Thrombomodulin and angiotensin-converting enzyme activity during pediatric open heart operations.
BACKGROUND
Thrombomodulin and angiotensin-converting enzyme are endothelial glycoproteins. The metabolism of these substances is altered when endothelial cells are damaged.


METHODS
Serum thrombomodulin level was assayed in 56 children and angiotensin-converting enzyme activity determined in 27 children with congenital heart disease before, during, and after open heart operations.


RESULTS
The thrombomodulin level was significantly higher in children with a high pulmonary blood flow who had pulmonary hypertension than in those with a normal pressure (p < 0.01), and although all patients showed an increase in serum thrombomodulin after coming off cardiopulmonary bypass, the increase was greater in those with preoperative pulmonary hypertension (p < 0.05). Serum angiotensin-converting enzyme activity was normal preoperatively in all children, irrespective of pulmonary arterial pressure, and decreased in all after coming off cardiopulmonary bypass but decreased to a significantly greater extent in those who had pulmonary hypertension preoperatively (p < 0.05).


CONCLUSIONS
These findings are compatible with the presence of pulmonary endothelial cell injury and dysfunction before intracardiac repair, which is exacerbated by cardiopulmonary bypass.
Komai
H
H
Vascular Biology and Pharmacology Unit, Institute of Child Health, London, England.
Haworth
S G
SG
D000293:Adolescent; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000097:blood*; D001794:Blood Pressure; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D004730:Endothelium, Vascular / Q000378:metabolism; D005260:Female; D006023:Glycoproteins / Q000032:analysis; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000097:blood; D007223:Infant; D007430:Intraoperative Care; D008297:Male; D011651:Pulmonary Artery; D011652:Pulmonary Circulation; D018180:Thrombomodulin / Q000032:analysis*
D000806:Angiotensin-Converting Enzyme Inhibitors; D006023:Glycoproteins; D018180:Thrombomodulin