THE INFLUENCE OF APROTININ, HEMOFILTRATION, OR BOTH ON CYTOKINES PRODUCTION IN PEDIATRICS UNDERGOING SURGICAL CORRECTION OF CONGENITAL HEART DISEASES.

Abstract

Cardio-pulmonary bypass, which is fundamental for cardiac surgery, JS associated with activation of the immune system and initiation of a systemic inflammatory response syndrome characterized by complement activation, neutrophils activation, and the release of proinflammatory cytokines. This syndrome is responsible for variant degrees of organ dysfunction following cardiac surgery as myocardial stunning, respiratory distress syndrome, neurological dysfunction, coagulation disorders, and renal impairment.

Neonates, infants, and children are at increased risk of development of the systemic inflammatory response as they have limited physiologic reserve and they are potentially vulnerable for capillary leak. The inflammatory response is more pronounced in infants than in adults after similar periods of CPB. (Andreasson eta/ , 1993).

The inflammatory response include a cascade of events beginning with release of complement fragments, TNF-a, and IL-l that stimulate the release of other inflammatory mediators as IL-6, and IL-8. These cytokines are mediators of vascular injury and organ dysfunction. Elevated serum cytokines levels have been reported during and after CPB, and they serve as markers of the intensity of the inflammatory process.

TNF-a is the earliest and one oftbe most important cytokines released m inflammatory response. It induces fever, hypotension, and promotes the release of other cytokines. (Hall et a/, 1997) IL-8 is a powerful chemoattractant for neutrophils and its serum concentrations are considered