Effect Of Cardiopulmonary Bypass And L-Arginine Injection On Plasma Nitric Oxide And Asymmetric Dimethylarginine Levels In Patients With Congential Heart Disease Complicated With Pulmonary Hypertension

Objective To evaluate the effects of cardiopulmonary bypass(CPB) on plasma nitric oxide(NO) and asymmetric dimethylarginine(ADMA) levels for congenital heart disease with pulmonary artery hypertension,and to investigate the effect of L-Arg injection on level of ADMA and NO in patients with CHD complicated moderate or severe pulmonary artery hypertension(PAH).Methods①eighteen ASAⅡorⅢpatients aged 11-40 yr,weighing 26-59 kg undergoing surgical intervention for congenital heart disease under CPB were divided into 3 groups according to pulmonary arterial systolic pressure(PASP): groupⅠPASP＜30mm Hg(n=6);groupⅡPASP30-50mm Hg(n=6) and groupⅢPASP＞50 mm Hg(n=6).Blood samples were taken before operation(baseline),at the start of CPB,at the termination of CPB and 12,24 and 72 h after CPB for determination of plasma NO and ADMA concentrations.②Twenty ASAⅡorⅢpatients undergoing surgical intervention for congenital heart disease under cardiopulmonary bypass(CPB) according to pulmonary arterial systolic pressure(PASP＞50mm Hg),It were randomized to received control group(group C) and additional L-Arg injection treatment group(group Z),each group has 10 patients.Blood samples were taken before treatment,before anesthesia induction,at the termination of CPB and 12,24 and 72h after CPB for determination of NO and ADMA concentrations.The PASP were taken before treatment,before operation,the first and the third day after operation. Results①The three groups were comparable with respect to M/F sex ratio,age, body weight and CPB time.The plasma ADMA concentration in groupⅡandⅢwere higher than in groupⅠ,but the plasma NO concentration in groupⅡandⅢwere lower than groupⅠ;After CPB the plasma ADMA,NO concentrations in groupⅠhave no difference compared to before operation;plasma ADMA concentration in groupⅡ,Ⅲwere significantly increased after CPB as compared with the baseline before operation. The plasma NO concentration was significantly decreased after CPB in groupⅡandⅢ.②The patients in groups C,Z the ADMA,NO levels and PASP have no difference before treatment;The ADMA levels in group Z were lower than in group C and NO were higher than in group C before anesthesia induction,before operation the PASP in group Z were lower than in group C;The ADMA levels in group Z were lower than in group C and NO were higher than in group C at 12,24 and 72 h after CPB.After operation the PASP in group Z were lower than in group C.Conclusion①CPB can increase plasma ADMA level and decrease plasma NO level in patients with congential heart disease complicated with pulmonary hypertension.②L-Arg injection effectively decreases the ADMA levels and increases the NO levels in patients undergoing surgical intervention for congenital heart disease under CPB,and L-Arg injection could decrease the pulmonary arterial pressure have the active meaning in patients with congenital heart disease after operation.