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STUDY OF DYNAMIC CHANGES IN SERUM INTERCELLULAR ADHESION MOLECULE-1 (ICAM-1) IN CHILDREN DURING OPEN HEART SURGERY UNDER CARDIOPULMONARY BYPASS

Li JH, Zhang ZW, Hu J

Children's Hospital Affiliated Medical College of Zhejiang University, Hangzhou, China

Objective: To evaluate the role of serum intercellular adhesion molecule (ICAM-1) change and clinic significance of monitoring the serum ICAM-1 level during pediatric cardiopulmonary bypass (CPB) surgery for congenital heart disease (CHD).

Method: Between Nov. 1998 and April 1999, 33 elective congenital heart disease, 24 ventricular septal defect and 9 atrial septal defect, patients for CPB surgery were enrolled in study group with 19 male and 14 females, at the age from 5 month to 11 years, mean 3.9 years. Body weight from 5-22 kg, mean 13.15 kg. Control group is consisted of 10 non CPB surgery patients, who had general thoracic or plastic surgery, with matched age and weight. The study group were further divided into 4 subgroups according to age, type of oxygenator, time of CPB and with or without pulmonary hypertension. ICAM-1 levels at the following time points, pre-surgery, 30 minutes after CPB began, right after surgery and 2, 12, 24, 48 hours after surgery were measured by double antibody sandwich ELISA from arterial specimen in 33 study group、10 control group at presurgery, in the surgery and 2 hours after surgery and 30 normal children. ICAM-1 levels of 30 normal children matched age and weight were measured as normal values.

Result: Patients with CHD and control group had normal value of serum ICAM-1 before operation. The serum ICAM-1 level in study group were significantly higher than those of controls. ICAM-1 levels started increasing as early as 30 minutes and peaked at 24 hours after surgery and stayed up after 48 hours after surgery (p < 0.05). The serum ICAM-1 level in subgroup of CPB ≥90 minuets were significantly higher than others at 24 hour post operation. Post CPB patients who need longer mechanical ventilation due to heart failure showed higher ICAM-1 level.

Conclusion: ICAM-1 showed higher and lasted longer after pediatric CPB surgery when comparing to control group and adult after CPB surgery. CPB time is direct cause of the elevation of ICAM-1. Monitoring of serum ICAM-1, in certain degree, may help in predicting prognosis and complication post CPB surgery.