title: Congenital cardiac lesions involving systolic flow abnormalities are associated with platelet dysfunction in children.
abstract: BACKGROUND
  Shear stress-induced platelet dysfunction (PD) is prevalent among adults with aortic stenosis. Our aim was to determine whether abnormal platelet function was associated with specific congenital cardiac lesions in children.
  
  
  METHODS
  The charts of 407 children who had undergone cardiopulmonary bypass and had preoperative platelet function analysis were evaluated. Patients were assigned to 1 of 11 different lesion categories. Platelet dysfunction (PD) was defined as prolonged closure time (CT) as measured with a platelet function analyzer. Odds ratio (OR) estimates for prolonged CT were calculated for each lesion category. Mean CTs were compared with Tukey-Kramer separated means testing. Analysis of variance modeling was used to determine association between hematocrit value and CT.
  
  
  RESULTS
  CT in patients with ventricular septal defects (VSD) and right ventricular outflow tract obstruction (RVOTO) lesions was prolonged. OR analysis found that patients with VSDs (OR, 2.46) or RVOTO (OR, 2.88) had at least a 95% probability of an abnormal CT. In contrast, patients with atrial septal defect (ASD), bidirectional Glenn procedure (BDG), and pulmonary insufficiency (PI) had a reduced probability of a prolonged CT (p < 0.05). A similar pattern was seen in parametric analysis comparing mean CTs across lesion categories. A lower preoperative hematocrit value was associated with prolonged CTs across all lesion types (p < 0.05).
  
  
  CONCLUSIONS
  PD was common in children with congenital cardiac lesions involving systolic flow abnormalities and was uncommon among children with lesions having diastolic abnormalities. Lower preoperative hematocrit values were associated with prolonged CTs, suggesting subclinical bleeding secondary to excessive platelet shearing.
authors.affiliation: Department of Pediatrics, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon.
authors.forename: David K
authors.initials: DK
authors.lastname: Bailly
authors.affiliation: Department of Pediatrics, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon; Department of Pathology, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon.
authors.forename: Lynn K
authors.initials: LK
authors.lastname: Boshkov
authors.affiliation: Department of Surgery, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon.
authors.forename: M Mujeeb
authors.initials: MM
authors.lastname: Zubair
authors.affiliation: Department of Surgery, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon.
authors.forename: Vanessa J C
authors.initials: VJ
authors.lastname: Rogers
authors.affiliation: Department of Surgery, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon.
authors.forename: Gurion
authors.initials: G
authors.lastname: Lantz
authors.affiliation: Department of Pediatrics, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon.
authors.forename: Laurie
authors.initials: L
authors.lastname: Armsby
authors.affiliation: Department of Obstetrics, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon.
authors.forename: A Roger
authors.initials: AR
authors.lastname: Hohimer
authors.affiliation: Department of Pediatrics, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon.
authors.forename: Julie
authors.initials: J
authors.lastname: Martchenke
authors.affiliation: Department of Pathology, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon.
authors.forename: Paul
authors.initials: P
authors.lastname: Sochacki
authors.affiliation: Department of Pediatrics, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon; Department of Surgery, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon. Electronic address: langleys@ohsu.edu.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Langley
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001791:Blood Platelet Disorders / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000097:blood* / Q000503:physiopathology; D006400:Hematocrit; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D013599:Systole / Q000502:physiology*