Ann Thorac Surg 2004;78:1885-1886
© 2004 The Society of Thoracic Surgeons
Correspondence
Reply
Yoshio Ootaki, MD, PhD
Department of Biomedical EngineeringLerner Research Institute The Cleveland Clinic Foundation, 9500 Euclid AveND3-100, Cleveland, OH 44195, USA
Masahiro Yamaguchi, MD, PhD,
Naoki Yoshimura, MD, PhD,
Shigeteru Oka, MD, PhD,
Masahiro Yoshida, MD,
Tomomi Hasegawa, MD
Department of Cardiothoracic Surgery, Kobe Children's Hospital, 1-1-1 Takakuradai, Suma-kuKobe, Hyogo, Japan
ootakiy{at}bme.ri.ccf.org
To the Editor:
We thank Drs Arena and Ferrero for their comments about our recent article [1]. We agree that platelet count could have affected serum VEGF levels in our study, and that plasma VEGF levels may be less affected by platelet counts. However, with respect to proliferation of abnormal vessels in congenital heart disease, do only plasma VEGF levels play an important role? Wynendaele and associates [2] reported that plasma VEGF levels more accurately reflect tumor progression, whereas Lee and colleagues [3] found that serum VEGF values more accurately predict tumor progression. The discussion of whether serum VEGF or plasma VEGF levels should be used as a marker of tumor progression or recurrence is ongoing [4].
Figure 1 illustrates the platelet counts in our study groups. Platelet counts were significantly higher in children with acyanotic heart disease (group N) (271 ± 68 x 109/L) than in children with cyanotic heart disease (group C) (237 ± 73 x 109/L; p = 0.0049). However, serum VEGF levels were significantly higher in group C than in group N (p < 0.001) [1]. Platelet counts in the subgroup with functional single ventricle associated with asplenia syndrome were the highest. However, there were no significant differences between groups with the exception of acyanotic group N and patients with pulmonary atresia associated with ventricular septal defect (p = 0.03). These results suggest that serum VEGF levels were affected not only by platelet counts but also by other factors. Recently, activation of platelets in cyanotic congenital heart disease was reported [5, 6]. Platelet contents may play an important role in serum VEGF levels.
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Fig 1. Platelet counts in group with acyanotic congenital heart disease (N), group with cyanotic congenital heart disease (C), and subgroups of group C. (C-A = functional single ventricle associated with asplenia syndrome; C-PA = pulmonary atresia associated with ventricular septal defect; C-O = other cyanotic heart disease; C-SV = functional single ventricle without asplenia syndrome.)
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To date, most studies concerning VEGF levels have been related to oncology. Further studies will be needed to clarify the effects of VEGF, plasma and serum levels of VEGF, and platelet numbers and contents on angiogenesis in congenital heart disease.
References
- Ootaki Y, Yamaguchi M, Yoshimura N, Oka S, Yoshida M, Hasegawa T. Vascular endothelial growth factor in children with congenital heart disease. Ann Thorac Surg. 2003;75:1523–1526[Abstract/Free Full Text]
- Wynendaele W, Derua R, Hoylaerts MF, et al. Vascular endothelial growth factor measured in platelet poor plasma allows optimal separation between cancer patients and volunteers: a key to study an angiogenic marker in vivo? Ann Oncol. 1999;10:965–971[Abstract/Free Full Text]
- Lee JK, Hong YJ, Han CJ, Hwang DY, Hong SI. Clinical usefulness of serum and plasma vascular endothelial growth factor in cancer patients: which is the optimal specimen? Int J Oncol. 2000;17:149–152[Medline]
- Verheul HM, Pinedo HM. The importance of platelet counts and their contents in cancer. Clin Cancer Res. 2003;9:3219–3221[Free Full Text]
- Kierzkowska B, Stanczyk J, Wiectawska B, et al. Activation of circulating platelets and platelet response to activating agents in children with cyanotic congenital heart disease: their relevance to palliative systemic-pulmonary shunt. Int J Cardiol. 2001;79:49–59[Medline]
- Horigome H, Hiramatsu Y, Shigeta O, Nagasawa T, Matsui A. Overproduction of platelet microparticles in cyanotic congenital heart disease with polycythemia. J Am Coll Cardiol. 2002;39:1072–1077[Abstract/Free Full Text]
