Ann Thorac Surg 2008;86:693-694. doi:10.1016/j.athoracsur.2008.02.064
© 2008 The Society of Thoracic Surgeons
Correspondence
Plasma Levels of Brain Natriuretic Peptide in Children With Left-To-Right Shunt Before and After Cardiac Surgery
Andreas M.E. Koch, MD
Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, University of Erlangen-Nürnberg, Loschgestr. 15, Erlangen D-91054, Germany
(Email: andreas.koch{at}uk-erlangen.de).
To the Editor:
Mainwaring and collegues [1] reported brain natriuretic peptide (BNP) levels in 18 children and adolescents before and after ventricular septal defect repair. We agree with their conclusions regarding the correlation of BNP levels with volume load. In the last years, we have measured the BNP in almost 200 healthy children [2] and more than 700 patients with congenital and acquired heart disease [3–6] using the Triage BNP test (Biosite Inc, San Diego, CA) [7]. Within these examinations we analyzed 74 children with left-to-right shunts due to atrial and ventricular septal defects. The plasma BNP levels were increased in these patients in comparison with the normals group (mean standard deviation score, +1.63; p < 0.001) and was positively correlated to shunt volume (r = 0.66; p < 0.001), to systolic right ventricular pressure (r = 0.69; p < 0.001), to mean pressure of the pulmonary artery (0.66; p < 0.001), and to increasing pulmonary resistance (r = 0.59; p < 0.001) [4]. In addition, we prospectively analyzed the effect of cardiac surgery on plasma BNPs in children with congenital heart disease. The cardiac diagnoses were atrial septal defect in 13 of 65 patients and ventricular septal defect in 12 of 65. The BNP levels significantly increased after cardiac surgery and remained significantly elevated during the first week (p < 0.001). After a first peak mean of 1.3 days (standard deviation, 0.7 days) after surgery there was a significant decrease of plasma BNP followed by a second peak of 5.1 days (1.1 days) after surgery. Postoperative BNP plasma concentration was correlated to BNP before surgery (r = 0.58; p < 0.001) to cardiopulmonary bypass time (r = 0.52; p < 0.001) and to serum lactate concentration on the first day after surgery (r = 0.49; p < 0.001) [5]. Almost exactly the same biphasic pattern was found in patients after myocardial infarction with two peaks at 16 hours and 5 days after admission [8]. In the rat heart, experimental ischemia leads to an increase of BNP messenger RNA in the ventricular myocardium and exogenously administered BNP-limited infarct size in a concentration-dependent matter [9, 10]. According to these findings, we assume that plasma BNP levels increase immediately after cardiac surgery, despite hemodynamic unloading, might be explained by a cytoprotective role of BNP.
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- Mainwaring RD, Parise C, Wright SB, Juris AL, Achtel RA, Fellah H. Brain natriuretic peptide levels before and after ventricular septal defect repair Ann Thorac Surg 2007;84:2066-2069.[Abstract/Free Full Text]
- Koch A, Singer H. Normal values of B-type natriuretic peptide in infants, children, and adolescents Heart 2003;89:875-878.[Abstract/Free Full Text]
- Koch A, Zink S, Singer H. B-type natriuretic peptide in patients with congenital heart disease Eur Heart J 2006;27:861-866.[Abstract/Free Full Text]
- Koch A, Kitzsteiner T, Zink S, Cesnjevar R, Singer H. Impact of cardiac surgery on plasma levels of B type natriuretic peptide in children with congenital heart disease Int J Cardiol 2007;114:339-344.[Medline]
- Koch A, Zink S, Singer H. B type natriuretic peptide in patients with systemic right ventricle Cardiology 2008;110:1-7.[Medline]
- Koch A, Zink S, Singer H, Dittrich S. B-type natriuretic peptide levels in patients with functionally univentricular hearts after cavopulmonary connection Eur J Heart Fail 2008;10:60-62.[Abstract/Free Full Text]
- Del Ry S, Giannessi D, Clerico A. Plasma brain natriuretic peptide measured by fully-automated immunoassay and by immunoradiometric assay compared Clin Chem Lab Med 2001;39:446-450.[Medline]
- Morita E, Yasue H, Yoshimura M, et al. Increased plasma levels of brain natriuretic peptide in patients with acute myocardial infarction Circulation 1993;88:82-91.[Abstract/Free Full Text]
- D'Souza SP, Yellon DM, Martin C, et al. B-type natriuretic peptide (BNP) limits infarct size in rat isolated heart via K-ATP channel opening Am J Physiol Heart Circ Physiol 2003;284:H1592-H1600.[Abstract/Free Full Text]
- Hama N, Itoh H, Shirakami G, et al. Rapid ventricular induction of brain natriuretic peptide gene expression in experimental acute myocardial infarction Circulation 1995;92:1558-1564.[Abstract/Free Full Text]
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