Hypothermic Perfadex solution reduces lung injury of the infant with TOF after cardiopulmonary bypass

Abstract

Objective To study the protective effects of pulmonary artery perfusion with hypothermic Perfadex solution on the lung functions of infants with Tetralogy of Fallot (TOF) after cardiopulmonary bypass (CPB).Methods A prospective study of 24 children with TOF was carried out.They were randomly divided into perfusion group (n =12) and control group (n =12).Routine operative techniques were performed in all patients,and pulmonary artery infusion of Perfadex solution was performed additionally in the perfusion group patients after CPB.Plasma interleukin-6 (IL- 6),IL-8,IL-10,Malondialdehyde (MDA) and the oxygen index(OI) were measured.Lung static compliance (Cstat) was calculated at different time points (before surgery,at the end of CPB,and 0 h,6h,24h postoperatively).Results When compared with the baseline values,,the plasma levels of IL-6,IL-8,IL- 10,MDA increased postoperatively in both groups [perfusion group IL-6 (367.1 ± 32.6) pg/ml,IL-8 (376.6 ± 40.4) pg/ml,IL-10 (265.4 ± 42.1 ) pg/ml,control group IL-6 (392.7 ± 41.5 ) pg/ml,IL-8 (477.2±39.7) pg/ml,IL-10 (197.8±42.6 )pg/ml at the end of CPB] The peak levels were seen at the end of surgery [perfusion group IL-6 (369.6 ± 37.8) pg/rnl IL-8 (536.7 ± 31.7) pg/ml,IL-10(511.5 ± 44.0) pg/ml; control group IL-6 (480.3 ± 46.3) pg/ml,IL-8 (585.5 ± 47.8 ) pg/ml,IL- 10 (390.8 ± 34.3)pg/ml] and maintained at a high level upto 24 h postoperatively.Compared with the control group,the IL- 6,IL-8,MDA levels were significantly lower in the perfusion group [IL-6 (266.5± 31.1 )pg/ml,IL-8 (373 ± 32.4) pg/ml,MDA ( 12.2 ± 4.6 )nmol/ml; vs.control group IL-6 (311.8± 42.2) pg/ml,IL-8 (477.6 ± 47.7)pg/ml,MDA (19.2 ± 5.5) nmol/ml,6 h postoperatively,P＜0.01or P＜0.05] and the IL-10 was higher (P＜0.01 or P＜0.05) in the protective group.The OI and Cstat were also higher in the lung perfusion group than in the control group [perfusion group OI (359.1 ±39.8) mmHg,Cstat (3.11 ± 0.88) ml/cmH2 O; control group OI (289.5 ± 42.8) mmHg,Cstat (2.71 ± 0.56 ) ml/cmH2 O,6 h postoperatively,P＜0.05].Conclusions Perfusion with hypothermic Perfadex solution could protect lung function during cardiopulmonary bypass. Key words: Tetralogy of fallot; Infant; Extracorporeal circulation; Perfadex solution, Lung injury