title: Perioperative endothelin levels in patients undergoing intracardiac repair for tetralogy of Fallot.
abstract: BACKGROUND
  Endothelin, a pro-inflammatory molecule, had been extensively studied in patients with cardiovascular illness. Impact on the perioperative outcome of patients with cyanotic congenital heart defects is still unknown. In the present study, we report perioperative changes in endothelin levels and their correlation with preoperative factors and clinical outcomes in a group of patients with tetralogy of Fallot (TOF) undergoing definitive repair.
  
  
  METHODS
  167 patients with TOF undergoing intracardiac repair under cardiopulmonary bypass were studied. Endothelin levels were taken at three different points of time and correlated with different clinical variables.
  
  
  RESULTS
  The baseline endothelin level correlated with patients' nutritional status and degree of cyanosis. The magnitude of inflammatory response in the post-cardiopulmonary bypass (post-CPB) period as measured by endothelin level was much higher and correlated more consistently with adverse clinical outcomes in the younger age group. On multivariable analysis, age at operation, preoperative degree of hypoxemia, and endothelin levels were found to be independent predictors of clinical outcomes.
  
  
  CONCLUSIONS
  A rise in serum endothelin levels in patients with TOF undergoing definitive repair on CPB, with preoperative severity of cyanosis, nutritional status, and adverse clinical outcomes. The endothelin levels may be monitored to identify patients with cyanosis at an increased risk of exhibiting augmented inflammatory response to CPB.
authors.affiliation: Department of Cardiac Anesthesiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Poonam Malhotra
authors.initials: PM
authors.lastname: Kapoor
authors.forename: Arun
authors.initials: A
authors.lastname: Subramanian
authors.forename: Vishwas
authors.initials: V
authors.lastname: Malik
authors.forename: Velayoudam
authors.initials: V
authors.lastname: Devagorou
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003490:Cyanosis / Q000175:diagnosis / Q000209:etiology; D016232:Endothelins / Q000097:blood*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000175:diagnosis / Q000209:etiology; D008297:Male; D016343:Monitoring, Intraoperative; D008991:Monitoring, Physiologic; D015999:Multivariate Analysis; D009752:Nutritional Status; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D013771:Tetralogy of Fallot / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D016232:Endothelins