title: Superior cavopulmonary anastomosis suppresses the activity and expression of pulmonary angiotensin-converting enzyme.
abstract: BACKGROUND
  Superior cavopulmonary anastomosis is widely used for palliation of various forms of univentricular heart defects. However, clinically significant pulmonary arteriovenous malformations develop in 15% to 25% of patients after surgery.
  
  
  OBJECTIVE
  To assess altered regulation of pulmonary vascular tone caused by superior cavopulmonary anastomosis in an ovine model.
  
  
  METHODS
  Lambs, aged 35 to 45 days, underwent an end-to-end anastomosis of the superior vena cava to the right pulmonary artery. In age-matched controls, a sham operation was performed. Arteriovenous malformations were detectable by contrast echocardiography by 8 weeks after surgery. Animals (n = 24) were studied at various time points after the operations. Expression of angiotensin-converting enzyme messenger RNA, protein levels, and enzyme activity were measured in lung homogenates. Levels of angiotensin II were measured by enzyme-linked immunosorbent assay.
  
  
  RESULTS
  Expression of angiotensin-converting enzyme messenger RNA and protein was significantly reduced at 1 to 5 weeks after superior cavopulmonary anastomosis. Angiotensin-converting enzyme activity in the right lung of animals subjected to superior cavopulmonary anastomosis was reduced 86% +/- 1% (standard deviation) compared with control values at 1 week (P =.003) and 77% +/- 8.5% at 2 weeks (P <.001) after surgery. This correlated with a 59% +/- 3.5% (P =.007) reduction in angiotensin II levels up to 5 weeks after cavopulmonary anastomosis. By 15 weeks after the operations, angiotensin II levels were equivalent to control levels (P =.19).
  
  
  CONCLUSIONS
  Superior cavopulmonary anastomosis causes an early reversible reduction in activity and expression of angiotensin-converting enzyme, resulting in decreased circulating levels of the vasoconstrictor angiotensin II. These results suggest that the ability of the pulmonary endothelium to regulate vascular tone is inhibited after superior cavopulmonary anastomosis. Dilation of the affected vasculature induced by cavopulmonary anastomosis may contribute to the disordered vascular remodeling observed in this setting.
authors.affiliation: Division of Cardiothoracic Surgery, University of California, San Francisco, Calif 94143-0118, USA.
authors.forename: S P
authors.initials: SP
authors.lastname: Malhotra
authors.forename: R K
authors.initials: RK
authors.lastname: Riemer
authors.forename: S
authors.initials: S
authors.lastname: Thelitz
authors.forename: Y P
authors.initials: YP
authors.lastname: He
authors.forename: F L
authors.initials: FL
authors.lastname: Hanley
authors.forename: V M
authors.initials: VM
authors.lastname: Reddy
mesh_terms: D000804:Angiotensin II / Q000097:blood; D000818:Animals; D001165:Arteriovenous Malformations / Q000097:blood / Q000175:diagnosis / Q000201:enzymology* / Q000209:etiology*; D001706:Biopsy; D015153:Blotting, Western; D004195:Disease Models, Animal; D004452:Echocardiography; D004730:Endothelium, Vascular / Q000201:enzymology*; D004797:Enzyme-Linked Immunosorbent Assay; D005786:Gene Expression Regulation / Q000502:physiology*; D018610:Heart Bypass, Right / Q000009:adverse effects*; D007703:Peptidyl-Dipeptidase A / Q000032:analysis* / Q000502:physiology*; D011651:Pulmonary Artery / Q000002:abnormalities* / Q000166:cytology*; D012333:RNA, Messenger / Q000032:analysis; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012756:Sheep; D013997:Time Factors
chemical_list: D012333:RNA, Messenger; D000804:Angiotensin II; D007703:Peptidyl-Dipeptidase A