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Endothelin-1 and asymmetric dimethylarginine in children with left-to-right shunt after intracardiac repair

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Abstract

Background

Endothelin-1 (ET-1) is an endogenous vasoconstrictive peptide hormone and asymmetric dimethylarginine (ADMA) acts as an endogenous inhibitor of nitric oxide synthase. We hypothesized that both could contribute to pulmonary hypertension in patients with left-to-right shunt after intracardiac repair.

Patients and methods

We prospectively analyzed ET-1 and ADMA plasma levels in 31 patients (m = 16; f = 15) at an age of 0.6 [0.2–27] years (median [range]) with left-to-right shunt (ASD II: n = 12; VSD: n = 11; AVSD: n = 8) presenting with a Qp/Qs of 2.7 [1.4–6.3] and a pulmonary arterial mean pressure (PAP) of 23 [13–57] mmHg. Blood specimens were taken prior to cardiopulmonary bypass (CPB), after weaning from CPB and at 3, 6, 12 and 24 h after CPB.

Results

12/31 patients were found to have pulmonary hypertension prior to intracardiac repair and 11/12 patients showed persistent pulmonary hypertension during the first 24 h after CPB. Patients with pulmonary hypertension at 12 h after CPB showed significant higher plasma ET-1 compared with patients with normal PAP (1.4 [0–7.9] versus 0.5 [0–2.5] pg/ml; P = 0.048 (Mann–Whitney)). Plasma ADMA decreased from 1.3 [0.75–2.3] µmol/l before CPB to 0.7 [0.4–2.1] µmol/l at 12 h (P < 0.05). However patients with pulmonary hypertension did not show different ADMA plasma levels.

Conclusions

Increased plasma ET-1 but not inhibition of nitric oxide synthase by ADMA is associated with pulmonary hypertension after intracardiac repair.

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Acknowledgements

This study was supported by a grant of the German Heart Foundation, Frankfurt/Main, Germany (grant no. F02/02).

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Authors and Affiliations

  1. Dept. of Cardiac Surgery, University Medical Center, University of Heidelberg, Im Neuenheimer Feld 153, 69120, Heidelberg, Germany

    Tsvetomir Loukanov MD, Christian Sebening MD & Matthias Kark MD

  2. Dept. of Pediatric Cardiology, University Medical Center, Freiburg, Germany

    Raoul Arnold MD

  3. Dept. of Pediatric Cardiology, University Medical Center, University of Heidelberg, Im Neuenheimer Feld 153, 69120, Heidelberg, Germany

    Jasmin Gross MD, Homa Klimpel, Joachim Eichhorn MD, Katharina Hoss, Herbert E. Ulmer MD & Matthias Gorenflo MD

Authors
  1. Tsvetomir Loukanov MD
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  2. Raoul Arnold MD
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  3. Jasmin Gross MD
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  4. Christian Sebening MD
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  5. Homa Klimpel
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  6. Joachim Eichhorn MD
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  7. Katharina Hoss
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  8. Herbert E. Ulmer MD
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  9. Matthias Kark MD
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  10. Matthias Gorenflo MD
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Corresponding author

Correspondence to Matthias Gorenflo MD.

Additional information

Tsvetomir Loukanov and Raoul Arnold equally contributed to this work and are both first authors of this manuscript.

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Loukanov, T., Arnold, R., Gross, J. et al. Endothelin-1 and asymmetric dimethylarginine in children with left-to-right shunt after intracardiac repair. Clin Res Cardiol 97, 383–388 (2008). https://doi.org/10.1007/s00392-008-0645-x

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  • DOI: https://doi.org/10.1007/s00392-008-0645-x

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