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Increased levels of brain and atrial natriuretic peptides after the first palliative operation, but not after a bidirectional Glenn anastomosis, in children with functionally univentricular hearts

Published online by Cambridge University Press:  24 May 2005

Håkan Wåhlander ,
Andreas Westerlind ,
Göran Lindstedt ,
Per-Arne Lundberg  and
Daniel Holmgren
Håkan Wåhlander
Affiliation:
Department of Pediatrics, Division of Cardiology, The Queen Silvia Children's Hospital, Göteborg, Sweden
Andreas Westerlind
Affiliation:
Department of Pediatrics, Division of Cardiology, The Queen Silvia Children's Hospital, Göteborg, Sweden
Göran Lindstedt
Affiliation:
Department of Pediatrics, Department of Clinical Chemistry, Sahlgrenska University Hospital, Göteborg, Sweden
Per-Arne Lundberg
Affiliation:
Department of Pediatrics, Department of Clinical Chemistry, Sahlgrenska University Hospital, Göteborg, Sweden
Daniel Holmgren
Affiliation:
Department of Pediatrics, Division of Cardiology, The Queen Silvia Children's Hospital, Göteborg, Sweden
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Abstract

We evaluated the concentrations of the brain and atrial natriuretic peptides in the plasma as markers of ventricular function and volume load in children with functionally univentricular hearts. We studied 7 children aged from 0.5 to 0.7 years with functionally univentricular hearts who had undergone a first palliative operation, and 10 children aged from 1.8 to 3.7 years who had undergone a bidirectional Glenn anastomosis at ages ranging from 0.4 to 1.0 year. As a control group, we studied 14 children without heart defects aged from 0.1 to 4.5 years. Levels of the brain natriuretic peptide were measured at 8.3 to 122 ng/l, with a mean of 52.8 ng/l, after the first palliative operation, compared to 0 to 16 ng/l, with a mean of 7.3 ng/l, after a bidirectional Glenn anastomosis, and 0 to 13.8 ng/l, with a mean of 5.9 ng/l, in the children serving as controls. Corresponding values for atrial natriuretic peptide were 17 to 203 ng/l, with a mean of 103 ng/l, after the first palliative operation, compared to 16 to 54 ng/l, with a mean of 29 ng/l, after the bidirectional Glenn anastomosis, and 12 to 52 ng/l, with a mean of 32 ng/l in the controls. Echocardiography showed that all the children with functionally univentricular hearts had normal ventricular function. Blood presssure, pulmonary arterial pressure, and arterial saturations of oxygen did not differ between the groups. We conclude, that in children with functionally univentricular hearts, the volume overload imposed on the heart after the first palliative operation is associated with increased production of brain and atrial natriuretic peptides, while after ventricular unloading, levels of the natriuretic peptides return to control values.

Keywords

Univentricular heartsingle ventricleGlenn anastomosis
Type
Original Article
Information
Cardiology in the Young , Volume 13 , Issue 3 , June 2003 , pp. 268 - 274
Copyright
© 2003 Cambridge University Press

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