Immune dysfunction in children after corrective surgery for congenital heart disease.
OBJECTIVE
To study the effect of open- and closed-heart surgery on the immune status of infants and children.


METHODS
Prospective study. Data collected before anesthesia and surgery and 2 and 24 hrs after surgery.


METHODS
Operating room and pediatric ICU in a children's hospital.


METHODS
Children undergoing surgery for correction of congenital heart disease (age 3 months to 12 yrs). A total of 31 patients were studied (open-heart surgery, n = 25; closed-heart surgery, n = 6).


RESULTS
Increased neutrophil counts and lymphopenia were observed after both open- and closed-heart surgery. Serum levels of the complement components C3 and C4 were depressed after open-heart surgery, but not after closed procedures. The percentage of T3+ and T4+ lymphocytes, proliferative responses of the lymphocytes and serum immunoglobulin (Ig)G and IgM were decreased from preoperative levels after open-heart surgery. The percentage of T8+ lymphocytes and serum IgA levels did not change. Intraoperative variables and postoperative severity of illness (Pediatric Risk of Mortality score) did not correlate with immune suppression.


CONCLUSIONS
The immune system is affected after pediatric cardiac surgery, particularly after open-heart surgery.
Hauser
G J
GJ
Department of Critical Care Medicine, Georgetown University Children's Medical Center, Washington, DC 20007.
Chan
M M
MM
Casey
W F
WF
Midgley
F M
FM
Holbrook
P R
PR
D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007070:Immunoglobulin A / Q000032:analysis; D007074:Immunoglobulin G / Q000032:analysis; D007075:Immunoglobulin M / Q000032:analysis; D007223:Infant; D007958:Leukocyte Count; D008213:Lymphocyte Activation / Q000276:immunology; D008231:Lymphopenia / Q000097:blood / Q000209:etiology / Q000276:immunology*; D009504:Neutrophils / Q000737:chemistry; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology / Q000276:immunology*; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D016176:T-Lymphocyte Subsets / Q000737:chemistry
D007070:Immunoglobulin A; D007074:Immunoglobulin G; D007075:Immunoglobulin M