title: [The predictive value of plasma B-type natriuretic peptide levels on outcome in children with pulmonary hypertension undergoing congenital heart surgery].
abstract: OBJECTIVE
  In children undergoing congenital heart surgery, plasma brain natriuretic peptide levels may have a role in development of low cardiac output syndrome that is defined as a combination of clinical findings and interventions to augment cardiac output in children with pulmonary hypertension.
  
  
  METHODS
  In a prospective observational study, fifty-one children undergoing congenital heart surgery with preoperative echocardiographic study showing pulmonary hypertension were enrolled. The plasma brain natriuretic peptide levels were collected before operation, 12, 24 and 48h after operation. The patients enrolled into the study were divided into two groups depending on: (1) Development of LCOS which is defined as a combination of clinical findings or interventions to augment cardiac output postoperatively; (2) Determination of preoperative brain natriuretic peptide cut-off value by receiver operating curve analysis for low cardiac output syndrome. The secondary end points were: (1) duration of mechanical ventilation ≥72h, (2) intensive care unit stay >7days, and (3) mortality.
  
  
  RESULTS
  The differences in preoperative and postoperative brain natriuretic peptide levels of patients with or without low cardiac output syndrome (n=35, n=16, respectively) showed significant differences in repeated measurement time points (p=0.0001). The preoperative brain natriuretic peptide cut-off value of 125.5pgmL-1 was found to have the highest sensitivity of 88.9% and specificity of 96.9% in predicting low cardiac output syndrome in patients with pulmonary hypertension. A good correlation was found between preoperative plasma brain natriuretic peptide level and duration of mechanical ventilation (r=0.67, p=0.0001).
  
  
  CONCLUSIONS
  In patients with pulmonary hypertension undergoing congenital heart surgery, 91% of patients with preoperative plasma brain natriuretic peptide levels above 125.5pgmL-1 are at risk of developing low cardiac output syndrome which is an important postoperative outcome.
authors.affiliation: Clínica de Anestesiologia e Reanimação, Kartal Koşuyolu High Speciality Training and Research Hospital, Istambul, Turquia. Electronic address: draysebay@yahoo.com.
authors.forename: Ayse
authors.initials: A
authors.lastname: Baysal
authors.affiliation: Clínica de Cirurgia Cardiovascular, Siyami Ersek Training and Research Hospital, Istambul, Turquia.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Saşmazel
authors.affiliation: Clínica de Cardiologia Pediátrica, Kartal Koşuyolu High Speciality Training and Research Hospital, Istambul, Turquia.
authors.forename: Ayse
authors.initials: A
authors.lastname: Yildirim
authors.affiliation: Clínica de Anestesiologia e Reanimação, Trabzon Kanuni Cardiovascular Research and Training Hospital, Trabzon, Turkey.
authors.forename: Buket
authors.initials: B
authors.lastname: Ozyaprak
authors.affiliation: Clínica de Anestesiologia e Reanimação, Şanlıurfa Training and Research Hospital, Şanlıurfa, Turquia.
authors.forename: Narin
authors.initials: N
authors.lastname: Gundogus
authors.affiliation: Clínica de Anestesiologia e Reanimação, Kartal Koşuyolu High Speciality Training and Research Hospital, Istambul, Turquia.
authors.forename: Tuncer
authors.initials: T
authors.lastname: Kocak
keywords: B‐type natriuretic peptide; Cardiopatias congênitas; Cardiopulmonary bypass; Circulação extracorpórea; Congenital heart defects; Desfecho; Outcome; Pediatria; Pediatrics; Peptídeo natriurético tipo‐B; Postoperative; Pós‐operatório