Drug protects infants with high-risk heart defect from neurologic and cardiac injury after heart surgery

Philadelphia, Pa. A drug used to treat gout in adults also helps protect infants from neurological and cardiac injury after heart surgery for a high-risk birth defect, according to researchers at The Childrens Hospital of Philadelphia. The drug, allopurinol, benefited infants with hypoplastic left heart syndrome (HLHS), in which a severely underdeveloped left ventricle is unable to pump enough blood to the body.

The research team, reporting in the July 2001 issue of the journal Pediatrics, compared 131 infants with HLHS to 187 infants having lower-risk heart defects. "We found that infants with HLHS treated with allopurinol had significantly fewer seizures than those not treated, and significantly fewer cardiac events, such as acute reductions in heart and respiratory rate," said pediatric neurologist Robert R. Clancy, M.D., of Childrens Hospital, the studys lead author. Allopurinol had no corresponding benefit for infants in the study with lower-risk heart conditions.

All 318 infants underwent heart surgery that required cardio-pulmonary bypass and deep hypothermic circulatory arrest (DHCA) in which blood circulation is halted under low-temperature conditions. "This was the first study of neuro-cardiac protection in infants with congenital heart disease who had surgery using DHCA," added Dr. Clancy. Allopurinol caused no significant adverse effects in any of the infants studied.

Allopurinol is commonly used to treat gout in adults. Previous studies in other diseases showed allopurinol could protect the heart and nervous system. Dr. Clancy said the benefits seen in this study may result from the drugs ability to scavenge or inhibit the production of oxygen free radicals, tissue-damaging chemicals produced during circulatory arrest.

Before reconstructive surgery was introduced in the early 1980s, HLHS was invariably fatal in early childhood. Survival rates for HLHS have been improving over the past 20 years, although children wi

Contact: John Ascenzi
Children's Hospital of Philadelphia

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