Brain natriuretic peptide levels before and after ventricular septal defect repair

Sutter Medical Center, Sacramento, California, United States
The Annals of thoracic surgery (Impact Factor: 3.65). 12/2007; 84(6):2066-9. DOI: 10.1016/j.athoracsur.2007.07.021
Source: PubMed

ABSTRACT Brain natriuretic peptide is a relatively recently discovered circulating mediator that has been correlated with the degree of heart failure in adults. This study evaluated the preoperative and postoperative brain natriuretic peptide levels in infants and children undergoing ventricular septal defect repair.
The study enrolled 18 infants and children (ages 2 months to 15.6 years) scheduled for surgical repair of their ventricular septal defects. Brain natriuretic peptide levels were drawn preoperatively and then postoperatively at 1, 24, 48, and 72 hours. The amount of shunt (the ratio of pulmonary blood flow [Q(p)]/systemic blood flow [Q(s)]) through the ventricular septal defect was determined by saturation levels performed in the catheterization laboratory or intraoperatively.
The preoperative brain natriuretic peptide levels (pg/mL) averaged 78 +/- 57, and the postoperative levels were 168 +/- 241 at 1 hour, 418 +/- 330 at 24 hours, 405 +/- 364 at 48 hours, and 391 +/- 397 at 72 hours. These differences were significant for each postoperative time point compared with preoperative values. Preoperative brain natriuretic peptide and the Q(p)/Q(s) were significantly correlated (age-adjusted R(2) = 0.33, p < 0.001).
Brain natriuretic peptide levels have a close correlation with the physiologic volume load caused by ventricular septal defects. The preoperative brain natriuretic peptide levels were also found to be predictive for the postoperative time course of brain natriuretic peptide level changes. These results suggest that brain natriuretic peptide levels may be a useful clinical marker in infants and children with ventricular septal defects.

  • Turkish Journal of Thoracic and Cardiovascular Surgery 04/2015; 23(2):209-216. DOI:10.5606/tgkdc.dergisi.2015.10469 · 0.14 Impact Factor
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    ABSTRACT: Plasma atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) levels increase after cardiopulmonary bypass (CPB) in pediatric patients. However, the exact reason for the postoperative increase remains unclear. This study elucidated the perioperative changes in plasma natriuretic peptide levels in children undergoing surgical isolated atrial septal defect (ASD) closure. Between 2010 and 2012, 24 pediatric patients (median 7.1, range 2.7-15.7 years) underwent surgery for simple ASD using CPB under ventricular fibrillation (Group A, 16 patients) or under cardiac arrest (Group B, 8 patients). Natriuretic peptide levels were measured before surgery, on postoperative day 0, 1, 3, and at the first outpatient visit. The pulmonary to systemic blood flow ratio (Qp/Qs) was estimated by echocardiography using an index of right ventricle end-diastolic area. Preoperative natriuretic peptide levels positively correlated with the Qp/Qs. Plasma ANP levels peaked on postoperative day 0, and its values were higher in Group A than in Group B patients (p < 0.001). Plasma BNP levels increased significantly in both Groups on postoperative day 1, and its values were significantly greater in Group A than in Group B patients (p = 0.007). There was a weak negative correlation between the amount of postoperative increase in natriuretic peptide levels and the Qp/Qs. There was no appreciable difference in the acute postoperative clinical course and echocardiographic parameter on postoperative day 3 between Group A and B patients. In conclusion, acute postoperative natriuretic peptide levels after isolated ASD closure were multifactorial, and they might be unreliable for predicting clinical outcomes.
    Pediatric Cardiology 03/2015; DOI:10.1007/s00246-015-1148-y · 1.55 Impact Factor
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    ABSTRACT: Background and aimThe plasma concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP) can reflect the cardiac functions in patients with cardiac diseases. Our aim is to assess the value of NT-proBNP in the diagnosis of heart failure and evaluation of cardiac functions in pediatric patients with ventricular septal defect (VSD).Patients and methodThe study comprised 40 children with VSD (mean age 12 ± 5 months) and 20 healthy children as a control group. Detailed echocardiographic examination was performed and the level of NT-proBNP level was measured.ResultsThe plasma level of NT-proBNP was significantly higher in patients with VSD than in control subjects (P < 0.05). Also, it was significantly increased in VSD patients with congestive heart failure (CHF) than those without heart failure (P < 0.05). Moreover, NT-proBNP level increased with increasing severity of clinical symptoms. There were positive correlations between NT-proBNP level and left ventricular end diastolic diameter, left ventricular end systolic diameter, estimated systolic pulmonary artery pressure and VSD size and negative correlations with ejection fraction (EF) and fractional shortening (FS) in VSD patients with or without heart failure. The plasma levels of NT-proBNP with cutoff value of 101 fmol/ml (854 pg/ml), predicted CHF with a sensitivity of 90.0%, specificity of 80%, and area under ROC curve was 0.980.ConclusionNT-proBNP level is a good marker of disease severity and correlates with echocardiographic measurements and clinical symptoms in pediatric patients with VSD.
    12/2012; 64(4):241–246. DOI:10.1016/j.ehj.2012.08.003



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