title: Serum N-terminal atrial natriuretic peptide in adult patients late after surgical repair of atrial septal defect.
abstract: BACKGROUND
  The purpose of surgical closure of atrial septal defect (ASD) is to relieve the cardiovascular system from a haemodynamic burden. Excessive amounts of atrial peptides are released in congestive heart failure, valvular diseases and congenital heart diseases.
  
  
  OBJECTIVE
  To examine whether patients after surgical repair of ASD have higher concentrations of N-terminal atrial natriuretic peptide (ANP-N) than age-, sex- and body mass index (BMI)-matched control subjects.
  
  
  METHODS
  Medical history, physical examination, standard 12-lead electrocardiogram, and ANP-N concentrations were obtained in 65 adult patients operated for ASD at the age of 21+/-13 years (mean+/-standard deviation), 21+/-6 years after surgical closure of ASD. Sixty-seven healthy subjects matched for age, sex and BMI served as controls.
  
  
  RESULTS
  In the patients serum ANP-N was higher than in the control subjects 0.41+/-0.32 nmol/l, median 0.31 nmol/l, interquartile range (IQR) 0.21-0.49 nmol/l vs. 0.24+/-0.12 nmol/l, median 0.23 nmol/l, IQR 0.17-0.29 nmol/l, (P=0.0003). Patients with concomitant diseases had higher ANP-N concentrations (0.51+/-0.39 nmol/l, median 0.34, IQR 0.26-0.73 nmol/l) than ASD patients without any history or signs of disease (0.28+/-0.16 nmol/l, median 0.27, IQR 0.17-0.40 nmol/l, P=0.01). The 'healthy' ASD patients had higher hormone concentrations than age-, sex- and BMI-matched control subjects (0.28+/-0.16 median 0.27 nmol/l, IQR 0. 17-0.40 nmol/l and 0.21+/-0.07 nmol/l, median 0.20 nmol/l, IQR 0. 15-0.27 nmol/l, P=0.01). Multiple stepwise linear regression analysis showed that age at operation was strongly associated with the post-operative ANP-N concentration (r(2)=0.25, P=0.0002).
  
  
  CONCLUSIONS
  ASD patients have higher ANP-N concentrations late after surgical repair. Hormone levels correlate with age at operation. Our finding supports the clinical praxis of operating on these patients in their childhood and adolescence.
authors.affiliation: Department of Clinical Physiology, Tampere University Hospital, P.O. Box 2000, FIN-33520, Tampere, Finland. kljola@uta.fi
authors.forename: T E
authors.initials: TE
authors.lastname: Iivainen
authors.forename: K W
authors.initials: KW
authors.lastname: Groundstroem
authors.forename: J T
authors.initials: JT
authors.lastname: Lahtela
authors.forename: T J
authors.initials: TJ
authors.lastname: Talvensaari
authors.forename: A
authors.initials: A
authors.lastname: Pasternack
authors.forename: A
authors.initials: A
authors.lastname: Uusitalo
mesh_terms: D000328:Adult; D000368:Aged; D009320:Atrial Natriuretic Factor / Q000097:blood*; D006348:Cardiac Surgical Procedures; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000097:blood* / Q000601:surgery; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012044:Regression Analysis
chemical_list: D009320:Atrial Natriuretic Factor