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Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response.  Labels: OBJECTIVE, METHODS, METHODS, RESULTS. Meshes: Adrenergic beta-Antagonists, Enzyme-Linked Immunosorbent Assay, Heart Defects, Congenital, Heart Failure, Humans, Infant, Infant, Newborn, Nitric Oxide, Propranolol, Pulmonary Circulation, Receptors, Tumor Necrosis Factor.
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Are endogenous nitric oxide and soluble tumor necrosis factor receptor levels enhanced in infants with congenital heart disease? Context: This study was designed to investigate cytokine and nitric oxide levels in pediatric patients suffering from chronic heart failure and to investigate effects of beta-blocker treatment on these levels. Fifteen infants with heart failure resulting from left-to-right shunts with pulmonary overcirculation were compared with 11 infants with cyanotic heart defects with reduced pulmonary blood flow. Four of these patients were finally treated with the beta-blocker propranolol. Endogenous nitric oxide production was determined by measuring total plasma nitrite/nitrate (Griess method), and levels of soluble tumor necrosis factor receptors type 1 and type 2 (TNF-R1 and TNF-R2, respectively) were measured by commercially available enzyme-linked immunosorbent assay. In infants with left-to-right shunts, soluble tumor necrosis factor receptor levels were significantly elevated as compared with infants with cyanosis (TNF-R1: 1.7 +/- 0.5 vs. 0.8 +/- 0.3 ng/mL; p =.0003; TNF-R2: 8.1 +/- 4.0 vs. 5.1 +/- 3.2 ng/mL; p =.049). In addition, we found a significant correlation between nitrate/nitrite levels and TNF-R1 (r =.70; p =.0001) or TNF-R2 (r =.62; p =.0013), respectively. Furthermore, the tumor necrosis factor receptor levels in four children after beta-blocker treatment were lower as compared with levels before beta-blocker treatment.
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Immune mechanisms, such as cytokine or nitric oxide production, may be involved in pathogenesis of heart failure in children, and may contribute to the beneficial effects of beta-blocker treatment observed in these patients. Final Decision: yes