Brain natriuretic peptide and magnetic resonance imaging in tetralogy with right ventricular dilatation.
BACKGROUND
Cardiac volumetry by magnetic resonance imaging can guide the timing for reoperation in minimally symptomatic or asymptomatic patients with pulmonary insufficiency after corrected tetralogy of Fallot. Pro-brain natriuretic peptide (BNP) is a marker of ventricular dysfunction and wall stress, and levels may complement magnetic resonance imaging in cardiac assessment before and after pulmonary valve replacement.


METHODS
Between May 2004 and October 2005, 23 consecutive patients with corrected tetralogy, severe pulmonary insufficiency, and right ventricular end-diastolic volume index greater than 150 mL/m2 underwent elective pulmonary valve replacement. Plasma proBNP levels and magnetic resonance imaging were obtained before and 6 months after pulmonary valve replacement.


RESULTS
There was no surgical mortality or morbidity. Preoperative right ventricular end-diastolic volume index correlated with pulmonary insufficiency, and inversely so with left ventricular ejection fraction, reflecting interventricular interaction. Preoperatively (r = -0.47) and 6 months postoperatively (r = -0.54), log BNP was inversely correlated with right ventricular ejection fraction. Mean preoperative proBNP levels, right ventricular end-diastolic volume index, and pulmonary insufficiency significantly (p < 0.0001) diminished 6 months after pulmonary valve replacement (231 versus 114 ng/L, 184 versus 109 mL/m2, and 44% versus 2%, respectively).


CONCLUSIONS
Plasma proBNP is elevated in patients with corrected tetralogy, severe pulmonary insufficiency, and right ventricular dilatation, and it significantly diminishes 6 months after pulmonary valve replacement, mirroring magnetic resonance imaging-documented better right ventricular ejection fraction and smaller right ventricular end-diastolic volume index. Pro-brain natriuretic peptide complements magnetic resonance imaging for cardiac assessment in patients requiring pulmonary valve insertion. Future validation of cutoff levels are required to establish proBNP as a useful diagnostic and follow-up tool in patients with chronic pulmonary insufficiency and failing right ventricles.
Dodge-Khatami
Ali
A
Division of Congenital Cardiovascular Surgery, University Children's Hospital, University of Zürich, Zürich, Switzerland. ali.dodge-khatami@kispi.unizh.ch
Büchel
Emanuela Valsangiacomo
EV
Knirsch
Walter
W
Kadner
Alexander
A
Rousson
Valentin
V
Dave
Hitendu H
HH
Bauersfeld
Urs
U
Prêtre
René
R
D015415:Biomarkers; D002675:Child, Preschool; D018450:Disease Progression; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D017380:Hypertrophy, Right Ventricular / Q000097:blood / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D007223:Infant; D008279:Magnetic Resonance Imaging; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D011665:Pulmonary Valve Insufficiency / Q000097:blood / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D012086:Reoperation; D013318:Stroke Volume; D013771:Tetralogy of Fallot / Q000097:blood / Q000473:pathology / Q000601:surgery*; D013997:Time Factors
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain