Dextran sulfate as a leukocyte-endothelium adhesion molecule inhibitor of lung injury in pediatric open-heart surgery

BACKGROUND: In spite of the progress in operative techniques and pre- and postoperative management for congenital heart disease, lung injury induced by the extracorporeal circulation is still a serious insult in pediatric open-heart operations. To prevent this injury, we used a leukocyte-endothelial cell adhesion molecule blocking agent, dextran sulfate, in a clinical setting. METHODS: Sixty mg/kg of dextran sulfate (DS) was intravenously infused to the patients just before cardiopulmonary bypass was started and 600 mg was added to the bypass circuit prime. Thirty patients (DS group, 14 patients with atrial septal defect, and 16 patients with ventricular septal defect) were compared with age and body-weight matched control patients (control group, 14 patients with atrial septal defect, 11 patients with ventricular septal defect). Postoperative respiratory index, white blood cell counts, complement C3 and plasma granulocyte elastase levels during and after the operation were measured. RESULTS: Respiratory index just after the termination of cardiopulmonary bypass was better preserved in the DS group than in the control group (0.50 +/- 0.08 versus 0.81 +/- 0.12, p < 0.01). The sum total amount of measured granulocyte elastase across whole study period was significantly lower in the DS group (p < 0.05). CONCLUSIONS: The data suggeste the possible effects of dextran sulfate in ameliorating post-perfusion lung damage by interfering with leukocyte-endothelial cell adhesion in pediatric open-heart operations. Future application to patients with more complex anomalies is anticipated.