title: Granulocyte elastase release and pulmonary hemodynamics in patients with atrial septal defect.
abstract: BACKGROUND
  In patients with increased pulmonary artery pressure, the pulmonary vascular endothelium is morphologically and functionally abnormal and may be vulnerable to neutrophil-mediated injury induced by cardiopulmonary bypass (CPB). We investigated the relation between levels of granulocyte elastase (GEL), interleukin-6, or interleukin-8 after CPB and preoperative pulmonary hemodynamics or changes in pulmonary function after the operation.
  
  
  METHODS
  We measured plasma levels of GEL, interleukin-6, and interleukin-8 before and after CPB in patients who underwent closure of an atrial septal defect. Preoperative and postoperative respiratory index were evaluated. Preoperative pulmonary hemodynamics were determined within 1 month before the operation.
  
  
  RESULTS
  The level of GEL rose significantly after CPB from baseline (164.8 +/- 81.3 versus 819.4 +/- 320.3 microg/L; p < 0.01). Levels of interleukin-6 and interleukin-8 showed no significant changes after CPB. Peak level of GEL was significantly correlated with preoperative systolic pulmonary artery pressure (r = 0.76; p = 0.017), mean pulmonary artery pressure (r = 0.75; p = 0.021) and pulmonary-to-systemic arterial pressure ratio (r = 0.77; p = 0.016), but not with the hemodynamic variables for pulmonary blood flow or pulmonary resistance. Moreover, the value of (postoperative respiratory index - preoperative respiratory index)/preoperative respiratory index was positively correlated with the peak level of GEL (r = 0.72; p = 0.030).
  
  
  CONCLUSIONS
  The increase in GEL level after CPB is proportional to the increase in preoperative pulmonary artery pressure, which may cause the accordant pulmonary vascular damage.
authors.affiliation: First Department of Surgery, Yamaguchi University School of Medicine, Ube, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Gohra
authors.forename: Y
authors.initials: Y
authors.lastname: Fujimura
authors.forename: H
authors.initials: H
authors.lastname: Ito
authors.forename: K
authors.initials: K
authors.lastname: Hamano
authors.forename: T
authors.initials: T
authors.lastname: Katoh
authors.forename: N
authors.initials: N
authors.lastname: Zempo
authors.forename: K
authors.initials: K
authors.lastname: Esato
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D002315:Cardiopulmonary Bypass; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000503:physiopathology* / Q000601:surgery*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D019272:Leukocyte Elastase / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011652:Pulmonary Circulation / Q000502:physiology*
chemical_list: D015850:Interleukin-6; D016209:Interleukin-8; D019272:Leukocyte Elastase