title: Prognostic significance and correlations of neurohumoral factors in early and late postoperative period after Fontan procedure.
abstract: We focused on neurohumoral activity and its clinical correlates early and late after fenestrated, lateral intra-atrial total cavopulmonary connection (TCPC). Between 2007 and 2010, we prospectively studied 28 early and 48 late postoperative TCPC patients. Plasma concentrations of vasopressin, endothelin-1, proBNP, proANP were determined. We reviewed clinical data to determine relationship between neurohumoral activation and clinical status after TCPC. There was a significant influence of preoperative ventricular end-diastolic pressure (VEDP) (P=0.008) and vasopressin concentration (P=0.02) on the appearance of prolonged pleural effusions. A significant correlation between a combined predictor (a product of preoperative vasopressin concentration and VEDP) and time of effusions (r=0.59, P=0.006) was found. The mean respiratory equivalent of carbon dioxide at peak exercise (VE/VCO(2peak)) was significantly lower in patients operated before the second year of life compared to patients operated after two years of age (27.5±1.39 vs. 48.6±3.86; P=0.039). There was a significant correlation of endothelin-1 (r=0.84; P=0.008) and proBNP (r=0.88; P=0.02) concentrations with VE/VCO(2peak). The prolonged postoperative pleural effusions can be predicted based on the product of preoperative vasopressin concentration and VEDP. Exercise performance is related to the age at TCPC. Endothelin-1 and proBNP can be useful for identification of high-risk Fontan patients.
authors.affiliation: Department of Pediatric Cardiac Surgery, Polish-American Children's Hospital, Jagiellonian University, Wielicka St. 265, 30-663 Krakow, Poland. mikolcz@gmail.com
authors.forename: Jacek
authors.initials: J
authors.lastname: Kolcz
authors.forename: Lidia
authors.initials: L
authors.lastname: Tomkiewicz-Pajak
authors.forename: Elzbieta
authors.initials: E
authors.lastname: Wojcik
authors.forename: Piotr
authors.initials: P
authors.lastname: Podolec
authors.forename: Janusz
authors.initials: J
authors.lastname: Skalski
mesh_terms: D000704:Analysis of Variance; D009320:Atrial Natriuretic Factor / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002675:Child, Preschool; D019332:Endothelin-1 / Q000097:blood*; D017079:Exercise Tolerance; D005260:Female; D018729:Fontan Procedure / Q000009:adverse effects; D006330:Heart Defects, Congenital / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010996:Pleural Effusion / Q000097:blood / Q000209:etiology; D011044:Poland; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014667:Vasopressins / Q000097:blood; D017725:Ventricular Pressure
chemical_list: D015415:Biomarkers; D019332:Endothelin-1; D014667:Vasopressins; D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor