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(Circulation. 2000;102:III-172.)
© 2000 American Heart Association, Inc.

Surgery for Congenital Heart Disease

Alterations in Endogenous Nitric Oxide Production After Cardiopulmonary Bypass in Lambs With Normal and Increased Pulmonary Blood Flow

D. Michael McMullan, MD; Janine M. Bekker, BS; Andrew J. Parry, MD; Michael J. Johengen, BS; Alexander Kon, MD; R. Scott Heidersbach, MD; Stephen M. Black, PhD; Jeffrey R. Fineman, MD

From the Departments of Cardiothoracic Surgery (D.M.M., A.J.P.) and Pediatrics (J.M.B., M.J.J., A.K., R.S.H., S.M.B.), University of California, San Francisco; Department of Pediatrics (J.R.F.), Northwestern University, Chicago, Ill; and Cardiovascular Research Institute (J.R.F.), San Francisco, Calif.

Correspondence to Jeffrey R. Fineman, MD, University of California, San Francisco, 505 Parnassus Ave, Box 0106, M-680, San Francisco, CA 94143-0106. E-mail jfineman{at}pedcard.ucsf.edu

Background—After cardiopulmonary bypass (CPB), altered vascular reactivity is a major source of complications, particularly for children with increased pulmonary blood flow. Although changes in agonist-induced NO activity are well described after CPB, potential changes in basal NO production and their role in post-CPB pulmonary hypertension remain unclear. By using aortopulmonary vascular graft placement in the fetal lamb (shunt lambs), we established a unique model of pulmonary hypertension that mimics congenital heart disease with increased pulmonary blood flow. The objective of the present study was to investigate potential alterations in endogenous NO production after CPB in lambs with normal and increased pulmonary blood flow.

Methods and Results—Vascular pressures and blood flows were monitored in 1-month-old lambs (n=7) with increased pulmonary blood flow and 6 age-matched control lambs. After shunt closure, hypothermic CPB (25°C) was performed for 2 hours. The hemodynamic variables were monitored for 4 hours after CPB. Before, during, and after CPB, peripheral lung biopsies were performed to determine tissue NO, nitrite, nitrate, and cGMP concentrations; total NO synthase (NOS) activity; and endothelial NOS protein levels. Hypothermic CPB increased both mean pulmonary arterial pressure and left pulmonary vascular resistance (P<0.05). The increase in pulmonary arterial pressure induced in shunt lambs was greater than that induced in control lambs (P<0.05). Four hours after CPB, tissue concentrations of NO, nitrite, nitrate, and cGMP were decreased to 70% of pre-CPB levels in both control and shunt lambs (P<0.05). Total NOS activity and endothelial NOS protein levels were unchanged.

Conclusions—Modest decreases in basal NO production, the inability to increase NO production, or both may play a role in the altered pulmonary vascular reactivity after CPB. The decrease in NO is independent of gene expression. However, other mechanisms for this decrease, such as substrate or cofactor availability, warrant further study.

Key Words: nitric oxide • cardiopulmonary bypass • hypertension • lungs • endothelium

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