Işık Şenkaya SIĞNAK, Murat YANAR, Hülüsi HELVACI

Doğuştan kalp cerrahisinde beyin natriüretik peptid plazma düzeyinin prognostik önemi

Amaç: Çalışmada doğuştan kalp cerrahisinde vücut dışı dolaşım desteği ile ameliyat edilen hastaların ameliyat öncesi ve sonrası N terminal-öncü beyin natriuretik peptid (NT-proBNP) düzeylerinin, ameliyat sonrası yetmezliğin erken tanısı ve takibindeki rolü ile morbidite ve mortalite arasındaki ilişkinin prognostik önemi araştırıldı. Çalışma planı: Ardışık 20 hastanın ameliyat öncesi ve sonrası ekokardiyografik bilgileri, ameliyat öncesi ve sonrası 2. ile 24. saatlerdeki NT-proBNP düzeyleri, hemodinamik ve laboratuvar sonuçları değerlendirildi. Hastalar, volüm yükü altındakiler grup 1 ve basınç yükü altındakiler grup 2 olarak iki gruba ayrıldı. Bulgular: İki grup arasında ameliyat öncesi ve sonrası NT-proBNP düzeyleri paralel seyir izledi. Her iki grupta da ameliyat sonrası NT-proBNP düzeyleri, ameliyat öncesi NT-proBNP düzeylerine göre daha yüksek bulundu. Grup içi ve genel değerlendirmeler ele alındığında NT-proBNP seviyesinin kardiyak fonksiyonlar hakkında fikir verdiği görülmektedir. Gruplar arasında ameliyat öncesi ve ameliyat sonrası plazma NT-proBNP düzeyleri arasında anlamlı fark bulunamadı. Sonuç: Sonuç olarak, ameliyat öncesi ve ameliyat sonrası N-proBNP seviyelerinde gruplar arasında istatistiksel olarak anlamlı bir fark bulunamamıştır. Doğuştan kalp hastalığı bulunan hastalarda NT-proBNP seviyelerinin ameliyat öncesi ve sonrası kalp yetmezliğinin erken değerlendirilmesinde önemli bir tanı aracı olduğunu savunuyoruz. İlave olarak, NT-proBNP kalp yetmezliğinin proaktif tedavisinin başlanmasında da önemli bir testtir.

Prognostic importance of plasma levels of brain natriuretic peptide in congenital cardiac surgery

Background: In this study we investigated the prognostic importance of the relationship of the role of pre- and postoperative N terminal-pro brain natriuretic peptide (NT-proBNP) levels in the early diagnosis and monitoring of postoperative deficiency with morbidity and mortality in patients operated on under extracorporeal circulation support for congenital cardiac surgery. Methods: The pre- and postoperative echocardiographic data, the pre- and postoperative 2- and 24-hour NT-proBNP levels along with the hemodynamic and laboratory values of 20 consecutive patients were evaluated. Patients were divided into two groups, with those being under volume load in group 1 and those being under pressure load in group 2. Results: The pre- and postoperative NT-proBNP levels followed a parallel course in both groups. The postoperative NT-proBNP levels were found to be higher when compared to the preoperative NT-proBNP levels in both groups. It has been observed that the NT-proBNP level gives an idea about cardiac functions when intra-group and general evaluations are considered. No significant difference could be found between the groups regarding the preoperative and postoperative NT-proBNP plasma levels. Conclusion: In conclusion, there was no statistically significant differenece between the groups in terms of pre- and postoperative NT-proBNP levels. We advocate that the NT-proBNP levels in patients with congenital hearth disease is an important diagnostic tool in the early evaluation of pre- and poetoperative cardiac failure. In addition, it is also important test to commence proactive treatment of cardiac failure.

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