Relation of postoperative pulmonary hemodynamics to inflammatory proteins and unsuspected presence of viruses in the respiratory tract in pediatric subjects with congenital cardiac septal defects

• Grant number: 19/19289-7
• Support type: Regular Research Grants
• Duration: May 01, 2020 - April 30, 2022
• Field of knowledge: Health Sciences - Medicine - Medical Clinics
• Principal researcher: Antonio Augusto Barbosa Lopes
• Grantee: Antonio Augusto Barbosa Lopes
• Home Institution: Instituto do Coração Professor Euryclides de Jesus Zerbini (INCOR). Hospital das Clínicas da Faculdade de Medicina da USP (HCFMUSP). Secretaria da Saúde (São Paulo - Estado). São Paulo , SP, Brazil
• Assoc. researchers: Clarisse Martins Machado ; Claudia Regina Pinheiro Castro Grau ; Filomena Regina Barbosa Gomes Galas ; Kelly Cristina de Oliveira Abud ; Marlene Rabinovitch ; Nair Yukie Maeda

Abstract

Patients with cardiac septal defects can present hemodynamic changes in the small circulation, characterized by changes in flow and pressure, accompanied by structural adaptations in the pulmonary vascular tree ranging from pulmonary arterial smooth muscle cell hypertrophy to severe occlusive lesions. This condition may lead to disorders during the treatment of pediatric patients, particularly after cardiac surgery. It is known that preoperative hemodynamic changes are not the only factor determining the magnitude of the pulmonary vascular response. Current evidence points to the pathogenic role of biological agents (for example viruses) in systemic vessel remodeling. Other studies point to the possible association between virus and pulmonary vascular remodeling. Inflammatory mediators expressed as a result of these pathogens, have direct implication in cellular alterations that lead to vascular remodeling. However, there are no published data about the pediatric population, especially in the field of congenital heart disease. Preliminary checks, in our group, show viral genetic material in the airways, in these children, out of infectious period, remaining to investigate its implications.The goal of this study will be to verify postoperative pulmonary hemodynamic behavior comparatively between pediatric carriers and non-carriers of viral genetic material in the airways. We wish to investigate the possible association between the presence of viral genome and modifications in the profile of inflammatory proteins potentially related to vascular remodeling.Patients up to the age of three years, with non-restrictive cardiac communications will be included. The preoperative hemodynamic characteristics will be defined by a Doppler echocardiography. Virus scanning will be done on nasopharynx and trachea material using immunofluorescence and real-time polymerase chain reaction (PCR). Inflammatory mediators (36 proteins) will be analyzed in serum by immunoenzymatic assay. The postoperative pulmonary and systemic hemodynamic behavior will be studied by direct measurements using catheters, with 30 determinations in the first 72 hours after surgery.In addition to the pathophysiological implications, the results may have a critical impact on the prevention and management of complications in this population. (AU)