title: Gut permeability in paediatric cardiac surgery.
abstract: BACKGROUND
  Intestinal mucosal ischaemia can occur in infants and children during and after cardiac surgery. Severe decreases in mucosal perfusion may cause complications such as necrotizing enterocolitis and postoperative mortality. We investigated gut permeability in paediatric patients undergoing cardiac surgery using the dual sugar permeability test and absorption of two other saccharides.
  
  
  METHODS
  Thirty-four patients undergoing palliative or corrective surgical procedures with and without cardiopulmonary bypass were investigated. Intestinal permeability was measured using 3-O-methyl-D-glucose, D-xylose, L-rhamnose and lactulose, given orally after induction of anaesthesia and 12 and 24 h later.
  
  
  RESULTS
  Lactulose/rhamnose ratios were raised from the outset [median 0.39 (confidence interval 0.07-1.8 for patients undergoing operations without cardiopulmonary bypass and 0.30 (0.02-2.6) with cardiopulmonary bypass]. The highest lactulose/rhamnose ratios were recorded 12 h after surgery 0.32 (0.07-6.9), when cardiopulmonary bypass was used. This is approximately seven times the value expected in healthy children. There was an improvement in patients not undergoing cardiopulmonary bypass: 0.22 (0.03-0.85) 12 h and 0.11 (0-0.48) 24 h after induction of anaesthesia. Patients undergoing repair of aortic coarctation showed the fastest recovery: 0.09 (0.03-0.31) 12 h and 0.07 (0.04-0.35) 24 h after induction of anaesthesia.
  
  
  CONCLUSIONS
  Patients with congenital heart defects have abnormal gut permeability when compared with healthy children of similar age. Cardiopulmonary bypass seems to affect the intestinal barrier morphologically (lactulose and rhamnose absorption) and functionally (3-O-methyl-D-glucose and D-xylose absorption).
authors.affiliation: Department of Anaesthesia, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands. jmalagon@lumc.nl
authors.forename: I
authors.initials: I
authors.lastname: Malagon
authors.forename: W
authors.initials: W
authors.lastname: Onkenhout
authors.forename: G
authors.initials: G
authors.lastname: Klok
authors.forename: P F H
authors.initials: PF
authors.lastname: van der Poel
authors.forename: J G
authors.initials: JG
authors.lastname: Bovill
authors.forename: M G
authors.initials: MG
authors.lastname: Hazekamp
mesh_terms: D002315:Cardiopulmonary Bypass; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007408:Intestinal Absorption; D007413:Intestinal Mucosa / Q000378:metabolism; D007432:Intraoperative Period; D007792:Lactulose / Q000652:urine; D008297:Male; D010539:Permeability; D011184:Postoperative Period; D011446:Prospective Studies; D012210:Rhamnose / Q000652:urine
chemical_list: D007792:Lactulose; D012210:Rhamnose