Value of brain natriuretic peptide in the perioperative follow-up of children with valvular disease.
OBJECTIVE
To characterize N-terminal pro-brain natriuretic peptide (N-proBNP) and troponin I (TnI) profile following mitral and/or aortic valve surgery and to evaluate correlations with echocardiography measures and outcome criteria.


METHODS
Prospective cross-controlled study in a university children's hospital.


METHODS
Twenty children with acquired valvular disease requiring valvular surgery.


METHODS
We prospectively studied clinical, biochemical, and echocardiographic characteristics at baseline and 6, 12, 24 h and 3-4 weeks postoperatively.


RESULTS
TnI peaked 6 h after surgery and remained elevated during the first 24 h. N-proBNP was significantly lower 3-4 weeks after surgery than during the perioperative period. Overall, N-proBNP was correlated with the Pediatric Heart Failure Index, left ventricle shortening fraction, left atrium to aorta ratio, left ventricle mass index, end-systolic wall stress, and with outcome measures such as inotropic score, duration of inotropic support, and ICU length of stay. Preoperative N-proBNP was significantly more elevated in patients with complicated outcome than in patients with uneventful postoperative course.


CONCLUSIONS
In pediatric valvular patients, perioperative N-proBNP is a promising risk stratification predicting factor. It is correlated with evolutive echocardiographic measures, need for inotropic support, and ICU length of stay.
Tissières
Pierre
P
ICU Research Laboratory, Department of Microbiology and Molecular Medicine, University of Geneva Medical School, CMU, Rue Michel-Servet 1, Geneva 4, Switzerland. Pierre.Tissieres@medecine.unige.ch
da Cruz
Eduardo
E
Habre
Walid
W
Aggoun
Yacine
Y
Mensi
Noury
N
Kalangos
Afksendyios
A
Beghetti
Maurice
M
D015415:Biomarkers / Q000097:blood*; D002648:Child; D004452:Echocardiography; D006349:Heart Valve Diseases / Q000097:blood* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011446:Prospective Studies; D012372:ROC Curve; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood
D015415:Biomarkers; D019210:Troponin I; D020097:Natriuretic Peptide, Brain