Pulmonary hypertension (PH) is a major cause of morbi-mortality among patients with congenital heart disease (CHD) and also a potentially severe complication after surgical repair. Oral citrulline, a precursor to NO synthesis, is safe and efficacious for decreasing the risk of postoperative PH. Biomarker research holds an enormous potential for diagnostic/prognostic purposes in different states of patients.
To evaluate the levels of plasma citrulline, arginine, homocysteine and nitric oxide (NO) metabolites and pulmonary artery pressures (PAP) pre-post cardiac surgery.
16 Argentine pediatric patients with CHD undergoing cardiopulmonary bypass were randomized in two groups: (A) with and (B) without perioperative citrulline supplementation.
a) Plasma citrulline median levels before surgery were lower in both groups respect to referential values, probably due to the poor nutritional status of our patients. Group A surpassed post-surgery the minimum recommended level to avoid PH; it did not happen in group B.
b) Arginine average concentration after surgery remained constant in group A; while in group B, it decreased abruptly 12 hours post-surgery. This behavior would be attributed to the high demand of arginine in a metabolic stress situation to form NO.
c) Homocisteine post-surgery average levels in group A were into the normal range and more stable with respect to group B.
d) NO average concentration after surgery remained more stable in group A, with a significant decrease in group B at 12 hs, a critical moment in the risk of PH.
e) Mean PAP in the postoperative period, none of the patients in group A showed values higher than 20 mmHg, whereas in group B, 67% of the measurements were ≥ than that reference level.
We reafirm that citrulline supplementation may be effective in reducing postoperative pulmonary hypertension and biomarkers could evidence patient status as a translational medicine application.