spasm in the cardiomyopathic Syriam hamster: a preventable cause of focal myocardial necrosis. Circulation 1982;66:342–354. 14. Wincker P, Britto C, Borges Pereira JB, Cardoso MA, Oelemann W, Morel CM.Use of amplified polymerase chain reaction procedure to detect Trypano- soma cruzi in blood samples from chonic chagasic patients in a rural endemic area. Am J Trop Med Hyg 1994;15:771–774. 15. Britto C, Cardoso MA, Monteiro Vanni CM, Hasslocher-Moreno A, Xavier SS, Oelemann W, Santoro A, Pirmez C, Morel CM, Wincker P. Polymerase chain reaction detection of Trypanosoma cruzi in human blood samples as a tool for diagnosis and treatment evaluation. Parasitology 1995;110:241–247. 16. Salomone OA, Juri D, Omelianuk MO, Sembaj A, Aguerri AM, Carriazo C, Moreno Barral J, Madoery RJ. Prevalence of circulating Trypanosoma cruzi detected by Polimerase Chain Reaction in patients with Chagas’ cardiomyopathy. Am J Cardiol 2000;85:1274 –1276. 17. Andrade ZA, Andrade SG, Correa R, Sadigursky M, Ferrans VJ. Myocardial changes in acute Trypanosoma cruzi infection: ultraestructural evidence of im- mune damage and the role of microangiopathy. Am J Pathol 1994;144:1403– 1411. 18. Guarda E, Katwa LC, Myers PR, Tyagi SC, Weber KT. Effects of endothelins on collagen turnover in cardiac fibroblasts. Cardiovasc Res 1993;27:2130 –2134. 19. Hocher B, George I, Rebstock J, Bauch A, Schwarz A, Neumayer HH, Bauer C. Endothelin system-dependent cardiac remodeling in renovascular hyperten- sion. Hypertension 1999;33:816 – 822. 20. Dashwood MR, Thomas PK. Neurovascular (125I)-ET-1 binding sites on human peripheral nerve. Endothelium 1997;5:119 –123. Relation of Early Pleural Effusion After Pediatric Open Heart Surgery to Cardiopulmonary Bypass Time and Systemic Inflammation as Measured by Serum Interleukin-6 Monesha Gupta, MBBS , Rosemary Johann-Liang, MD, Cristina P. Sison, PhD , Jan Quaegebeur, MD, and Deborah M. Friedman, MD W e examined the role of serum interleukin-6 (IL-6) as an indirect mediator of capillary per- meability and marker for systemic inflammation 1–7 in early postoperative pleural effusions. We hypothe- sized thatpostcardiopulmonary systemic inflamma- tion may be mediated by proinflammatory cytokines and that their activation may play a role in the early pleural effusion, even in the Fontan or Glenn types of physiology. Thus, pleural effusions may be amenable to anti-inflammatory therapy 8 or to changes aimed at modulation of the initial insult, postcardiopulmonary bypass. 9,10 The modified Fontan and the Glenn proce- dures are steps in series of operations that are per- formed fora single ventricle in complex, cyanotic congenital heartdisease. These procedures are asso- ciated with high central venous pressures postopera- tively and are associated with early and late pleural effusions. 11–18 Other congenital heart surgeries, with- outevidence of a high central venous pressure, are also associated at times with large pleural effusions. 19 • • • The study was performed at a single center and the protocol was approved by the Institutional Review Board. It was a prospective, blinded, clinical observa- tionalinvestigation involving pediatric patients who underwent open heart surgeries between 1997 and 1998.Two surgeons performed the operations. In- formed consent was required from parents or guard- iansbefore enrollment into the study. Twenty-two consecutive children requiring elective cardiopulmo- nary bypass (CPB) surgery for congenital heartdis- ease formed the study cohort. The patients underwent the following open heart surgeries: modified Fontan procedure (4 patients), bidirectional Glenn procedure (1 patient), repair of atrial septal defect(5 patients), repair of ventricular septal defect(4 patients), repair of atrioventricular canal defect (3 patients), repair of tetralogy of Fallot (3 patients), removal of a suprami- tral stenosing ring (1 patient), and repair of tricuspid valve (1 patient). Three of the modified Fontan pro- cedures were fenestrated and 1 was an extracardiac conduitplacement. All patients who underwent the Fontan procedure had undergone the Glenn procedure in the past and all their hepatic veins were shunted into pulmonary circulation after surgery. The patients were divided into 2 groups based on their operative physi- ology.Group I(n 5 5) included the patients who underwent a cavopulmonary anastomosis (Fontan or Glenn procedure) and were expected to have higher systemic venous pressures postoperatively. Group II (n 5 17) patients underwent the remaining types of procedures. All patients required sternotomy to access the heart and all patients were placed on a CPB machine. The cardiopulmonary unit consisted of a membrane oxy- genator (Terumo, New Jersey), rollerpump (Cobe, Arvada,Colorado),non– heparin-coated polyvinyl chloride circuit tubing (Cobe, with an arterial filter), and hemoconcentrator (Minntech HP 400, Minneapo- lis, Minnesota). The cardiopulmonary unit was primed with donorblood when needed and an electrolyte solution with albumin, mannitol, and heparin. Flow rate was maintained at 2.2 L/min/m 2 and hematocrit was maintained at $25%. Myocardial protection was obtained with 15 ml/kg of cardioplegia solution at 4°C that contained dextrose water to which sodium bicar- bonate, mannitol, and potassium chloride were added. Core temperature was loweredand hypothermia From the Division of Pediatric Cardiology, New York Presbyterian Hospital, College of Physicians and Surgeons of Columbia University and WeillMedicalCollege of Cornell University; Division of Pediatric Infectious Diseases, New York Presbyterian Hospital, Weill Medical College of Cornell University; and Department of Research, Division of Biostatistics, North Shore University Hospital, New York, New York. Dr. Gupta’s address is: Division of Pediatric Cardiology, MMC 94, 420 Delaware Street S.E., Minneapolis, Minnesota 55455. E-mail: gupta030@tc.umn.edu. Manuscript received May 12, 2000; revised manuscript received and accepted December 15, 2000. 1220 ©2001 by Excerpta Medica, Inc. All rights reserved. 0002-9149/01/$–see frontmatter The American Journal of Cardiology Vol. 87 May 15, 2001 PII S0002-9149(01)01503-X