Continuous perfusion of pulmonary arteries during total cardiopulmonary bypass favorably affects levels of circulating adhesion molecules and lung function

Objectives: Lung injury is a serious complication of cardiopulmonary bypass in infants with congenital heart disease and pulmonary hypertension. Cessa tion of blood flow in the pulmonary arteries during cardiopulmonary bypass is known to provoke lung dysfunction. We assessed the effect of continuous pulmonary perfusion on circulating adhesion molecules and on lung function. Methods: Fourteen infants with congenital heart disease and pulmonary hyper tension were enrolled in the study. During total cardiopulmonary bypass, 8 patients underwent continuous perfusion of the pulmonary arteries (perfusio n group), and the remaining 6 patients did not (control group). Plasma leve ls of circulating intercellular adhesion molecule 1, soluble granule membra ne protein 140, and sialyl Lewis(x) and PaO2/fraction of inspired oxygen ra tios were measured before commencement and serially for 24 hours after term ination of bypass, Results: Plasma levels of circulating intercellular adhesion molecule I dec reased significantly at the termination of bypass in both groups but return ed to prebypass levels immediately in the control group, whereas in the per fusion group the values remained significantly less than those before bypas s. Plasma levels of soluble granule membrane protein 140 in the control gro up were significantly higher at 6 and 12 hours after bypass than levels bef ore bypass, whereas in the perfusion group the values remained at the preby pass level throughout the postbypass period. Trends of plasma levels of sia lyl Lewis(x) were alike in both groups. Pao(2)/fraction of inspired oxygen ratios in the control group decreased significantly from 6 hours after bypa ss, whereas values in the perfusion group remained at the prebypass value t hroughout the postbypass period. Conclusions: This study suggests that in infants having congenital heart di sease and pulmonary hypertension, continuous pulmonary perfusion during tot al cardiopulmonary bypass minimizes ischemic insult and neutrophil-endothel ial interaction mediated by adhesion molecules in the pulmonary microvessel s.