biven­tric­u­lar ­repair (­group C) ­were stud­ied. Plasma sam­ples ­were ­obtained for meas­ur­ing ET-1 on the ­first post­op­er­a­tive day (Early I), on return­ing to ­floor ­care ­from the inten­sive ­care ­unit (Early II), and dur­ing post­op­er­a­tive car­diac cath­et­er­iza­tion (Late).
Results. Plasma con­cen­tra­tions of ET-1 ­increased in ­group F (Early I, 4.37±1.78 pg/ml; Early II, 4.07±1.90 pg/ml) as com­pared ­with the ­basal val­ue of 1.0±0.5 pg/ml. The cen­tral ­venous pres­sure, ­which ­reflects the pul­mo­nary cir­cu­la­to­ry ­state, ­soon ­after the Fontan oper­a­tion cor­re­lat­ed sig­nif­i­cant­ly ­with the ­increased ET-1 con­cen­tra­tion (y=1.809 x+6.484; r=0.809; p=0.0026). Although the Late ET-1 con­cen­tra­tions in ­group F ­were sig­nif­i­cant­ly ­decreased, the cen­tral ­venous pres­sure and the ET-1 con­cen­tra­tions dem­on­strat­ed a sig­nif­i­cant cor­re­la­tion (y=3.074 x +5.427; r=0.740; p=0.0227).
Conclusions. The ­increased humo­ral vasoac­tive sub­stanc­es ­such as ET-1, ­which induc­es pul­mo­nary vaso­con­stric­tion fol­low­ing the Fontan oper­a­tion, may ­have impor­tant impli­ca­tions for the Fontan cir­cu­la­tion.

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