Secretion of A-type and B-type natriuretic peptides into the bloodstream and pericardial space in children with congenital heart disease.
OBJECTIVE
To determine the secretion of A-type and B-type natriuretic peptides into the bloodstream and pericardial space in children with congenital heart disease.


METHODS
Plasma and pericardial fluid samples were obtained from 77 patients undergoing total correction for congenital heart disease. All patients underwent detailed right-sided and left-sided cardiac catheterization preoperatively.


RESULTS
A-type natriuretic peptide levels in pericardial fluid were lower than those in plasma (33.0 +/- 23.1 versus 39.8 +/- 33.6 pg/mL, P <.05), and B-type natriuretic peptide levels in pericardial fluid showed marked elevations compared with those in plasma (231.9 +/- 305.6 versus 19.8 +/- 29.3 pg/mL, P <.0001). The A-type and B-type natriuretic peptide levels in plasma correlated with those in pericardial fluid (R =.522, P <.0001; R =.595, P <.0001). For A-type and B-type natriuretic peptide levels in plasma, the relation with biventricular volume had the highest correlation (R =.669, P <.0001; R =.652, P <.0001). The patients with a pulmonary-to-systemic flow ratio greater than 2 (n = 19) had high levels of natriuretic peptides not only in plasma (58.3 +/- 43.2, 40.5 +/- 49.4 pg/mL, P <.05) but also in pericardial fluid (44.4 +/- 31.5, 287.2 +/- 198.5 pg/mL, P <.05), and higher correlation between A-type and B-type natriuretic peptide plasma levels and left ventricular volume (R =.913, P <.0001; R =.787, P <.0001).


CONCLUSIONS
B-type natriuretic peptide is secreted not only into the bloodstream but also into the pericardial space in children with congenital heart disease. Natriuretic peptide levels in plasma correlated well with biventricular volume. The left ventricle was considered to be the main source of secreted natriuretic peptides in the patients with a pulmonary-to-systemic flow ratio greater than 2.
Ootaki
Yoshio
Y
Department of Cadiothoracic Surgery, Kobe's Children Hospital, Hyogo, Japan. y.ootaki@nifty.ne.jp
Yamaguchi
Masahiro
M
Yoshimura
Naoki
N
Oka
Shigeteru
S
Yoshida
Masahiro
M
Hasegawa
Tomomi
T
D000293:Adolescent; D000704:Analysis of Variance; D009320:Atrial Natriuretic Factor / Q000097:blood* / Q000378:metabolism; D015415:Biomarkers / Q000097:blood; D006328:Cardiac Catheterization / Q000379:methods; D006348:Cardiac Surgical Procedures / Q000379:methods; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006330:Heart Defects, Congenital / Q000097:blood* / Q000175:diagnosis* / Q000601:surgery; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D016014:Linear Models; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood* / Q000378:metabolism; D011300:Preoperative Care; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor