Respiratory viruses and postoperative hemodynamics in patients with unrestrictive congenital cardiac communications: a prospective cohort study

European Journal of Medical Research

Research

Marlene Rabinovitch¹  Maria Francilene S. Souza²  Kelly C. O. Abud²  Eloisa S. Carvalho²  Paula V. Gaiolla²  Antonio Augusto Lopes²  Claudia R. P. Castro²  Juliana Pereira³  Nair Y. Maeda⁴  Lucy S. Vilas Boas⁵  Clarisse M. Machado⁵ 

[1] Division of Pediatric Cardiology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA;Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil;Laboratory of Medical Investigation on Pathogenesis and Targeted Therapy in Onco-Immuno-Hematology (LIM-31), University of São Paulo, São Paulo, Brazil;Pró-Sangue Foundation, São Paulo, Brazil;Virology Laboratory, Institute of Tropical Medicine, University of São Paulo School of Medicine, São Paulo, Brazil;

关键词: Congenital heart disease;    Respiratory viruses;    Pulmonary hypertension;    Pediatric cardiac surgery;    Postoperative inflammatory response;    Pediatric intensive care;   

DOI  :  10.1186/s40001-023-01003-y

 received in 2023-01-05, accepted in 2023-01-08,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundPulmonary vascular abnormalities pose a risk for severe life-threatening hemodynamic disturbances following surgical repair of congenital cardiac communications (CCCs). In the distal lung, small airways and vessels share a common microenvironment, where biological crosstalks take place. Because respiratory cells infected by viruses express a number of molecules with potential impact on airway and vascular remodeling, we decided to test the hypothesis that CCC patients carrying viral genomes in the airways might be at a higher risk for pulmonary (and systemic) hemodynamic disturbances postoperatively.MethodsSixty patients were prospectively enrolled (age 11 [7–16] months, median with interquartile range). Preoperative pulmonary/systemic mean arterial pressure ratio (PAP/SAP) was 0.78 (0.63–0.88). The presence or absence of genetic material for respiratory viruses in nasopharyngeal and tracheal aspirates was investigated preoperatively in the absence of respiratory symptoms using real-time polymerase chain reaction (kit for detection of 19 pathogens). Post-cardiopulmonary bypass (CPB) inflammatory reaction was analyzed by measuring serum levels of 36 inflammatory proteins (immunoblotting) 4 h after its termination. Postoperative hemodynamics was assessed using continuous recording of PAP and SAP with calculation of PAP/SAP ratio.ResultsViral genomes were detected in nasopharynx and the trachea in 64% and 38% of patients, respectively. Rhinovirus was the most prevalent agent. The presence of viral genomes in the trachea was associated with an upward shift of postoperative PAP curve (p = 0.011) with a PAP/SAP of 0.44 (0.36–0.50) in patients who were positive versus 0.34 (0.30–0.45) in those who were negative (p = 0.008). The presence or absence of viral genomes in nasopharynx did not help predict postoperative hemodynamics. Postoperative PAP/SAP was positively correlated with post-CPB levels of interleukin-1 receptor antagonist (p = 0.026), macrophage migration inhibitory factor (p = 0.019) and monocyte chemoattractant protein-1 (p = 0.031), particularly in patients with virus-positive tracheal aspirates.ConclusionsPatients with CCCs carrying respiratory viral genomes in lower airways are at a higher risk for postoperative pulmonary hypertension, thus deserving special attention and care. Preoperative exposure to respiratory viruses and post-CPB inflammatory reaction seem to play a combined role in determining the postoperative behavior of the pulmonary circulation.

【 授权许可】

CC BY   
© The Author(s) 2023

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