Angiotensin-converting enzyme inhibition alters the inflammatory and fibrinolytic response to cardiopulmonary bypass in children*

• DOI: 10.1097/pcc.0b013e3181fe3925
• Publication Date: 2010-10-23T05:47:55Z
• Authors: Gregory A. Fleming; Frederic T. Billings; Tom M. Klein; David P. Bichell; Karla G. Christian; Mias Pretorius
• Keywords: Heart Defects, Congenital; Inflammation; Male; Cardiopulmonary Bypass; Fibrinolysis; Infant; Angiotensin-Converting Enzyme Inhibitors; Hospitals, Pediatric; 3. Good health; 03 medical and health sciences; Postoperative Complications; 0302 clinical medicine; Child, Preschool; Humans; Female; Prospective Studies

Objective: Many children with a congenital heart defect undergo surgical correction requiring cardiopulmonary bypass. One-sixth of these patients take an angiotensin-converting enzyme inhibitor for failure treatment. The effect inhibition on the fibrinolytic and inflammatory response in undergoing bypass is unknown. In adults, attenuates increase plasminogen activator inhibitor-1 after bypass, whereas interleukin-6 uncertain. This study tests hypothesis that preoperative postoperative expression children. Design: Single-center prospective, randomized, nonblinded study. Setting: University-affiliated pediatric hospital. Patients: Children elective taking inhibitor. Interventions: were randomized to continue until morning surgery (angiotensin-converting group, n = 11) or discontinue therapy 72 hrs before (no 9). Measurement Main Results: Blood samples collected at baseline 30 mins arrival intensive care unit, day 1. Baseline bradykinin concentrations significantly higher activity lower group compared no (p .04 .001, respectively). Plasminogen antigen increased 15-fold peaked 1 (from 4.6 ± 1.2 67.7 9.5 ng/mL; p < .001). Postoperative correlated time (r2 0.40, .03) was .03). proinflammatory markers interleukin-8 as well anti-inflammatory marker interleukin-10 (all Interleukin-6 .02) even controlling potential confounding factors such age, time, transfusion volume. Conclusion: Angiotensin-converting but enhances