During treatment protocol for univentricular heart serum levels of natriuretic peptides decrease.
OBJECTIVE
In children treated for univentricular heart (UVH), prospective evaluation of serum levels of N-terminal proatriopeptide (ANPN) and N-terminal pro-brain natriuretic peptide (NT-proBNP) was performed.


METHODS
Serum samples were analysed in 19 children before the first operation, before the bi-directional Glenn (BDG) operation, at age 1 year and before total cavopulmonary connection (TCPC). In addition, we performed cross-sectional measurement of peptide levels in 32 children: 22 hypoplastic left ventricle (LV), 10 hypoplastic right ventricle (RV) before; and in 12 children: nine hypoplastic LV, three hypoplastic RV, 2 (range: 0.5-5.3) years after the TCPC operation. Controls comprised 12 children aged less than 6 months and 41 children aged from 6 months to 7 years.


RESULTS
Between the first and second operations, peptide levels decreased. Before TCPC, further decreases had occurred. Throughout follow-up, peptide levels were higher than in controls. In the cross-sectional study, before TCPC, median ANPN concentration measured 0.37 (range: 0.18-1.00) nmol l(-1) (P=0.059, compared with controls) and NT-proBNP 155 (range: 13-718) ng l(-1) (P<0.001). After TCPC, median ANPN concentration measured 0.39 (range: 0.09-0.98) nmol l(-1) (P=ns) and NT-proBNP 201 (range: 76-1406) ng l(-1) (P<0.001). Before TCPC, levels of NT-proBNP were higher in patients with RV than with LV morphology.


CONCLUSIONS
Natriuretic peptide levels decreased during treatment protocol for UVH, but NT-proBNP levels remained higher than in controls. These reflect reduction of volume overload of the single ventricle and can prove useful for haemodynamic monitoring.
Eerola
Anneli
A
Department of Pediatrics, University Hospital of Tampere, Tampere, Finland. anneli.eerola@fimnet.fi
Jokinen
Eero
E
Sairanen
Heikki
H
Pihkala
Jaana
J
D009320:Atrial Natriuretic Factor / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D018618:Echocardiography, Doppler, Color; D004812:Epidemiologic Methods; D005260:Female; D018729:Fontan Procedure / Q000379:methods; D006330:Heart Defects, Congenital / Q000097:blood / Q000601:surgery; D006352:Heart Ventricles / Q000002:abnormalities* / Q000473:pathology / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D058327:Norwood Procedures / Q000379:methods; D010446:Peptide Fragments / Q000097:blood*; D011184:Postoperative Period; D011498:Protein Precursors / Q000097:blood*
D015415:Biomarkers; C099254:N-terminal proatrial natriuretic peptide; D010446:Peptide Fragments; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor