Hakan CEYRAN, Füsun GÜZELMERİÇ, Murat BAŞARAN, Nihat ÇİNE, Eylem TUNÇER, Akın ARSLAN, Yasemin YAVUZER, Eray AKSOY

Plasma brain natriuretic peptide values after ventricular septal defect repair: a potential predictor of negative outcomes

Amaç: Bu çalışmada ventriküler septal defekt tamiri sonrasıplazma beyin natriüretik peptid değerleri ile klinik sonuçlararasında doğrusal bir ilişki olup olmadığı araştırıldı.Çalışmaplanı: Hastanemiz çocuk kalp cerrahisi kliniğindeprospektif bir kohort çalışması planlandı. Bu kesitselçalışmaya Şubat 2012 - Ekim 2012 tarihleri arasındaventriküler septal defekt tamiri uygulanan 20 hasta (13 erkek,7 kız; ort. yaş 9.2±4.3 ay; dağılım 4-18 ay) alındı. Hastalardancerrahi öncesinde başlangıçta ve cerrahi sonrası dönemde altıfarklı zaman noktasında kan örneklemesi yapıldı.Bul gu lar: Hastane mortalitesi 5% idi. Ortalama B-tipnatriüretik peptid düzeylerinin cerrahi öncesi değeri, cerrahiöncesi pulmoner arter basıncı ile anlamlı bir ilişki gösteriyordu(p0.05), bireyler içi dağılımın standart sapmasıdaha uzun yoğun bakım kalış süresi ile ilişkili bulundu(p

Ventriküler septal de fekt tamiri sonrası plazma beyin natriüretic peptid değerleri: Olumsuz sonuçların potansiyel öngördürücüsü

Background: This study aims to investigate whether there is alinear relationship between clinical outcomes and plasma brainnatriuretic peptide levels following ventricular septal defect repair.Methods: A prospective cohort study was designed at the pediatriccardiac surgery clinic of our institution. This cross-sectionalstudy included 20 patients (13 boys, 7 girls; mean age 9.2±4.3months; range, 4 to 18 months) who underwent ventricular septaldefect repair between February 2012 and September 2012. Bloodsamples were taken at baseline before surgery, followed by sixsampling at different time points during the postoperative course.Results: In-hospital mortality was 5%. The mean preoperativeB-type natriuretic peptide levels were significantly correlatedwith the preoperative mean pulmonary artery pressure(p0.05), whereasintra-individual B-type natriuretic peptide standard deviationwas correlated with longer times of intensive care unit stay(p

PDF

___

1. Sudoh T, Kangawa K, Minamino N, Matsuo H. A new natriuretic peptide in porcine brain. Nature 1988;332:78-81.
2. Levin ER, Gardner DG, Samson WK. Natriuretic peptides. N Engl J Med 1998;339:321-8.
3. Hall C. Essential biochemistry and physiology of (NT-pro) BNP. Eur J Heart Fail 2004;6:257-60.
4. Carmona F, Manso PH, Vicente WV, Castro M, Carlotti AP. Risk stratification in neonates and infants submitted to cardiac surgery with cardiopulmonary bypass: a multimarker approach combining inflammatory mediators, N-terminal pro-B-type natriuretic peptide and troponin I. Cytokine 2008;42:317-24.
5. Baptista MJ, Rocha G, Clemente F, Azevedo LF, Tibboel D, Leite-Moreira AF, et al. N-terminal-pro-B type natriuretic peptide as a useful tool to evaluate pulmonary hypertension and cardiac function in CDH infants. Neonatology 2008;94:22-30.
6. Nahum E, Pollak U, Dagan O, Amir G, Frenkel G, Birk E. Predictive value of B-type natriuretic peptide level on the postoperative course of infants with congenital heart disease. Isr Med Assoc J 2013;15:216-20.
7. Makimura M, Koga H. N-terminal pro-brain natriuretic peptide as a useful predictor of early surgery in neonates with congenital heart diseases: a prospective observational study. Pediatr Cardiol 2014;35:77-81.
8. Niedner MF, Foley JL, Riffenburgh RH, Bichell DP, Peterson BM, Rodarte A. B-type natriuretic peptide: perioperative patterns in congenital heart disease. Congenit Heart Dis 2010;5:243-55.
9. Nir A. Is it time to incorporate natriuretic peptide levels into perioperative evaluation of infants with congenital heart disease? Isr Med Assoc J 2013;15:245-6.
10. Wernovsky G, Wypij D, Jonas RA, Mayer JE Jr, Hanley FL, Hickey PR, et al. Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants. A comparison of low-flow cardiopulmonary bypass and circulatory arrest. Circulation 1995;92:2226-35.
11. Westerlind A, Wåhlander H, Lindstedt G, Lundberg PA, Holmgren D. Clinical signs of heart failure are associated with increased levels of natriuretic peptide types B and A in children with congenital heart defects or cardiomyopathy. Acta Paediatr 2004;93:340-5.
12. Koch A, Zink S, Singer H. B-type natriuretic peptide in paediatric patients with congenital heart disease. Eur Heart J 2006;27:861-6.
13. Cowley CG, Bradley JD, Shaddy RE. B-type natriuretic peptide levels in congenital heart disease. Pediatr Cardiol 2004;25:336-40.
14. Kunii Y, Kamada M, Ohtsuki S, Araki T, Kataoka K, Kageyama M, et al. Plasma brain natriuretic peptide and the evaluation of volume overload in infants and children with congenital heart disease. Acta Med Okayama 2003;57:191-7.
15. Suda K, Matsumura M, Matsumoto M. Clinical implication of plasma natriuretic peptides in children with ventricular septal defect. Pediatr Int 2003;45:249-54.
16. Mir TS, Falkenberg J, Friedrich B, Gottschalk U, Lê TP, Laer S, et al. Levels of brain natriuretic peptide in children with right ventricular overload due to congenital cardiac disease. Cardiol Young 2005;15:396-401.
17. Mainwaring RD, Parise C, Wright SB, Juris AL, Achtel RA, Fallah H. Brain natriuretic peptide levels before and after ventricular septal defect repair. Ann Thorac Surg 2007;84:2066-9.
18. Gessler P, Knirsch W, Schmitt B, Rousson V, von Eckardstein A. Prognostic value of plasma N-terminal pro-brain natriuretic peptide in children with congenital heart defects and open-heart surgery. J Pediatr 2006;148:372-6.
19. Massimiliano C, Simona S, Bruno M, Aldo C, Das BB. Clinical relevance of different B-type natriuretic peptide decisional cutoff values for the diagnosis of congenital heart disease in the first weeks of life. Pediatr Cardiol 2011;32:537.
20. Amirnovin R, Keller RL, Herrera C, Hsu JH, Datar S, Karl TR, et al. B-type natriuretic peptide levels predict outcomes in infants undergoing cardiac surgery in a lesion-dependent fashion. J Thorac Cardiovasc Surg 2013;145:1279-87.
21. Reardon LC, Williams RJ, Houser LS, Miner PD, Child JS, Aboulhosn JA. Usefulness of serum brain natriuretic peptide to predict adverse events in patients with the Eisenmenger syndrome. Am J Cardiol 2012;110:1523-6.
22. Eindhoven JA, van den Bosch AE, Jansen PR, Boersma E, Roos-Hesselink JW. The usefulness of brain natriuretic peptide in complex congenital heart disease: a systematic review. J Am Coll Cardiol 2012;60:2140-9.
23. Das BB. Plasma B-type natriuretic peptides in children with cardiovascular diseases. Pediatr Cardiol 2010;31:1135-45.