A Study Evaluating the Efficacy and Safety of IV L-Citrulline for the Prevention of Clinical Sequelae of Acute Lung Injury Induced by Cardiopulmonary Bypass in Pediatric Patients Undergoing Surgery for Congenital Heart Defects
Ventricular Septal Defect, Atrioventricular Septal Defect, Primum Atrial Septal Defect
About this trial
This is an interventional prevention trial for Ventricular Septal Defect
Eligibility Criteria
Inclusion Criteria:
- Patients, parents, or legal guardian willing and able to sign informed consent
- Male and female subjects aged ≤18 years of age (females of child-bearing potential willing to practice an acceptable form of birth control)
- Patients undergoing cardiopulmonary bypass for repair of a large unrestrictive ventricular septal defect, an ostium primum/secundum atrial septal defect, or a partial or complete atrioventricular septal defect
- Pre-operative echocardiogram confirming cardiovascular anatomy and defect to be repaired
Exclusion Criteria:
Evidence of pulmonary artery or vein abnormalities that will not be addressed surgically. Specific abnormalities excluded include:
- significant pulmonary artery narrowing not amenable to surgical correction
- previous pulmonary artery stent placement
- significant left sided AV valve regurgitation not amenable to surgical correction
- pulmonary venous return abnormalities not amenable to surgical correction
- pulmonary vein stenosis not amenable to surgical correction
- Preoperative requirement for mechanical ventilation or IV inotrope support
- Presence of fixed or idiopathic pulmonary hypertension (i.e. Eisenmenger's Syndrome) prior to surgical repair
- Pre-operative use of medications to treat pulmonary hypertension
- Pregnancy; Sexually active females of child-bearing potential must be willing to practice an acceptable method of birth control for the duration of study participation (e.g. oral contraceptive, hormonal implant, intra-uterine device)
- Participation in another clinical trial within 30 days of Screening or while participating in the current study, including the 28 days of follow-up post study drug administration.
- Any condition which, in the opinion of the investigator, might interfere with the study objectives
Sites / Locations
- Children's of AlabamaRecruiting
- Children's Hospital of ColoradoRecruiting
- Heart Center, Ann & Robert H. Lurie Children's Hospital of ChicagoRecruiting
- Riley Hospital for Children at Indiana University HealthRecruiting
- Cardinal Glennon Children's HospitalRecruiting
- Duke University Medical Center Surgical Office of Clinical Research (SOCR)Recruiting
- Cincinnati Children's Hospital Medical CenterRecruiting
- Nationwide Children's Hospital- The Heart CenterRecruiting
- Seattle Children's Research InstituteRecruiting
- University of Wisconsin-MadisonRecruiting
Arms of the Study
Arm 1
Arm 2
Experimental
Placebo Comparator
Active
Placebo
Patients will receive: an L-citrulline bolus of 150 mg/kg at the initiation of cardiopulmonary bypass the addition L-citrulline to maintain a steady state target concentration of approximately 100 μmol/L of L-citrulline during cardiopulmonary bypass an L-citrulline bolus of 10 mg/kg 30 minutes after decannulation from cardiopulmonary bypass, followed immediately by a 9 mg/kg/hour continuous L-citrulline infusion or placebo for up to 48 hours post-first dose. The infusion rate will be adjusted (up or down titration of drug infusion) to achieve a target steady state concentration of 100 μmol/L. Infusion will be discontinued once invasive arterial blood pressure monitoring is discontinued or at 48 hours, whichever occurs first.
Plasmalyte A administered to the same schedule as the active treatment arm.