Cell Biochemistry Martinsried


Preoperative Prediction of Postcardiotomy (PCS) and Capillary Leak
Syndromes (CLS), in Children Cardiac Surgery

G.Valet, A.Tarnok1)

1) Klinik für Kinderkardiologie, Herzzentrum Leipzig, Germany




PCS and CLS represent unwanted postoperative complication in children cardiac surgery e.g. for septum defects or open Ductus Botalli. Besides the requirement for substantial intensive care treatment, permanent lung damage may result in affected children.

The cause for PCS/CLS development is unknown. It could result either from preoperative or from operative conditions. The goal of this investigation was to screen blood samples for various leukocyte CD antigens as well as for changes in cytokines, soluble adhesion molecules, complement components, histamine, neopterin, CRP, kreatinin, blood cell differentials as potential indicators for the occurrence of postoperative CLS.

The resulting database contained 59 preoperatively measured parameters for each of 9 patients with postoperative CLS and 9 complication free patients. Data were exported from Microsoft Excel format as dBase3 files and reimported into the standardized multiparameter data classification program CLASSIF1 (1)

The retrospectively prospective classification (2) shows that all (100%) CLS patients can be preoperatively identified from a pattern of 10 of the 59 parameters. Increased age, weight, IL-10, soluble ICAM-1, E-selectin, PECAM, serum and urine histamine, % and absolute granulocyte counts in combination with a decrease of C1-inhibitor concentration are preoperative indicators for postoperative PCS/CLS occurrence. The preoperative parameter changes in the risk patients are compatible with the existence of a latent preoperative infection.

The CLASSIF1 triple matrix analysis provides a preoperative risk indicator, a hypothesis how PCS/CLS may be generated and a means for therapy control. Provided the above hypothesis is correct, preoperative antibiotic treatment and recontrol of the data pattern at several days interval will permit to follow the normalization of the above parameter pattern. Once the parameter pattern is normalized, the risk for the postoperative occurrence of CLS should be minimal.

Literature References:
1. A Tarnok, M Pipek, G Valet, J Richter, J Hambsch, P Schneider (1999) Children with post-surgical capillary leak syndrome can be distinguished by antigen expression on neutrophils and monocytes, in: Progress in Biomedical Optics, Proceedings Systems and Technologies for Clinical Diagnostics and Drug Discovery II, eds: GE Cohn, JC Owicki, SPIE Vol.3603:61-71
2. A Tarnok, J Hambsch, M Borte, G Valet, P Schneider (1997) Immunological and serological discrimination of children with and without post-surgical capillary leak syndrome.
In: The Immune Consequences of Trauma, Shock and Sepsis, ed. E Faist, Monduzzi Editore, Bologna, p.845-849
3. G Valet, M Valet, D Tschöpe, H Gabriel, G Rothe, W Kellermann, H Kahle (1993) White cell and thrombocyte disorders: Standardized, self-learning flow cytometric list mode data classification with the CLASSIF1 Program System.
Ann.NY Acad.Sci 677:233-251




2002 G.Valet
Max-Planck-Institut für Biochemie, Am Klopferspitz 18a, D-82152 Martinsried, Germany, Tel: +49/89/8578-2518, -2525, Fax: +49/89/8578-2563, INTERNET: http://www.biochem.mpg.de/valet/cellbio.html
Last Update: Mar.12,2002