The role of plasma endothelin in the Fontan circulation.
BACKGROUND
Various vasoactive substances are released during cardiopulmonary bypass. They may deteriorate pulmonary circulation after the Fontan operation. Effects of plasma endothelin-1 (ET-1), a vasoconstricting peptide, on the Fontan circulation have not been investigated.


METHODS
Eleven patients (aged 11.1+/-7.5 years) who underwent the modified Fontan operation (group F) and seven patients (aged 9.9+/-6.0 years) who underwent the biventricular repair (group C) were studied. Plasma samples were obtained for measuring ET-1 on the first postoperative day (Early I), on returning to floor care from the intensive care unit (Early II), and during postoperative cardiac catheterization (Late).


RESULTS
Plasma concentrations of ET-1 increased in group F (Early I, 4.37+/-1.78 pg/ml; Early II, 4.07+/-1.90 pg/ml) as compared with the basal value of 1.0+/-0.5 pg/ml. The central venous pressure, which reflects the pulmonary circulatory state, soon after the Fontan operation correlated significantly with the increased ET-1 concentration (y=1.809 x+6.484; r=0.809; p=0.0026). Although the Late ET-1 concentrations in group F were significantly decreased, the central venous pressure and the ET-1 concentrations demonstrated a significant correlation (y=3.074 x +5.427; r=0.740; p=0.0227).


CONCLUSIONS
The increased humoral vasoactive substances such as ET-1, which induces pulmonary vasoconstriction following the Fontan operation, may have important implications for the Fontan circulation.
Yamagishi
M
M
Department of Pediatric Cardiovascular Surgery, Children's Research Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan. myama@koto.kpu-m.ac.jp
Kurosawa
H
H
Hashimoto
K
K
Nomura
K
K
Kitamura
N
N
D000293:Adolescent; D015415:Biomarkers / Q000032:analysis; D002315:Cardiopulmonary Bypass / Q000379:methods*; D016022:Case-Control Studies; D002496:Central Venous Pressure / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D019332:Endothelin-1 / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D018729:Fontan Procedure / Q000379:methods*; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000601:surgery*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D011184:Postoperative Period; D011379:Prognosis; D011652:Pulmonary Circulation / Q000502:physiology*; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome
D015415:Biomarkers; D019332:Endothelin-1