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Ann Thorac Surg 1998;66:500-505
© 1998 The Society of Thoracic Surgeons

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Original articles: cardiovascular

Adrenomedullin in patients at high risk for pulmonary hypertension

^a Section of Cardiothoracic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA

Address reprint requests to Dr Vijay, Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, EH 215, Indianapolis, IN 46202-5125
e-mail: (pvijay{at}iupui.edu)

Presented at the Thirty-fourth Annual Meeting of The Society of Thoracic Surgeons, New Orleans, LA, Jan 26–28, 1998.

Background. Adrenomedullin is a newly identified peptide with profound hypotensive effects. We investigated perioperative adrenomedullin levels among patients with congenital heart disease with and without pulmonary hypertension.

Methods. Levels of plasma adrenomedullin, endothelin-1, and nitric oxide metabolites were measured in three groups: (1) low pulmonary flow (n = 11); (2) high flow/low pulmonary arterial pressure (less than 60% systemic pressure) (n = 9); and (3) high flow/high pressure (n = 10). Samples were obtained preoperatively, on and off pump, and 3, 6, and 12 hours after bypass.

Results. Adrenomedullin levels were highest in the low pulmonary flow group (189.7 ± 15 pg/mL low flow versus 103.1 ± 9.5 pg/mL high flow/low pulmonary and 139 ± 17.5 pg/mL high flow/high pressure at 12 hours; p 0.05). The arterial pressure/systemic pressure re-mained significantly lower in the high flow/low pulmonary pressure compared with the high flow/high pressure group (0.37 ± 0.08 versus 0.62 ± 0.11; p < 0.005). Perioperative endothelin-1 and nitric oxide levels remained low in the low pulmonary flow group but increased progressively in both high flow groups.

Conclusions. Circulating plasma adrenomedullin appears to affect baseline vascular tone in patients with intact endothelial function. It may interact with nitric oxide and endothelin-1 to help regulate blood pressure perioperatively in patients with congenital heart disease.

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