Abstract
Perioperative stress detection in children with congenital heart disease (CHD), particularly in the brain, is still limited. Among biomarkers, γ-amino-aminobutyric acid (GABA) assessment in biological fluids appears to be promising for its regulatory action on the cardiovascular and cerebral systems. We aimed to investigate cyanotic (C) or non-cyanotic (N) CHD children for GABA blood level changes in the perioperative period. We conducted an observational study in 68 CHD infants (C: n = 33; N: n = 35) who underwent perioperative clinical, standard laboratory and monitoring parameter recordings and GABA assessment. Blood samples were drawn at five predetermined time-points before, during and after surgery. No significant perioperative differences were observed between groups in clinical and laboratory parameters. In C, perioperative GABA levels were significantly lower than N. Arterial oxygen saturation and blood concentration significantly differed between C and N children and correlated at cardiopulmonary by-pass (CPB) time-point with GABA levels. The present data showing higher hypoxia/hyperoxia-mediated GABA concentrations in C children suggest that they are more prone to perioperative cardiovascular and brain stress/damage. The findings suggest the usefulness of further investigations to detect the “optimal” oxygen concentration target in order to avoid the side effects associated with re-oxygenation during CPB.
Highlights
Congenital heart disease (CHD) is one of the most common types of birth defects, accounting for about 0.8% of full-term infants
In the present study we aimed to investigate, in infants who were complicated by cyanotic congenital heart disease (CHD) (C) or non-cyanotic CHD (N), whether G-aminobutyric acid (GABA) blood levels in the perioperative period: (i) changed between C and N infants and (ii) correlated with standard perioperative parameters [3]
No significant differences were found in the two groups regarding gender, neurological examination and perioperative in-hospital mortality (p > 0.05, for all), whilst age and weight on admission to the study differed between groups (p < 0.05, for both)
Summary
Congenital heart disease (CHD) is one of the most common types of birth defects, accounting for about 0.8% of full-term infants. Bearing in mind that CHD can occur 10 times more frequently in stillborn and premature than in term infants, the incidence of CHD must be considered significantly higher [1]. The explanation resides in advances in open heart surgery, in anesthetic techniques and in cardiopulmonary by-pass (CPB) management that has substantially decreased the inhospital mortality rate [2,3]. This expands the horizon to address functional neurologic and cardiac outcomes in long-term survivors [1,2,3]. CPB still remains a risky interventional procedure, characterized by a period of planned and deliberate hypoxia–
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