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. 2023 Jan 20;28(1):38.
doi: 10.1186/s40001-023-01003-y.

Respiratory viruses and postoperative hemodynamics in patients with unrestrictive congenital cardiac communications: a prospective cohort study

Kelly C O Abud  1 , Clarisse M Machado  2 , Lucy S Vilas Boas  2 , Nair Y Maeda  3 , Eloisa S Carvalho  1 , Maria Francilene S Souza  1 , Paula V Gaiolla  1 , Claudia R P Castro  1 , Juliana Pereira  4 , Marlene Rabinovitch  5 , Antonio Augusto Lopes  6
Affiliations

Respiratory viruses and postoperative hemodynamics in patients with unrestrictive congenital cardiac communications: a prospective cohort study

Kelly C O Abud et al. Eur J Med Res. .

Abstract

Background: Pulmonary vascular abnormalities pose a risk for severe life-threatening hemodynamic disturbances following surgical repair of congenital cardiac communications (CCCs). In the distal lung, small airways and vessels share a common microenvironment, where biological crosstalks take place. Because respiratory cells infected by viruses express a number of molecules with potential impact on airway and vascular remodeling, we decided to test the hypothesis that CCC patients carrying viral genomes in the airways might be at a higher risk for pulmonary (and systemic) hemodynamic disturbances postoperatively.

Methods: Sixty patients were prospectively enrolled (age 11 [7-16] months, median with interquartile range). Preoperative pulmonary/systemic mean arterial pressure ratio (PAP/SAP) was 0.78 (0.63-0.88). The presence or absence of genetic material for respiratory viruses in nasopharyngeal and tracheal aspirates was investigated preoperatively in the absence of respiratory symptoms using real-time polymerase chain reaction (kit for detection of 19 pathogens). Post-cardiopulmonary bypass (CPB) inflammatory reaction was analyzed by measuring serum levels of 36 inflammatory proteins (immunoblotting) 4 h after its termination. Postoperative hemodynamics was assessed using continuous recording of PAP and SAP with calculation of PAP/SAP ratio.

Results: Viral genomes were detected in nasopharynx and the trachea in 64% and 38% of patients, respectively. Rhinovirus was the most prevalent agent. The presence of viral genomes in the trachea was associated with an upward shift of postoperative PAP curve (p = 0.011) with a PAP/SAP of 0.44 (0.36-0.50) in patients who were positive versus 0.34 (0.30-0.45) in those who were negative (p = 0.008). The presence or absence of viral genomes in nasopharynx did not help predict postoperative hemodynamics. Postoperative PAP/SAP was positively correlated with post-CPB levels of interleukin-1 receptor antagonist (p = 0.026), macrophage migration inhibitory factor (p = 0.019) and monocyte chemoattractant protein-1 (p = 0.031), particularly in patients with virus-positive tracheal aspirates.

Conclusions: Patients with CCCs carrying respiratory viral genomes in lower airways are at a higher risk for postoperative pulmonary hypertension, thus deserving special attention and care. Preoperative exposure to respiratory viruses and post-CPB inflammatory reaction seem to play a combined role in determining the postoperative behavior of the pulmonary circulation.

Keywords: Congenital heart disease; Pediatric cardiac surgery; Pediatric intensive care; Postoperative inflammatory response; Pulmonary hypertension; Respiratory viruses.

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Conflict of interest statement

The authors of the study declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram showing patient inclusion and exclusion during the period of the study
Fig. 2
Fig. 2
Respiratory viral genomes detected in nasopharyngeal and tracheal aspirates (total of 58 and 55 cases analyzed, respectively). FluA and FluB: influenza A and influenza B, respectively; H1N1: influenza A H1N1; CoV43, CoV63, CoV229 and HKU: coronavirus OC43, NL63, 229E and HKU1, respectively; HPIV1, HPIV2, HPIV3 and HPIV4: human parainfluenza virus 1, 2, 3 and 4, respectively; HMPVA/B: human metapneumovirus A/B; HRSVA/B: human respiratory syncytial virus A/B; HPeV: human parechovirus; EV: enterovirus; HAdV: human adenovirus; HBoV: human bocavirus; HRV: human rhinovirus; Mpneu: Mycoplasma pneumoniae
Fig. 3
Fig. 3
Pressure and oxygen saturation curves during the first 12 h of postoperative care according to the presence (squares) or absence (circles) of respiratory viral genomes in nasopharyngeal (A–D) and tracheal (E–H) aspirates. Results are presented as means with SE. P values correspond to differences between groups analyzed using the general linear model for repeated measures after Box–Cox transformation of the dependent variables. O2 Sat: peripheral oxygen saturation; PAP and SAP: pulmonary arterial pressure and mean systemic arterial pressure, respectively; PAP/SAP: pulmonary/systemic arterial pressure ratio
Fig. 4
Fig. 4
Interactive influence of respiratory viral genomes and early postoperative hemodynamics (pulmonary/systemic mean arterial pressure ratio, PAP/SAP) on post-hospitalization pulmonary arterial pressure. Shown are the results of patients for whom it was possible to analyze viral genetic material in tracheal aspirates and systolic pulmonary arterial pressure on 6-month postoperative echocardiogram. Data were analyzed using the general linear model and results are presented as means with SE. Groups not sharing the same letter were different at post hoc multiple comparisons
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