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Ann Thorac Surg 2008;86:429-435. doi:10.1016/j.athoracsur.2008.03.068
© 2008 The Society of Thoracic Surgeons
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Yanmin Yang
Jiming Cai
Zhiwei Xu
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Original Articles: General Thoracic

Continuous Pulmonary Infusion of L-Arginine During Deep Hypothermia and Circulatory Arrest Improves Pulmonary Surfactant Integrity in Piglets

Yanmin Yang, MD*, Zhaokang Su, MD, Jiming Cai, MD, Shunmin Wang, MD, Jinfen Liu, MD, Zhiwei Xu, MD, Wenxiang Ding, MD

Department of Cardiovascular and Thoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China

Accepted for publication March 26, 2008.

* Address correspondence to Dr Yang, Cardiac Studies, Institute for Biodiagnostics, National Research Council of Canada, 435 Ellice Ave, Winnipeg, Manitoba, R3B1Y6, Canada (Email: victor.yang{at}nrc-cnrc.gc.ca).

Presented at the Forty-fourth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2008.

Background: The integrity of pulmonary surfactant (PS) is impaired during deep hypothermia and circulatory arrest (DHCA), a preferred bypass strategy for infants undergoing complex cardiac operations, due mainly to bypass-induced systemic inflammation. The requirement of L-arginine, a precursor of nitric oxide, is elevated during acute pulmonary inflammation. We hypothesized that continuous intrapulmonary supplementation of L-arginine during DHCA can maintain the integrity of PS metabolism and thus protect the pulmonary function.

Methods: Sixteen piglets underwent 90-minute circulatory arrest at 18°C before rewarming. During circulatory arrest, antegrade infusion of Ringer's lactate solution alone (n = 8) or containing L-arginine (1 mg/kg/min, n = 8) was initiated into the pulmonary circulation. Disaturated phosphatidylcholine, total phospholipids, and total proteins from tracheal aspirates were measured serially until the experiment ended (4 hours after rewarming). Various variables of pulmonary function were also monitored.

Results: L-arginine led to less decrement of disaturated phosphatidylcholine/total phospholipids and disaturated phosphatidylcholine/total proteins after DHCA. At 4 hours after rewarming, L-arginine had significantly mitigated the deterioration of pulmonary static compliance (3.6 ± 0.5 vs 3.3 ± 0.3 mL/cm H2O) and partial pressure of arterial oxygen/fraction of inspired oxygen (330 ± 48 vs 296 ± 32 mm Hg). Pulmonary retention of water (6.2 ± 1.0 vs 5.5 ± 1.2) was significantly reduced. The L-arginine-treated group showed an increase in NO metabolites (NO2 –/NO3 –) from the pulmonary circulation, the extent of which is correlated to PS content.

Conclusions: Continuous L-arginine supplementation during DHCA attenuated PS depletion and, therefore, ameliorated postoperative pulmonary dysfunction.






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