HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Yasuharu Imai Yoshinori Takanashi Makoto Nakazawa Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Hiramatsu, T. Articles by Nakazawa, M. Search for Related Content PubMed PubMed Citation Articles by Hiramatsu, T. Articles by Nakazawa, M.

Ann Thorac Surg 1998;65:761-764
© 1998 The Society of Thoracic Surgeons

---

Original Articles: Cardiovascular

Hemodynamic Effects of Human Atrial Natriuretic Peptide After Modified Fontan Procedure

Department of Pediatric Cardiac Surgery, Heart Institute of Japan, Tokyo Women’s Medical College, Tokyo, Japan
Department of Pediatric Cardiology, Heart Institute of Japan, Tokyo Women’s Medical College, Tokyo, Japan

Accepted for publication August 24, 1997.

Dr Hiramatsu, Department of Pediatric Cardiac Surgery, Heart Institute of Japan, Tokyo Women’s Medical College, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162 Japan.

Background. Reduction of pulmonary vascular resistance and maintenance of urine output are important after the modified Fontan procedure. Atrial natriuretic peptide (ANP) has the effects of a vasodilator (including the pulmonary arteries) and a physiologic diuretic, and newly synthesized human ANP is available. We measured plasma ANP levels before and after the Fontan procedure and examined the effects of human ANP on hemodynamic parameters after the Fontan procedure.

Methods. Eight patients, aged 2 to 15 years, underwent the Fontan procedure (atriopulmonary connection). Blood samples were taken before and 3 hours after operation, and plasma ANP levels were measured by radioimmunoassay. The correlation between central venous pressure and ANP was examined. Human ANP was infused intravenously at a dosage of 0.1 µg · kg^-1 · min^-1 for 1 hour after the Fontan procedure under controlled ventilation and another blood sample was obtained. Urine volume and central venous pressure were measured, and pulmonary vascular resistance and the cardiac index were calculated by the thermodilution catheter method before and after human ANP infusion. One hour after human ANP infusion was discontinued, the evaluation was repeated. No other diuretics were given and the infusion rates of catecholamine were kept constant during these measurements.

Results. Plasma ANP levels before and after the Fontan procedure were 29.1 and 54.9 pg/mL, respectively, and a positive correlation was obtained between central venous pressure and plasma ANP levels (r = 0.661, p < 0.05). Human ANP infusion significantly decreased central venous pressure and pulmonary vascular resistance, and increased urine volume and the cardiac index, whereas the plasma ANP level was elevated to 617.5 pg/mL. Systemic blood pressure did not change significantly.

Conclusions. Atrial natriuretic peptide is secreted in response to elevated central venous pressure after the Fontan procedure, but its concentration might not be sufficient. Human ANP can be a therapeutic choice after the Fontan procedure as a physiologic diuretic and a pulmonary vasodilator.

This article has been cited by other articles:

				J. M. Costello, C. L. Backer, P. A. Checchia, C. Mavroudis, R. G. Seipelt, and D. M. Goodman Effect of cardiopulmonary bypass and surgical intervention on the natriuretic hormone system in children J. Thorac. Cardiovasc. Surg., September 1, 2005; 130(3): 822 - 829. [Abstract] [Full Text] [PDF]

				H. Senzaki, S. Masutani, J. Kobayashi, T. Kobayashi, N. Sasaki, H. Asano, S. Kyo, Y. Yokote, and A. Ishizawa Ventricular Afterload and Ventricular Work in Fontan Circulation: Comparison With Normal Two-Ventricle Circulation and Single-Ventricle Circulation With Blalock-Taussig Shunts Circulation, June 18, 2002; 105(24): 2885 - 2892. [Abstract] [Full Text] [PDF]

				H. Peter Brunner-La Rocca, W. Kiowski, D. Ramsay, and G. Sutsch Therapeutic benefits of increasing natriuretic peptide levels Cardiovasc Res, August 15, 2001; 51(3): 510 - 520. [Abstract] [Full Text] [PDF]

				N. Yoshimura, M. Yamaguchi, Y. Oshima, S. Oka, Y. Ootaki, T. Hasegawa, and C. Shimazu Suppression of the secretion of atrial and brain natriuretic peptide after total cavopulmonary connection J. Thorac. Cardiovasc. Surg., October 1, 2000; 120(4): 764 - 769. [Abstract] [Full Text] [PDF]

				V E Hjortdal, E V Stenbøg, H B Ravn, K Emmertsen, K T Jensen, E B Pedersen, K H Olsen, O K Hansen, and K E Sørensen Neurohormonal activation late after cavopulmonary connection Heart, April 1, 2000; 83(4): 439 - 443. [Abstract] [Full Text]

				A. Sezai, M. Shiono, Y. Orime, H. Hata, M. Hata, N. Negishi, and Y. Sezai Low-dose continuous infusion of human atrial natriuretic peptide during and after cardiac surgery Ann. Thorac. Surg., March 1, 2000; 69(3): 732 - 738. [Abstract] [Full Text] [PDF]

				T. Hiramatsu, Y. Imai, Y. Takanashi, K. Seo, M. Terada, M. Aoki, and M. Nakazawa Time course of endothelin-1 and adrenomedullin after the Fontan procedure Ann. Thorac. Surg., July 1, 1999; 68(1): 169 - 172. [Abstract] [Full Text] [PDF]