Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jul 18;14(1):16612.
doi: 10.1038/s41598-024-67097-4.

Down syndrome and postoperative hemodynamics in patients undergoing surgery for congenital cardiac communications

Eloisa Sassá Carvalho  1 , Juliano Gomes Penha  1 , Nair Yukie Maeda  2 , Kelly Cristina O Abud  1 , Maria Francilene S Souza  1 , Claudia R P Castro  1 , Johnny X Dos Santos  1 , Juliana Pereira  3 , Antonio Augusto Lopes  4   5
Affiliations

Down syndrome and postoperative hemodynamics in patients undergoing surgery for congenital cardiac communications

Eloisa Sassá Carvalho et al. Sci Rep. .

Abstract

Although Down syndrome (DS) is considered a risk factor for hemodynamic instabilities (mainly pulmonary hypertension-PH) following surgery for congenital cardiac communications, many DS patients do surprising well postoperatively. We prospectively analyzed perioperative factors for a possible correlation with post-cardiopulmonary bypass (CPB) inflammatory reaction and postoperative PH in pediatric subjects. Sixty patients were enrolled (age 3 to 35 months), 39 of them with DS. Clinical and echocardiographic parameters (anatomical and hemodynamic) were computed preoperatively. Pulmonary and systemic mean arterial pressures (PAP and SAP) were assessed invasively intra and postoperatively. Immediate postoperative PAP/SAP ratio (PAP/SAPIPO) and the behavior of pressure curves were selected as primary outcome. Serum levels of 36 inflammatory proteins were measured by chemiluminescence preoperatively and 4 h post CPB. Of all factors analyzed, peripheral oxygen saturation (O2Sat, bedside assessment) was the only preoperative predictor of PAP/SAPIPO at multivariate analysis (p = 0.007). Respective values in non-DS, DS/O2Sat ≥ 95% and DS/O2Sat < 95% subgroups were 0.34 (0.017), 0.40 (0.027) and 0.45 (0.026), mean (SE), p = 0.004. The difference between non-DS and DS groups regarding postoperative PAP curves (upward shift in DS patients, p = 0.015) became nonsignificant (p = 0.114) after adjustment for preoperative O2Sat. Post-CPB levels of at least 5 cytokines were higher in patients with O2Sat < 95% versus those at or above this level, even within the DS group (p < 0.05). Thus, a baseline O2Sat < 95% representing pathophysiological phenomena in the airways and the distal lung, rather than DS in a broad sense, seems to be associated with post-CPB inflammation and postoperative PH in these patients.

Keywords: Congenital heart diseases; Down syndrome; Inflammatory mediators; Pediatric cardiac surgery; Postoperative intensive care; Pulmonary hypertension.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Role of Down syndrome, type of cardiac anomaly and preoperative peripheral oxygen saturation (O2 Sat) on early postoperative hemodynamics (PAP/SAPIPO, pulmonary/systemic mean arterial pressure ratio, mean of first four values computed in the intensive care unit, readings at 2 h intervals). Analyses were performed using the general linear model after Box-Cox transformation of the dependent variable. Results are presented as means with SE (A,C–E) or adjusted means with SE after inclusion of baseline oxygen saturation as a covariate in the statistical model (B,F with covariate p values of 0.006 and 0.005, respectively). In (C–E) groups not sharing the same letter were different (post-hoc multiple comparisons). AVSD atrioventricular septal defect, VSD ventricular septal defect.
Figure 2
Figure 2
Mean pulmonary and systemic arterial pressure (respectively, PAP and SAP) and peripheral oxygen saturation (O2Sat) computed during the first 12 h of postoperative intensive care for patients with (squares, n = 39) and without (circles, n = 21) Down syndrome. Data were analyzed using the general linear model for repeated measures after Box-Cox transformation of the dependent variable. Results are presented as means with SE (A,C,E) or adjusted means with SE using baseline oxygen saturation as a covariate in the model (B, D,F, p < 0.05 for the covariate in all tests).
Figure 3
Figure 3
Serum levels of inflammatory mediators 4 h after weaning from cardiopulmonary bypass in patients with preoperative peripheral oxygen saturation (O2Sat) < 95% (n = 20) compared to those who were at or above this level (n = 40). Shown are the levels of interleukins 6 and 16 (IL-6 and IL-16), interferon gamma-induced protein 10 (IP-10), stromal cell-derived factor 1 (SDF-1) and complement components 5/5a (C5/C5a). Protein levels were determined as units of pixel intensity (upi) and results are presented as geometric means with 95% CI. The Mann–Whitney test was used for all comparisons.
Figure 4
Figure 4
Post-cardiopulmonary bypass serum levels of inflammatory proteins for the specific group of patients with Down syndrome. Comparisons were made between patients with preoperative peripheral oxygen saturation (O2Sat) < 95% (n = 19) and those who were at or above this level (n = 20). Shown are the levels of interleukins 8 and 16 (IL-8 and IL-16), interferon gamma-induced protein 10 (IP-10), stromal cell-derived factor 1 (SDF-1), complement components 5/5a (C5/C5a) and macrophage inflammatory protein 1 alpha and beta (MIP-1alpha and MIP-1beta). Results are presented as geometric means with 95% CI. Differences were tested using the Mann–Whitney test.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Abman SH, Hansmann G, Archer SL, et al. American heart association council on cardiopulmonary, critical care, perioperative and resuscitation; council on clinical cardiology; council on cardiovascular disease in the young; council on cardiovascular radiology and intervention; council on cardiovascular surgery and anesthesia; and the american thoracic society. Pediatric pulmonary hypertension: Guidelines from the American heart association and American thoracic society. Circulation. 2015;132(21):2037–2099. doi: 10.1161/CIR.0000000000000329. - DOI - PubMed
    1. Adatia I, et al. Pulmonary hypertension and postoperative congenital heart disease. In: Beghetti M, et al., editors. Pediatric Pulmonary Hypertension. Elsevier Urban Fischer; 2011. pp. 209–232.
    1. Myers PO, Tissot C, Beghetti M. Assessment of operability of patients with pulmonary arterial hypertension associated with congenital heart disease. Circ. J. 2014;78(1):4–11. doi: 10.1253/circj.cj-13-1263. - DOI - PubMed
    1. Jone PN, Ivy DD, Hauck A, et al. Pulmonary hypertension in congenital heart disease: A scientific statement from the American heart association. Circ. Heart Fail. 2023;16(7):e00080. doi: 10.1161/HHF.0000000000000080. - DOI - PubMed
    1. Laignier MR, Lopes-Júnior LC, Santana RE, et al. Down syndrome in Brazil: Occurrence and associated factors. Int. J. Environ. Res. Public Health. 2021;18(22):11954. doi: 10.3390/ijerph182211954. - DOI - PMC - PubMed