PubMed · 16181893
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Robert Savage, Lars G Svensson. 2005. Invited commentary.. https://doi.org/10.1016/j.athoracsur.2005.02.033
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Consumption of a meal is followed by an increase in cardiac output (CO) which appears to be closely related to the concomitant increase in blood flow to the gastrointestinal organs. To gain information on the mechanism behind this increase in CO we have previously used Doppler ultrasound technique to record circulatory responses to a standardized meal in five patients with recently transplanted and thus denervated hearts. We obtained the surprising result that they reacted to the consumption of a meal with a greater increase in CO than did five matched normal controls. The patients also presented above-normal levels of heart rate (HR) and CO at rest. The same five patients have now been tested 18 months later to re-examine their remarkable cardiac response to ingestion of a meal. The hearts of two patients showed some signs of reinnervation, whereas the hearts of the other three were apparently still fully denervated. However, all five patients once again evolved a marked cardiac response to ingestion of a meal. Postprandial CO reached significantly higher levels in the patients than in the controls. The persistence of such a pronounced postprandial augmentation of CO in transplanted and largely denervated hearts strengthens the assumption that the heart is induced to increase its postprandial performance through the action of a humoral agent of some sort, possibly one of the hormones from the duodenal-pancreatic region.
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OBJECTIVE: To evaluate the acute inflammatory response and cardiac output in children after surgery for ventricular septal defect. DESIGN AND SETTING: Prospective, observational study in a level III multidisciplinary neonatal and pediatric intensive care unit. PATIENTS: Ten children undergoing open-heart surgery for ventricular septal defect. INTERVENTIONS: All children received methylprednisolone (30 mg/kg) in cardiopulmonary bypass (CPB) prime. MEASUREMENTS AND RESULTS: Before and after cardiopulmonary bypass, plasma interleukin-10 and tumor necrosis factor alpha were measured by enzyme-linked immunosorbent assay, and lymphocyte subsets in peripheral blood by flow cytometry. Relative values (post-/pre-CPB) of interleukin-10 and tumor necrosis factor alpha were calculated. The cardiac index (CI) was measured continuously beat-to-beat by a pulse contour analysis (PiCCO). Children above the cutoff value (median cardiac index value 3.0 l min(-1) m(-2)) were designated as the normal CI group and those below this value as the low CI group. In the normal CI group the relative values of interleukin-10 remained almost seven times higher than pre-CPB values at 24 h while in the low CI group they decreased almost to pre-CPB values. Furthermore, the normal CI group, but not the low CI group, exhibited more than threefold decrease in T-lymphocytes (lymphocyte T-cells, T-helper cells, and cytotoxic T-cells) 24 h after CPB. CONCLUSIONS: Children operated on for ventricular septal defect developed either a normal or low CI. The higher relative values of interleukin-10 and lower counts of lymphocyte T-cells, T-helper and cytotoxic T-cells differentiated the normal CI group from the low CI group at 24 h after cardiopulmonary bypass.