HYPERAMYLASEMIA AFTER CARDIAC-SURGERY IN INFANTS AND CHILDREN

Objective: This study was conducted to clarify the incidence of hypera mylasemia after cardiac surgery in infants and children. Design and pa tients: 186 infants and children operated on at Children's Hospital, H elsinki, during an 11-month period were enrolled in the study. Serum s amples were taken before and on 3 consecutive days after cardiac surge ry at the intensive care unit and before discharge from the hospital. Measurements: We measured serum total amylase and serum pancreatic amy lase with two different assays: (1) reduction of salivary amylase from total amylase activity and (2) measurement of mass concentration with monoclonal antibodies. Results: Preoperative values for both total am ylase and pancreatic isoenzymes were strongly age-related. At least on e of the three tests showed postoperative hyperamylasemia (> +2 SD abo ve starting values of the age group and maximal value > 3 times the in dividual starting value) in 64/186 (34%) Patients. 22/186 (12%) patien ts had abnormal results in all assays. A more than tenfold rise in pan creatic amylase, suggesting pancreatitis, was found in 14 patients (8% ). Mortality was 21% in this subgroup, but 5% in the rest of the patie nts, Hyperamylasemia was more common after 1 year of age, and after op en-heart surgery, especially homograft implantation or cardiac transpl antation. Conclusions: Hyperamylasemia is a common finding after cardi ac surgery in pediatric patients. Amylase isoenzyme measurements are n eeded for clinical decision making. Age-group-related reference values are mandatory for the right interpretation of amylase values.