title: Suppression of the secretion of atrial and brain natriuretic peptide after total cavopulmonary connection.
abstract: OBJECTIVE
  Among the modifications of the Fontan operation currently being used, total cavopulmonary connection offers the greatest potential for optimizing early and long-term postoperative outcomes. Although studies have established that abrupt increases in right atrial pressure elevate the plasma atrial natriuretic peptide level after the Fontan procedure, changes in plasma natriuretic peptide levels after total cavopulmonary connection have not been clarified. Our hypothesis is that secretion of atrial natriuretic peptide may be suppressed in patients undergoing total cavopulmonary connection because the atrium continues to function at low pressure in those patients. In this study, we measured plasma levels of atrial and brain natriuretic peptide before and during the postoperative period in patients undergoing total cavopulmonary connection.
  
  
  METHODS
  We evaluated 60 patients: 30 patients underwent total cavopulmonary connection and 30 patients underwent definitive repair for Fallot's tetralogy. Blood samples for measurement of atrial and brain natriuretic peptide were obtained before the operation and in the postoperative period.
  
  
  RESULTS
  Plasma levels of atrial and brain natriuretic peptide were significantly lower during the early postoperative period in patients undergoing total cavopulmonary connection than in patients undergoing definitive repair for Fallot's tetralogy. No correlations were identified between the atrial natriuretic peptide levels and central venous pressure after total cavopulmonary connection.
  
  
  CONCLUSIONS
  These results suggest that total cavopulmonary connection attenuates the secretion of atrial and brain natriuretic peptide in the early postoperative period. The suppressed release of atrial and brain natriuretic peptide after total cavopulmonary connection may have clinical importance.
authors.affiliation: Department of Cardiothoracic Surgery, Kobe Children's Hospital, Kobe, Japan. ynaoki@za2.so-net.ne.jp
authors.forename: N
authors.initials: N
authors.lastname: Yoshimura
authors.forename: M
authors.initials: M
authors.lastname: Yamaguchi
authors.forename: Y
authors.initials: Y
authors.lastname: Oshima
authors.forename: S
authors.initials: S
authors.lastname: Oka
authors.forename: Y
authors.initials: Y
authors.lastname: Ootaki
authors.forename: T
authors.initials: T
authors.lastname: Hasegawa
authors.forename: C
authors.initials: C
authors.lastname: Shimazu
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D009320:Atrial Natriuretic Factor / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D005260:Female; D018729:Fontan Procedure; D006330:Heart Defects, Congenital / Q000097:blood / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D016896:Treatment Outcome
chemical_list: D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor