title: Plasma vascular endothelial growth factor level is a predictor of the severity of postoperative capillary leak syndrome in neonates undergoing cardiopulmonary bypass.
abstract: Capillary leak syndrome (CLS), characterized by extravascular fluid accumulation and significant organ dysfunction, is a serious complication in children undergoing cardiopulmonary bypass (CPB). We examined the relationship between plasma vascular endothelial growth factor (VEGF) levels and severity of CLS. The kinetics of VEGF in the plasma of 11 neonates and 7 older children undergoing CPB were investigated, correlating plasma VEGF levels and CLS clinical presentation. The degree of postoperative CLS was quantified by measuring parameters of extracellular volume and end-organ dysfunction. A chest-wall soft-tissue-width index (CSTWI) was designed in order to standardize the extracellular fluid accumulation. Most CLS parameters were significantly more prominent in the neonatal patients. Low plasma VEFG levels (>35 pg/ml) were found in 3 neonatal control patients and all but, sample from the older group patient. The neonates had significantly higher preoperative VEGF plasma levels (684.4 +/- 559.1 pg/ml, P = 0.02), which decreased during the operation to levels below 35 pg/ml and increased again 24 h postoperatively to levels significantly higher than in the older patients (484 +/- 270.3 pg/ml, P = 0.001). Multilinear regression analysis found preoperative VEGF levels to independently correlate with CLS as represented by CSTWI (P < 0.01, r = 0.726). Both the occurrence of post-CPB CLS and plasma VEGF levels pre- and postoperatively were thus higher in neonates than in children. Plasma VEGF level is a predictor of the severity of postoperative CLS.
authors.affiliation: Department of Cardiothoracic Surgery, Rabin Medical Center, Tel-Aviv University, Petah-Tikva, Israel.
authors.forename: D
authors.initials: D
authors.lastname: Abrahamov
authors.forename: E
authors.initials: E
authors.lastname: Erez
authors.forename: M
authors.initials: M
authors.lastname: Tamariz
authors.forename: O
authors.initials: O
authors.lastname: Dagan
authors.forename: E
authors.initials: E
authors.lastname: Pearl
authors.forename: Y
authors.initials: Y
authors.lastname: Abrahamov
authors.forename: B
authors.initials: B
authors.lastname: Gendel
authors.forename: N
authors.initials: N
authors.lastname: Desai
authors.forename: J
authors.initials: J
authors.lastname: Kats
authors.forename: B
authors.initials: B
authors.lastname: Vidne
authors.forename: V
authors.initials: V
authors.lastname: Barak
mesh_terms: D019559:Capillary Leak Syndrome / Q000097:blood* / Q000209:etiology; D002315:Cardiopulmonary Bypass; D016022:Case-Control Studies; D016228:Endothelial Growth Factors / Q000097:blood*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016014:Linear Models; D008222:Lymphokines / Q000097:blood*; D008297:Male; D011182:Postoperative Care; D011237:Predictive Value of Tests; D042461:Vascular Endothelial Growth Factor A; D042442:Vascular Endothelial Growth Factors
chemical_list: D016228:Endothelial Growth Factors; D008222:Lymphokines; D042461:Vascular Endothelial Growth Factor A; D042442:Vascular Endothelial Growth Factors