Comportamento da homocisteína e de marcadores de inflamação e de lesão miocárdica em crianças portadoras de cardiopatia congênita submetidas à cirurgia cardíaca

Abstract

Cardiac surgery with cardiopulmonary bypass is considered a major cause of systemic inflammatory response, and may have important clinical implications. Analysis of the level of inflammation and myocardial injury may be useful to determine prognosis. Homocysteinemia has been related to the physiopathology of cardiovascular diseases, and may be linked to the mechanisms of oxidative stress. The aim of this study was to determine the concentration of homocysteine and other inflammation and myocardial injury markers in pediatric patients with congenital heart disease who were submitted to cardiac surgery. In addition, the relation between homocysteine and clinical and surgical variables in this group of patients was also analyzed. A total of 29 patients were prospectively studied. Serum levels of homocysteine, inflammation markers (absolute number of white blood cells and band cells and C-reactive protein) and myocardial injury markers (creatine kinases and troponin T) were assessed at three different moments: D0 preoperatively (control), D1 immediately postoperatively (upon admission to the pediatric ICU) and D2 three days after surgery. Averages of homocysteine were, respectively, 7.53  0.51 M at D0, 9.43  0.66 M at D1 and 8.12  0.60 M at D2. Variation in homocysteine levels was not related to the type of congenital heart disease. Cardiopulmonary bypass led to an increase in homocysteine levels, which was not related to duration of the procedure, cardiopulmonary bypass or aortic clamping. Levels of inflammation and myocardial injury markers also increased immediately postoperatively in response to the surgical procedure. A positive correlation was observed between homocysteine and C-reactive protein three days after surgery. In conclusion, serum levels of homocysteine, inflammation markers and myocardial injury markers increase immediately postoperatively in patients with congenital heart disease submitted to cardiac surgery. Increased homocysteine levels are related to cardiopulmonary bypass and increased C-reactive protein levels. However, increased homocysteine levels are not related to any of the other markers studied.