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Clinical Investigations: SURGERY |

Plasma L-Arginine and Metabolites of Nitric Oxide Synthase in Patients With Left-To-Right Shunt After Intracardiac Repair*

Matthias Gorenflo, MD; Michael V. Ullmann, MD; Katharina Eitel; Jasmin Gross; Walter Fiehn, MD; Siegfried Hagl, MD; Jens Dreyhaupt, PhD
Author and Funding Information

*From the Department of Pediatric Cardiology (Drs. Gorenflo, Eitel, and Gross), Department of Cardiac Surgery (Drs. Ullmann and Hagl), Central Laboratory of the Department of Medicine (Dr. Fiehn), and the Department of Medical Biometry and Informatics (Dr. Dreyhaupt), University Medical Center, Heidelberg, Germany.

Correspondence to: Matthias Gorenflo, MD, Department of Pediatric Cardiology, University Medical Center, INF 153, D-69120 Heidelberg, Germany; e-mail: Matthias_Gorenflo@med.uni-heidelberg.de



Chest. 2005;127(4):1184-1189. doi:10.1378/chest.127.4.1184
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Study objective: Human plasma L-arginine serves as a substrate pool for endothelial-derived nitric oxide (NO) synthase. In this pilot study, we tested the hypothesis that plasma L-arginine and other metabolites of the L-arginine NO pathway could correlate with postoperative pulmonary hypertension after cardiopulmonary bypass (CPB).

Design: Forty-two patients (median age, 0.5 years; range, 0.1 to 28 years) with atrial septal defect (n = 15), ventricular septal defect (n = 18), atrioventricular canal (n = 8), and aortopulmonary window (n = 1) were enrolled. The influence of patient age, preoperative pulmonary hypertension, duration of CPB, plasma L-arginine, guanosine 3′, 5′-cyclic monophosphate (cGMP), and nitrate on postoperative pulmonary hypertension during the first 24 h after CPB was studied by logistic regression.

Results: Nineteen of 42 patients were found to have preoperative pulmonary hypertension. Thirteen of 42 patients showed persistent pulmonary hypertension after intracardiac repair with a mean pulmonary artery pressure (PAP) of 38 mm Hg (range, 23 to 55 mm Hg) at 24 h after CPB. L-arginine concentrations in plasma were significantly lower 24 h after CPB than before: 52 μmol/L (range, 18 to 95 μmol/L) vs 79 μmol/L (range, 31 to 157 μmol/L). Plasma cGMP levels were higher and plasma nitrate levels were lower immediately after weaning from CPB (p < 0.0033). On logistic regression analysis, only patient age (p = 0.02) and preoperative PAP (p = 0.01) were related to postoperative pulmonary hypertension.

Conclusion: Low plasma L-arginine does not relate to persistent pulmonary hypertension in patients with left-to-right shunt after CPB and intracardiac repair.

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