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Increased levels of brain and atrial natriuretic peptides after the first palliative operation, but not after a bidirectional Glenn anastomosis, in children with functionally univentricular hearts

Published online by Cambridge University Press:  24 May 2005

Håkan Wåhlander ,
Andreas Westerlind ,
Göran Lindstedt ,
Per-Arne Lundberg  and
Daniel Holmgren
Håkan Wåhlander
Affiliation:
Department of Pediatrics, Division of Cardiology, The Queen Silvia Children's Hospital, Göteborg, Sweden
Andreas Westerlind
Affiliation:
Department of Pediatrics, Division of Cardiology, The Queen Silvia Children's Hospital, Göteborg, Sweden
Göran Lindstedt
Affiliation:
Department of Pediatrics, Department of Clinical Chemistry, Sahlgrenska University Hospital, Göteborg, Sweden
Per-Arne Lundberg
Affiliation:
Department of Pediatrics, Department of Clinical Chemistry, Sahlgrenska University Hospital, Göteborg, Sweden
Daniel Holmgren
Affiliation:
Department of Pediatrics, Division of Cardiology, The Queen Silvia Children's Hospital, Göteborg, Sweden
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Abstract

We evaluated the concentrations of the brain and atrial natriuretic peptides in the plasma as markers of ventricular function and volume load in children with functionally univentricular hearts. We studied 7 children aged from 0.5 to 0.7 years with functionally univentricular hearts who had undergone a first palliative operation, and 10 children aged from 1.8 to 3.7 years who had undergone a bidirectional Glenn anastomosis at ages ranging from 0.4 to 1.0 year. As a control group, we studied 14 children without heart defects aged from 0.1 to 4.5 years. Levels of the brain natriuretic peptide were measured at 8.3 to 122 ng/l, with a mean of 52.8 ng/l, after the first palliative operation, compared to 0 to 16 ng/l, with a mean of 7.3 ng/l, after a bidirectional Glenn anastomosis, and 0 to 13.8 ng/l, with a mean of 5.9 ng/l, in the children serving as controls. Corresponding values for atrial natriuretic peptide were 17 to 203 ng/l, with a mean of 103 ng/l, after the first palliative operation, compared to 16 to 54 ng/l, with a mean of 29 ng/l, after the bidirectional Glenn anastomosis, and 12 to 52 ng/l, with a mean of 32 ng/l in the controls. Echocardiography showed that all the children with functionally univentricular hearts had normal ventricular function. Blood presssure, pulmonary arterial pressure, and arterial saturations of oxygen did not differ between the groups. We conclude, that in children with functionally univentricular hearts, the volume overload imposed on the heart after the first palliative operation is associated with increased production of brain and atrial natriuretic peptides, while after ventricular unloading, levels of the natriuretic peptides return to control values.

Keywords

Univentricular heartsingle ventricleGlenn anastomosis
Type
Original Article
Information
Cardiology in the Young , Volume 13 , Issue 3 , June 2003 , pp. 268 - 274
Copyright
© 2003 Cambridge University Press

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References

Hagler DJ, Edwards WD. Univentricular Atrioventricular Connection. In: Allen HD, Clark EB, Gutgesell HP, Driscoll DJ (eds). Moss and Adams' Heart Disease in Infants, Children, and Adolescents. Lippincott Williams & Wilkins, Philadelphia, PA, USA, 2001, pp 1027–1084.
Sluysmans T, Sanders SP, van der, Velde, et al. Natural history and patterns of recovery of contractile function in single left ventricle after Fontan operation. Circulation 1992; 86: 1753–1761.Google Scholar
Uemura H, Yagihara T, Kawashima Y, et al. What factors affect ventricular performance after a Fontan-type operation? J Thorac Cardiovasc Surg 1995; 110: 405–415.Google Scholar
de Bold AJ, Bruneau BG, Kuroski dBM. Mechanical and neuroendocrine regulation of the endocrine heart. Cardiovasc Res 1996; 31: 7–18.Google Scholar
Schrier RW, Abraham WT. Hormones and hemodynamics in heart failure. N Engl J Med 1999; 341: 577–585.Google Scholar
Suzuki T, Yamazaki T, Yazaki Y. The role of the natriuretic peptides in the cardiovascular system. Cardiovasc Res 2001; 51: 489–494.Google Scholar
Bettencourt P, Ferreira A, Dias P, Castro A, Martins L, Cerqueira-Gomes M. Evaluation of brain natriuretic peptide in the diagnosis of heart failure. Cardiology 2000; 93: 19–25.Google Scholar
Tulevski II, Groenink M, van Der W, et al. Increased brain and atrial natriuretic peptides in patients with chronic right ventricular pressure overload: correlation between plasma neurohormones and right ventricular dysfunction. Heart 2001; 86: 27–30.Google Scholar
Yasue H, Yoshimura M, Sumida H, et al. Localization and mechanism of secretion of B-type natriuretic peptide in comparison with those of A-type natriuretic peptide in normal subjects and patients with heart failure. Circulation 1994; 90: 195–203.Google Scholar
Nagaya N, Nishikimi T, Okano Y, et al. Plasma brain natriuretic peptide levels increase in proportion to the extent of right ventricular dysfunction in pulmonary hypertension. J Am Coll Cardiol 1998; 31: 202–208.Google Scholar
Muders F, Kromer EP, Griese DP, et al. Evaluation of plasma natriuretic peptides as markers for left ventricular dysfunction. Am Heart J 1997; 134: 442–449.Google Scholar
Bolger AP, Sharma R, Li W, et al. Neurohormonal activation and the chronic heart failure syndrome in adults with congenital heart disease. Circulation 2002; 106: 92–99.Google Scholar
Hjortdal VE, Stenbog EV, Ravn HB, et al. Neurohormonal activation late after cavopulmonary connection. Heart 2000; 83: 439–443.Google Scholar
Ohuchi H, Hasegawa S, Yasuda K, Yamada O, Ono Y, Echigo S. Severely impaired cardiac autonomic nervous activity after the Fontan operation. Circulation 2001; 104: 1513–1518.Google Scholar
Hayabuchi Y, Matsuoka S, Kuroda Y. Plasma concentrations of atrial and brain natriuretic peptides and cyclic guanosine monophosphate in response to dobutamine infusion in patients with surgically repaired tetralogy of fallot. Pediatr Cardiol 1999; 20: 343–350.Google Scholar
Holmström H, Hall C, Thaulow E. Plasma levels of natriuretic peptides and hemodynamic assessment of patent ductus arteriosus in preterm infants. Acta Paediatr 2001; 90: 184–191.Google Scholar
Dai ZK, Huang TY, Wu JR, Huang MY, Dai ZR. Relationship between hemodynamics and plasma atrial natriuretic peptide in children with ventricular septal defect or patent ductus arteriosus. Chung Hua Min Kuo Hsiao Erh Ko I Hsueh Hui Tsa Chih 1995; 36: 86–92.Google Scholar
Matsuoka S, Kurahashi Y, Miki Y, et al. Plasma atrial natriuretic peptide in patients with congenital heart diseases. Pediatrics 1988; 82: 639–643.Google Scholar
Huang TY, Dai ZK, Wu JR, Huang MY. Relationship between left atrial pressure and atrial natriuretic peptide in children with cardiac disease. Kao Hsiung I Hsueh Ko Hsueh Tsa Chih 1995; 11: 197–204.Google Scholar
Iivainen TE, Groundstroem KW, Lahtela JT, Talvensaari TJ, Pasternack A, Uusitalo A. Serum N-terminal atrial natriuretic peptide in adult patients late after surgical repair of atrial septal defect. Eur J Heart Fail 2000; 2: 161–165.Google Scholar
Nagaya N, Nishikimi T, Uematsu M, et al. Secretion patterns of brain natriuretic peptide and atrial natriuretic peptide in patients with or without pulmonary hypertension complicating atrial septal defect. Am Heart J 1998; 136: 297–301.Google Scholar
Berman NB, Kimball TR. Systemic ventricular size and performance before and after bidirectional cavopulmonary anastomosis. J Pediatr 1993; 122: S63–S67.Google Scholar
Forbes TJ, Gajarski R, Johnson GL, et al. Influence of age on the effect of bidirectional cavopulmonary anastomosis on left ventricular volume, mass and ejection fraction. J Am Coll Cardiol 1996; 28: 1301–1307.Google Scholar
Mahle WT, Wernovsky G, Bridges ND, Linton AB, Paridon SM. Impact of early ventricular unloading on exercise performance in preadolescents with single ventricle Fontan physiology. J Am Coll Cardiol 1999; 34: 1637–1643.Google Scholar
Ohuchi H, Suzuki H, Toyohara K, et al. Abnormal cardiac autonomic nervous activity after right ventricular outflow tract reconstruction. Circulation 2000; 102: 2732–2738.Google Scholar
Fruhwald FM, Fahrleitner A, Watzinger N, et al. Natriuretic peptides in patients with diastolic dysfunction due to idiopathic dilated cardiomyopathy. Eur Heart J 1999; 20: 1415–1423.Google Scholar
Weil J, Bidlingmaier F, Dohlemann C, Kuhnle U, Strom T, Lang RE. Comparison of plasma atrial natriuretic peptide levels in healthy children from birth to adolescence and in children with cardiac diseases. Pediatr Res 1986; 20: 1328–1331.Google Scholar
Holmström H, Hall C, Stokke TO, Thaulow E. Plasma levels of N-terminal proatrial natriuretic peptide in children are dependent on renal function and age. Scand J Clin Lab Invest 2000; 60: 149–159.Google Scholar
Yoshibayashi M, Kamiya T, Saito Y, et al. Plasma brain natriuretic peptide concentrations in healthy children from birth to adolescence: marked and rapid increase after birth. Eur J Endocrinol 1995; 133: 207–209.Google Scholar