OBJECTIVETo study lung protection by perfusion with hypothermic protective solution to the pulmonary artery during total correction of tetralogy of Fallot (TOF).

METHODSSixty-four consecutive children with TOF were randomly divided into control group (n = 30) and lung protective group (n = 34). The way of lung protection in the lung protective group was to perfuse with hypothermic protective solution to the pulmonary artery. Patients in the control group were subjected to routine approach. Patients' hemodynamics and lung functions were monitored. Plasma malondialdehyde (MDA), TNF-alpha and IL-6, IL-8 in tracheal suction were measured. Lung biopsy specimens were obtained after operations to study histological changes.

RESULTSThe oxygen index was higher in the lung protect group than in the control group at 6 h, 12 h and 24 h after operation (t = 2.400, P < 0.05; t = 3.898, P < 0.01; t = 3.339, P < 0.01, respectively). The time for ICU and mechanical ventilation was significantly less in the lung protective group than in the control group (t = -2.652, P < 0.05; t = -2.081, P < 0.05). The level of MDA was lower in the lung protective group than in the control group at 0 h and 6 h after operations (t = -4.255, P < 0.01; t = -2.372, P < 0.05 respectively). The level of TNF-alpha was lower in the lung protective group than in the control group at 0 h, 6 h and 24 h after operation (t = 3.112, P < 0.01; t = 3.072, P < 0.01; t = 2.306, P < 0.05, respectively). The levels of IL-6, IL-8 in tracheal suction were lower in the lung protective group (t = -2.419, P < 0.05; t = -2.613, P < 0.01). Tissue examination showed intraalveolar edema, capillary hyperemia, leukocytes accumulated, and mitochondria swelling in the control group, whereas no change in the lung protective group.

CONCLUSIONPerfusion with hypothermic protective solution to the pulmonary artery in CPB could reduce lung injury during the total correction of TOF.