Published online January 2, 2008
PEDIATRICS Vol. 121 Supplement January 2008, pp. S124-S125 (doi:10.1542/peds.2007-2022DDDD)
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IMMUNOLOGY


RESPONSE OF THE IMMUNE SYSTEM TO SURGICAL STRESS IN CHILDREN WITH CONGENITAL HEART DISEASES AND CONCURRENT THYMOMEGALY

Nilufar Akhmedovaa, Diloram Akhmedovab, Barno Khalmatovaa and Bobur Salievb

a Tashkent Medical Academy, Tashkent, Uzbekistan
b Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan

ABSTRACT

INTRODUCTION: According to the World Health Organization, children with congenital heart diseases (CHDs) account for 1% of all newborns. High lethality, short lifetime, and unfavorable prognosis emphasize the urgency of the problem. According to the existing data in the literature, children with CHD often present with enlargement of the thymus. Prevention of complications after surgery directly depends on the condition of the immune system, the main organ in which is the thymus.

OBJECTIVE: Our aim was to study immune system condition in children with CHD and concurrent thymomegaly before and after surgery.

METHODS: Twenty-eight children (aged 1 month to 3 years) with CHD were observed. The control group was composed of 20 healthy children of the same age. Immunologic studies were carried out on all the children before and after surgery.

RESULTS: Before surgery, the children with CHD and thymomegaly presented a decrease of CD3+ lymphocytes by 1.2 times and CD4+ lymphocytes and immunoregulatory index by 1.5 times compared with the control children, with humoral immunity parameters being within normal limits. There was a characteristic increase of natural killer cell activity (CD16+) by 1.2 times and an insignificant increase of relative and absolute content of CD20+ cells. After surgery for CHD, a decrease of CD3+ and CD4+ cells and a sharp decrease of immunoregulatory index and relative content of lymphocytes was found compared with both the data before surgery (P < .05) and control values (P < .01). In the majority of children with CHD, a significant increase of CD95+ (P < .05) and CD25+ (P > .05) cells was noted compared with those before surgery, whereas the number of CD38+ cells was sharply reduced, which indicates depletion of compensatory capabilities of children after surgery.

CONCLUSIONS: Low content of activation markers, especially CD95+ cells before surgery and CD38+ cells after surgery, is an unfavorable prognostic sign in children with CHD and concurrent thymomegaly.

Submitted by Nilufar Akhmedova