Dilutional and modified ultrafiltration reduces pulmonary hypertension after operations for congenital heart disease

A prospective randomized study

K. Bando, P. Vijay, Mark Turrentine, T. G. Sharp, L. J. Means, G. J. Ensing, B. J. Lalone, Y. Sekine, L. Szekely, John Brown, R. M. Ungerleider

Research output: Contribution to journalArticle

66 Citations (Scopus)

Abstract

Objective: A prospective randomized study was performed to test whether removal of endothelin-1, by ultrafiltration techniques, will reduce pulmonary hypertension after operations for congenital heart disease. Methods: Twenty- four patients with pulmonary hypertension (systolic pulmonary/systemic arterial pressure ratio > 60%) undergoing cardiac operations were randomized into a control group (n = 12) having conventional ultrafiltration and an experimental group (n = 12) undergoing dilutional ultrafiltration during and modified ultrafiltration after cardiopulmonary bypass. Plasma endothelin-1, nitric oxide metabolites, and cyclic guanosine monophosphate were assayed before bypass, 10 minutes into bypass, after bypass, and 0, 3, 6, and 12 hours after the operation in both groups, as well as in the ultrafiltrates and after modified ultrafiltration in the experimental group. Both groups received α-blockers (chlorpromazine and/or prazosin) postoperatively using the same guidelines. Results: The ultrafiltrates contained significant amounts of endothelin-1 (1.81 ± 0.86 pg/ml, dilutional, and 6.44 ± 1.82 pg/ml, modified ultrafiltrate). Endothelin-1 and the pulmonary/systemic pressure ratio were significantly lower in experimental compared with control patients. Nitric oxide metabolites and cyclic guanosine monophosphate increased similarly in both groups for 12 hours after the operation (p = not significant). Three of 12 control patients (25%) but no experimental patients had pulmonary hypertensive crises (p = 0.07). The experimental patients required significantly less ventilatory support (67 ± 47 hours vs 178 ± 139 hours for control patients, p = 0.048). Conclusions: Dilutional and modified ultrafiltration reduce endothelin-1 and the pulmonary/systemic pressure ratio postoperatively and may become an important adjunct for preventing pulmonary hypertension after operations for congenital heart disease in high-risk patients.

Original languageEnglish
Pages (from-to)517-527
Number of pages11
JournalJournal of Thoracic and Cardiovascular Surgery
Volume115
Issue number3
DOIs
StatePublished - 1998

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Ultrafiltration
Pulmonary Hypertension
Heart Diseases
Endothelin-1
Prospective Studies
Lung
Cyclic GMP
Nitric Oxide
Pressure
Prazosin
Chlorpromazine
Cardiopulmonary Bypass
Arterial Pressure
Guidelines
Control Groups

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Dilutional and modified ultrafiltration reduces pulmonary hypertension after operations for congenital heart disease : A prospective randomized study. / Bando, K.; Vijay, P.; Turrentine, Mark; Sharp, T. G.; Means, L. J.; Ensing, G. J.; Lalone, B. J.; Sekine, Y.; Szekely, L.; Brown, John; Ungerleider, R. M.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 115, No. 3, 1998, p. 517-527.

Research output: Contribution to journalArticle

Bando, K. ; Vijay, P. ; Turrentine, Mark ; Sharp, T. G. ; Means, L. J. ; Ensing, G. J. ; Lalone, B. J. ; Sekine, Y. ; Szekely, L. ; Brown, John ; Ungerleider, R. M. / Dilutional and modified ultrafiltration reduces pulmonary hypertension after operations for congenital heart disease : A prospective randomized study. In: Journal of Thoracic and Cardiovascular Surgery. 1998 ; Vol. 115, No. 3. pp. 517-527.
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abstract = "Objective: A prospective randomized study was performed to test whether removal of endothelin-1, by ultrafiltration techniques, will reduce pulmonary hypertension after operations for congenital heart disease. Methods: Twenty- four patients with pulmonary hypertension (systolic pulmonary/systemic arterial pressure ratio > 60{\%}) undergoing cardiac operations were randomized into a control group (n = 12) having conventional ultrafiltration and an experimental group (n = 12) undergoing dilutional ultrafiltration during and modified ultrafiltration after cardiopulmonary bypass. Plasma endothelin-1, nitric oxide metabolites, and cyclic guanosine monophosphate were assayed before bypass, 10 minutes into bypass, after bypass, and 0, 3, 6, and 12 hours after the operation in both groups, as well as in the ultrafiltrates and after modified ultrafiltration in the experimental group. Both groups received α-blockers (chlorpromazine and/or prazosin) postoperatively using the same guidelines. Results: The ultrafiltrates contained significant amounts of endothelin-1 (1.81 ± 0.86 pg/ml, dilutional, and 6.44 ± 1.82 pg/ml, modified ultrafiltrate). Endothelin-1 and the pulmonary/systemic pressure ratio were significantly lower in experimental compared with control patients. Nitric oxide metabolites and cyclic guanosine monophosphate increased similarly in both groups for 12 hours after the operation (p = not significant). Three of 12 control patients (25{\%}) but no experimental patients had pulmonary hypertensive crises (p = 0.07). The experimental patients required significantly less ventilatory support (67 ± 47 hours vs 178 ± 139 hours for control patients, p = 0.048). Conclusions: Dilutional and modified ultrafiltration reduce endothelin-1 and the pulmonary/systemic pressure ratio postoperatively and may become an important adjunct for preventing pulmonary hypertension after operations for congenital heart disease in high-risk patients.",
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T1 - Dilutional and modified ultrafiltration reduces pulmonary hypertension after operations for congenital heart disease

T2 - A prospective randomized study

AU - Bando, K.

AU - Vijay, P.

AU - Turrentine, Mark

AU - Sharp, T. G.

AU - Means, L. J.

AU - Ensing, G. J.

AU - Lalone, B. J.

AU - Sekine, Y.

AU - Szekely, L.

AU - Brown, John

AU - Ungerleider, R. M.

PY - 1998

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AB - Objective: A prospective randomized study was performed to test whether removal of endothelin-1, by ultrafiltration techniques, will reduce pulmonary hypertension after operations for congenital heart disease. Methods: Twenty- four patients with pulmonary hypertension (systolic pulmonary/systemic arterial pressure ratio > 60%) undergoing cardiac operations were randomized into a control group (n = 12) having conventional ultrafiltration and an experimental group (n = 12) undergoing dilutional ultrafiltration during and modified ultrafiltration after cardiopulmonary bypass. Plasma endothelin-1, nitric oxide metabolites, and cyclic guanosine monophosphate were assayed before bypass, 10 minutes into bypass, after bypass, and 0, 3, 6, and 12 hours after the operation in both groups, as well as in the ultrafiltrates and after modified ultrafiltration in the experimental group. Both groups received α-blockers (chlorpromazine and/or prazosin) postoperatively using the same guidelines. Results: The ultrafiltrates contained significant amounts of endothelin-1 (1.81 ± 0.86 pg/ml, dilutional, and 6.44 ± 1.82 pg/ml, modified ultrafiltrate). Endothelin-1 and the pulmonary/systemic pressure ratio were significantly lower in experimental compared with control patients. Nitric oxide metabolites and cyclic guanosine monophosphate increased similarly in both groups for 12 hours after the operation (p = not significant). Three of 12 control patients (25%) but no experimental patients had pulmonary hypertensive crises (p = 0.07). The experimental patients required significantly less ventilatory support (67 ± 47 hours vs 178 ± 139 hours for control patients, p = 0.048). Conclusions: Dilutional and modified ultrafiltration reduce endothelin-1 and the pulmonary/systemic pressure ratio postoperatively and may become an important adjunct for preventing pulmonary hypertension after operations for congenital heart disease in high-risk patients.

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