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A transthoracic Doppler echocardiography study of C-reactive protein and coronary microcirculation in children after open heart surgery.

Aburawi, Elhadi LU ; Liuba, Petru LU ; Berg, Ansgar LU and Pesonen, Erkki LU (2007) In Cardiology in the Young 17(5). p.472-477
Abstract
Background Systemic inflammation has been suggested to underlie in part the elevated risk of arrhythmias and myocardial dysfunction during the first weeks after cardiac surgery. Recent transthoracic Doppler studies from our centre indicated increased basal coronary arterial flow in children 5 days after cardiopulmonary bypass surgery. In these children, we investigated whether the inflammatory mediator, C-reactive protein, could influence this association.



Methods The peak flow velocity, velocity time-integral in diastole and systole, and basal blood flow in the proximal part of the left anterior descending artery, were assessed by transthoracic Doppler echocardiography 1 day before, and 5 days after, cardiac surgery in... (More)
Background Systemic inflammation has been suggested to underlie in part the elevated risk of arrhythmias and myocardial dysfunction during the first weeks after cardiac surgery. Recent transthoracic Doppler studies from our centre indicated increased basal coronary arterial flow in children 5 days after cardiopulmonary bypass surgery. In these children, we investigated whether the inflammatory mediator, C-reactive protein, could influence this association.



Methods The peak flow velocity, velocity time-integral in diastole and systole, and basal blood flow in the proximal part of the left anterior descending artery, were assessed by transthoracic Doppler echocardiography 1 day before, and 5 days after, cardiac surgery in 17 children with ventricular and atrioventricular septal defects whose mean age at surgery was 6 months. Levels of C-reactive protein in the plasma were measured at both time-points.



Results Prior to surgery, all children had levels of C-reactive protein under the limit for detection, that is less than 0.8 milligrams per litre. The levels of the protein had increased significantly by the second day, when the median value was 25, and the range from 20 to 142 milligrams per litre. They remained elevated on the fifth day after surgery, when the median was 11, and the range from 3 to 20 milligrams per litre. On the fifth day, the percentage increase in velocity time integral corrected for left ventricular mass was significantly lower in those patients with C-reactive protein greater than or equal to 10 milligrams per litre than in the remaining patients. Also, both the velocity time integral and the velocity of diastolic peak flow correlated inversely with log C-reactive protein, r being equal to −0.54 and p less than 0.02 and r equal to −0.74 and p less than 0.01, respectively, particularly among those patients in whom clamping of the aorta lasted for more than 1 hour, r for this statistic being equal to −0.8.



Conclusion The postsurgical increase in the velocity of coronary arterial flow in children is inversely associated with rising levels of C-reactive protein. The duration of the aortic cross-clamping during surgery strengthens the association between levels of C-reactive protein and the microcirculatory changes. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Inflammation, coronary arteries, paediatric cardiology, congenital heart disease
in
Cardiology in the Young
volume
17
issue
5
pages
472 - 477
publisher
Cambridge University Press
external identifiers
  • wos:000250707900004
  • scopus:35948947270
ISSN
1467-1107
DOI
10.1017/S1047951107000972
language
English
LU publication?
yes
id
05e8d185-1c10-41a4-b5e7-4f35a869c787 (old id 540736)
date added to LUP
2007-10-10 20:56:18
date last changed
2017-01-01 05:09:03
@article{05e8d185-1c10-41a4-b5e7-4f35a869c787,
  abstract     = {Background Systemic inflammation has been suggested to underlie in part the elevated risk of arrhythmias and myocardial dysfunction during the first weeks after cardiac surgery. Recent transthoracic Doppler studies from our centre indicated increased basal coronary arterial flow in children 5 days after cardiopulmonary bypass surgery. In these children, we investigated whether the inflammatory mediator, C-reactive protein, could influence this association.<br/><br>
<br/><br>
Methods The peak flow velocity, velocity time-integral in diastole and systole, and basal blood flow in the proximal part of the left anterior descending artery, were assessed by transthoracic Doppler echocardiography 1 day before, and 5 days after, cardiac surgery in 17 children with ventricular and atrioventricular septal defects whose mean age at surgery was 6 months. Levels of C-reactive protein in the plasma were measured at both time-points.<br/><br>
<br/><br>
Results Prior to surgery, all children had levels of C-reactive protein under the limit for detection, that is less than 0.8 milligrams per litre. The levels of the protein had increased significantly by the second day, when the median value was 25, and the range from 20 to 142 milligrams per litre. They remained elevated on the fifth day after surgery, when the median was 11, and the range from 3 to 20 milligrams per litre. On the fifth day, the percentage increase in velocity time integral corrected for left ventricular mass was significantly lower in those patients with C-reactive protein greater than or equal to 10 milligrams per litre than in the remaining patients. Also, both the velocity time integral and the velocity of diastolic peak flow correlated inversely with log C-reactive protein, r being equal to −0.54 and p less than 0.02 and r equal to −0.74 and p less than 0.01, respectively, particularly among those patients in whom clamping of the aorta lasted for more than 1 hour, r for this statistic being equal to −0.8.<br/><br>
<br/><br>
Conclusion The postsurgical increase in the velocity of coronary arterial flow in children is inversely associated with rising levels of C-reactive protein. The duration of the aortic cross-clamping during surgery strengthens the association between levels of C-reactive protein and the microcirculatory changes.},
  author       = {Aburawi, Elhadi and Liuba, Petru and Berg, Ansgar and Pesonen, Erkki},
  issn         = {1467-1107},
  keyword      = {Inflammation,coronary arteries,paediatric cardiology,congenital heart disease},
  language     = {eng},
  number       = {5},
  pages        = {472--477},
  publisher    = {Cambridge University Press},
  series       = {Cardiology in the Young},
  title        = {A transthoracic Doppler echocardiography study of C-reactive protein and coronary microcirculation in children after open heart surgery.},
  url          = {http://dx.doi.org/10.1017/S1047951107000972},
  volume       = {17},
  year         = {2007},
}