Acute sternal opening after cardiac surgery in children: effect on plasma atrial natriuretic peptide.
Plasma atrial natriuretic peptide (ANP) was measured immediately before and 15 minutes after re-opening of the sternotomy and delayed sternal closure were performed to alleviate possible myocardial compression in 3 children. As acute re-opening of the sternotomy is a rare occurrence our sample size was necessarily small. ANP increased following the procedure in all 3 patients, and this was significant (p less than 0.02) when compared to plasma levels obtained from 9 children who underwent sternotomy prior to elective cardiac surgery. Following acute re-opening of the sternotomy there was an increase in median urine output and a decrease in median central venous pressure. Our results illustrate that it is atrial wall stress rather than intra-atrial pressure that determines release of ANP, and in addition suggest ANP may be a factor in the rapid clinical improvement following delayed sternal closure for atypical tamponade in children.
Burch
M
M
Brompton Hospital, London.
Lincoln
C
C
Carter
N
N
Smith
A
A
D009320:Atrial Natriuretic Factor / Q000097:blood* / Q000502:physiology; D001794:Blood Pressure; D006348:Cardiac Surgical Procedures; D002305:Cardiac Tamponade / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D004231:Diuresis / Q000502:physiology; D005260:Female; D006325:Heart Atria / Q000503:physiopathology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012086:Reoperation; D013249:Sternum / Q000601:surgery*
D009320:Atrial Natriuretic Factor