Original ArticlesEffect of cardiopulmonary bypass on urea cycle intermediates and nitric oxide levels after congenital heart surgery☆,☆☆
Section snippets
Patients
Approval from the Vanderbilt Institutional Review Board was obtained before this study was done. Between August 2000 and August 2001, any infant undergoing cardiopulmonary bypass for repair of their unrestrictive VSD or AVSD at Vanderbilt University Medical Center was considered eligible for enrollment. All patients were screened in the preoperative evaluation clinic and considered eligible if specific exclusion criteria were not met, including left-sided AV valve insufficiency, pulmonary
Patient characteristics
Twenty-six infants were enrolled in this study, including 12 patients undergoing AVSD repair and 14 undergoing unrestrictive VSD repair (Table).Age (mo) 5.72 ± 3.62 Range 1–11 Weight (kg) 5.58 ± 2.08 Range 3.12–13 Cardiopulmonary bypass time (min) 95.1 ± 24.1 Range 49–140 Race, n (%) White 18 (69.2) Black 6 (23.1) Hispanic 2 (7.7) Sex, n (%) Male 10 (38.5) Female 16 (61.5)
Urea cycle intermediates and nitric oxide metabolites
The effect of cardiopulmonary bypass on citrulline levels was profound, with a precipitous drop seen immediately after
Discussion
Our study revealed that cardiopulmonary bypass significantly decreases several urea cycle intermediates and nitric oxide metabolites after repair of unrestrictive VSD and AVSD, which could have significant clinical implications. Patients undergoing these specific cardiac procedures are at risk for elevated postoperative pulmonary vascular resistance caused by excess preoperative pulmonary blood flow. A decrease in the availability of nitric oxide and its precursors could increase the risk for
Acknowledgements
We thank the nursing staff and the ECMO specialists of the Vanderbilt University Medical Center Pediatric Intensive Care Unit for their valuable support in collecting samples in this study, Nathan Scott for his technical assistance, and the physician and nursing staff of the cardiology, cardiac surgery, and cardiac anesthesia services.
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2022, Journal of Cardiothoracic and Vascular AnesthesiaParenteral amino acid supplementation with high-dose insulin prevents hypoaminoacidemia during cardiac surgery
2020, NutritionCitation Excerpt :Citrulline levels slightly decreased after surgery in both groups. As a precursor for arginine synthesis, decreased citrulline levels might have a delayed impact on arginine concentration after surgery, which may eventually decrease nitric oxide production and potentially increase the risk of postoperative pulmonary hypertension [39–41]. Glutamine is the most abundant AA in plasma and a conditionally essential AA, especially in a catabolic stress state.
Effects of glucocorticoids on serum amino acid levels during cardiac surgery in children
2018, Clinical Nutrition ESPENCitation Excerpt :In this state, protein turnover doubles; amino acids are redistributed in neonates [2]; and the production of urea cycle intermediates is lower in children [3]. In the postoperative period, arginine, citrulline, and nitric oxide (NO) metabolites are much less available [3]. As children with congenital heart disease (CHD) often have increased metabolic demands and decreased energy, they are at risk for a poor nutritional status [4].
Carbamoyl phosphate synthetase 1 deficiency in Italy: Clinical and genetic findings in a heterogeneous cohort
2012, GeneCitation Excerpt :Residue 1406 is located within the regulatory domain. A relationship between the p.Thr1406Asn polymorphism and serum concentration of arginine has been reported (Barr et al. 2003; Pearson et al., 2001). This polymorphism also significantly influences venous nitric oxide concentrations and both NOS-dependent and independent vasodilation.
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2011, Molecular Genetics and Metabolism
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Supported by USPHS grant NIH RO1 ES-09915.
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Reprint requests: Frederick E. Barr, MD, Division of Pediatric Critical Care, Department of Pediatrics, Vanderbilt University School of Medicine, 714 Medical Arts Bldg, Nashville, TN 37232-1565.