GRANULOCYTE ELASTASE RELEASE AND PULMONARY HEMODYNAMICS IN PATIENTS WITH ATRIAL SEPTAL-DEFECT

Background. In patients with increased pulmonary artery pressure, the pulmonary vascular endothelium is morphologically and functionally abn ormal and may be vulnerable to neutrophil-mediated injury induced by c ardiopulmonary bypass (CPB). We investigated the relation between leve ls of granulocyte elastase (GEL), interleukin-6, or interleukin-8 afte r CPB and preoperative pulmonary hemodynamics or changes in pulmonary function after the operation. Methods. We measured plasma levels of GE L, interleukin-6, and interleukin-8 before and after CPB in patients w ho underwent closure of an atrial septal defect. Preoperative and post operative respiratory index were evaluated. Preoperative pulmonary hem odynamics were determined within 1 month before the operation.Results. The level of GEL rose significantly after CPB from baseline (164.8 +/ - 81.3 versus 819.4 +/- 320.3 mu g/L; p < 0.01). Levels of interleukin -6 and interleukin-8 showed no significant changes after CPB. Peak lev el of GEL was significantly correlated with preoperative systolic pulm onary artery pressure (r = 0.76; p = 0.017), mean pulmonary artery pre ssure (r = 0.75; p = 0.021) and pulmonary-to-systemic arterial pressur e ratio (r = 0.77; p = 0.016), but not with the hemodynamic variables for pulmonary blood flow or pulmonary resistance. Moreover, the value of (postoperative respiratory index - preoperative respiratory index)/ preoperative respiratory index was positively correlated with the peak level of GEL (r = 0.72; p = 0.030). Conclusions. The increase in GEL level after CPB is proportional to the increase in preoperative pulmon ary artery pressure, which may cause the accordant pulmonary vascular damage. (C) 1998 by The Society of Thoracic Surgeons.