natriuretic-peptide--brain and Heart-Septal-Defects--Ventricular

Brain natriuretic peptide and N-terminal pro-brain natriuretic peptide are two well-established markers for cardiac failure in acquired heart disease. Nevertheless, the clinical utility of these markers in patients with congenital heart disease remains unclear. Therefore, the aim of this study was to evaluate the diagnostic and prognostic value of these markers in patients with congenital heart disease. A PubMed and EMBASE literature search was executed with focus on the most common simple congenital heart defects, atrial septal defect and ventricular septal defect. Data on brain natriuretic peptide measurement, cardiac function parameters, and follow-up were collected. In patients with atrial or ventricular septal defect, brain natriuretic peptide levels were mildly increased when compared with healthy age-matched controls. Shunt severity and pulmonary artery pressure correlated strongly with natriuretic peptide levels. A clear association between brain natriuretic peptide and functional class was demonstrated. After closure of the defect, a rise in brain natriuretic peptide levels in the first hours to days was observed. After longer follow-up, natriuretic peptide levels decreased and became comparable to pre-procedural values. In conclusion, this systematic review shows that brain natriuretic peptide levels are mildly increased in patients with unrepaired and repaired atrial or ventricular septal defect. Brain natriuretic peptide measurement might be a useful additional tool in the diagnostic work-up of patients with atrial or ventricular septal defect. Further investigation in a larger, prospective study with long-term follow-up is warranted to elucidate the true prognostic value of natriuretic peptides in patients with simple congenital heart disease.

Topics: Biomarkers; Heart Septal Defects, Atrial; Heart Septal Defects, Ventricular; Humans; Infant, Newborn; Natriuretic Peptide, Brain; Prognosis

Background. B-type natriuretic peptide has been shown to be a very sensitive and specific marker of heart failure. In this study, we aimed to investigate the effect of percutaneous closure of ventricular septal defects with Amplatzer septal occluders on brain natriuretic peptide levels. Methods. Between 2008 and 2011, 23 patients underwent successfully percutaneous ventricular septal defect closure in 4 cardiology centers. Brain natriuretic peptide levels were measured in nine patients (4 male, mean ages were 25.3 ± 14.3) who underwent percutaneous closure with Amplatzer occluders for membranous or muscular ventricular septal defects were enrolled in the study. Brain natriuretic peptide levels were measured one day before and one month after the closure. Patients were evaluated clinically and by echocardiography one month after the procedure. Results. Percutaneous closures of ventricular septal defects were successfully performed in all patients. There was not any significant adverse event in patients group during followup. Decrease in brain natriuretic peptide levels after closure were statistically significant (97.3 ± 78.6 versus 26.8 ± 15.6, P = 0.013). Conclusion. Brain Natriuretic Peptide levels are elevated in patients with ventricular septal defects as compared to controls. Percutaneous closure of Ventricular Septal Defect with Amplatzer occluders decreases the BNP levels.

Topics: Biomarkers; Cardiovascular Surgical Procedures; Heart Septal Defects, Ventricular; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Plastic Surgery Procedures; Septal Occluder Device; Treatment Outcome

Galectin-3 is a biomarker used to detect cardiac remodelling and fibrosis. It could also potentially be a biomarker for developing new treatments. Aldosterone and galectin-3 levels and their relationship to N-terminal pro-brain natriuretic peptide (NT-proBNP) and left ventricular dilatation have not yet been studied in infants with ventricular septal defect (VSD). In this study, we aimed to investigate the biomarker feature of galectin-3 in infants with VSD.. Aldosterone, galectin-3, and NT-ProBNP levels were quantified and left ventricular diameters were measured with M mode echocardiography in infants with isolated VSD who had received heart failure treatment. The results were compared with those of healthy children of similar age and gender.. This study included 22 infants (13 girls, nine boys) with VSD who formed the patient group and 22 healthy infants (13 girls, nine boys) who formed the control group. There was a significant difference between the two groups regarding the median left ventricular end-dia stolic diameter and the median left ventricular end-systole diameter. The patient and control groups had no significant difference with respect to aldosterone levels (median values 43.5 pg/mL vs 41.3 pg/mL, respectively) (P = .851), although there was a significant difference with regard to galectin-3 levels (median values: 4 vs 2.5 ng/mL, respectively) (P = .015) and NT-proBNP levels (median values: 204.3 vs 94.2 pg/mL, respectively) (P = .003).. Galectin-3 increases independent of left ventricular dilatation and may have a biomarker value with similar strength as NT-proBNP in infants with VSD.

Topics: Aldosterone; Biomarkers; Child; Female; Galectin 3; Heart Septal Defects, Ventricular; Humans; Infant; Male; Natriuretic Peptide, Brain; Peptide Fragments

The aim of this study was to explore B-type natriuretic peptide (BNP) level expression of child patients suffering from ventricular septal defects (VSD) and analyze the relationship between BNP and cardiac function and heart failure (HF).. Ninety-two pediatric patients with VSD treated at our hospital from October 2012 to September 2014 were enrolled in this study. They were divided into three groups: the no HF group (N.=30), the mild HF group (N.=31) and the moderate/severe HF group (N.=31), based on their scoring in the New York University Pediatric Heart Failure Index (NYU PHFI). Thirty-two healthy children attending our institution over the same period were enrolled as a control group. Venous blood samples were collected to test serum BNP level and left ventricular ejection fraction (LVEF), LVEF shortening (LVEFS), Left Ventricular End-Diastolic Dimension Index (LVEDDI) and Cardiac Index (CI) of all children.. In VSD patients, serum BNP and LVEDDI levels were significantly higher than those in the control group, while LVEF, LVEFS and CI were significantly lower (P<0.05). HF severity was observed to be directly proportional to BNP and LVEDDI levels, but inversely proportional to LVEF, LVEFS and CI (statistical significance, P<0.05). Serum BNP content was negatively correlated to LVEF, LVEFS and CI (r=-1.142, -1.171 and -1.156, respectively; P<0.05), but positively correlated to LVEDDI and HF (r=0.134 and 1.143, respectively; P<0.05).. Serum BNP levels pediatric VSD patients was in linear correlation with the Cardiac Index, and positively correlated to HF. This is significant in terms of diagnosis, treatment and prognosis of HF.

Topics: Child; Heart Failure; Heart Septal Defects, Ventricular; Humans; Natriuretic Peptide, Brain; Stroke Volume; Ventricular Function, Left

Ventricular septal defect (VSD) generally has a good prognosis unless complicated by heart failure (HF). We report a case of sudden infant death because of clinically undiagnosed VSD in a seemingly healthy 16-day-old boy. Although a cardiac murmur was auscultated at birth, detailed clinical examination was not performed. Medicolegal autopsy revealed a perimembranous large VSD with a single coronary artery. The infant was diagnosed to have had HF based on the increased weight of the heart and extremely high serum brain natriuretic peptide levels. Histological examination revealed the degeneration of cardiomyocytes. The large VSD was thought to be the major cause of HF, although single coronary artery-associated cardiomyopathy might have also partially contributed to it. The decline in the physiological neonatal pulmonary resistance, which occurs over the first 1 or 2 weeks following birth, led to the acute progression of HF, resulting in circulatory collapse and sudden death. Detailed clinical examination should be performed for neonates with cardiac murmur to prevent avoidable death.

Topics: Coronary Vessel Anomalies; Death, Sudden, Cardiac; Heart Failure; Heart Septal Defects, Ventricular; Humans; Infant, Newborn; Male; Natriuretic Peptide, Brain

Topics: Aorta; Echocardiography; Female; Heart Defects, Congenital; Heart Septal Defects, Ventricular; Hemodynamics; Humans; Hypertrophy, Right Ventricular; Imaging, Three-Dimensional; Magnetic Resonance Angiography; Middle Aged; Natriuretic Peptide, Brain; Palliative Care; Peptide Fragments; Pulmonary Atresia; Tomography, X-Ray Computed

To investigate the therapeutic strategy for the multiple ventricular septal defects (VSD) combined with a muscular ventricular septal defect (MVSD) in the infants and young children.. We analyzed clinical data of 63 child patients with multiple VSD who received the treatment between January 2009 and April 2013 in our hospital. There were 33 males and 30 females, the patients aged from 6 to 28 (10 ± 6) months and weighed between 5.5 and 18.0 (7.1 ± 2.9) kg. Primary repair was performed for all of the patients; the MVSD in 7 patients was not detected during the surgery and no extra treatment was taken. The surgical suture was performed for 36 patients, hybrid repair under the direct vision for 8 patients, and hybrid repair via the right ventricle for 7 patients. After surgery, we followed up the patients regularly to reexamine the X-ray image of the chest, EEG, and color Doppler echocardiography to observe the closure of MVSD and the presence of a residual shunt.. All of the 63 enrolled patients with multiple VSD survived without perioperative death. Three patients who were undergoing hybrid repair under direct vision received delayed sternal closure. One patient who was undergoing hybrid repair under direct vision had a postoperative cardiac dysfunction. 55 patients were followed up for 1 to 24 months. 28 patients had residual shunt of varying degrees during the follow-up, and most of the MVSD of patients with residual shunt was less than 4 mm, who were receiving further follow-up and observation.. Appropriate surgical strategies can be applied according to the specific surgical condition for the treatment of MVSD in infants with multiple VSD, and the satisfactory clinical outcome can be achieved.

Topics: Cardiac Catheterization; Child, Preschool; Creatine Kinase, MB Form; Echocardiography; Electroencephalography; Female; Follow-Up Studies; Heart Septal Defects, Ventricular; Heart Ventricles; Humans; Infant; Male; Natriuretic Peptide, Brain; Thorax; Treatment Outcome; Troponin I

The aim of this study was to investigate the potential role of N-terminal pro-brain natriuretic peptide in the assessment of shunt severity and invasive haemodynamic parameters in children with atrial septal defects and ventricular septal defects.. This is a prospective, controlled (n:62), observational study. Correlation analysis was performed between N-terminal pro-brain natriuretic peptide levels and various invasive haemodynamic measurements in 127 children (ventricular septal defect: 64; atrial septal defect: 63). A ratio of pulmonary to systemic blood flow (Qp/Qs⩾1.5) was considered to indicate a significant shunt.. Statistically significant relationship was found between the mean N-terminal pro-brain natriuretic peptide values of the patients, with Qp/Qs⩾1.5 in both defect types and control group. For ventricular septal defect, N-terminal pro-brain natriuretic peptide level⩾113.5 pg/ml was associated with high specificity and sensitivity for determining the significant shunt. In addition, the cut-off point for determining the significant shunt for atrial septal defect was 57.9 pg/ml. Significant positive correlation was found between all invasive haemodynamic parameters and N-terminal pro-brain natriuretic peptide levels in patients with ventricular septal defects. Whereas significant positive correlation was found only between mean pulmonary artery pressure, right ventricular end-diastolic pressure, and systemic pressure to pulmonary pressure ratio and N-terminal pro-brain natriuretic peptide levels in patients with atrial septal defects.. Our study demonstrated that the N-terminal pro-brain natriuretic peptide measurements could be used as a supporting parameter in determining significance of the shunt.

Topics: Biomarkers; Cardiac Catheterization; Case-Control Studies; Child; Child, Preschool; Cross-Sectional Studies; Echocardiography; Female; Heart Septal Defects, Atrial; Heart Septal Defects, Ventricular; Hemodynamics; Humans; Infant; Male; Natriuretic Peptide, Brain; Prospective Studies; ROC Curve; Turkey

Infants with post-tricuspid valve shunts (PTS) may benefit from interatrial communication (IAC). The effect of IAC on left ventricular (LV) performance in these patients was studied. IAC was documented prospectively in 55 patients with PTS. Clinical status, echocardiographic dimensions of LV, mitral inflow Doppler, tissue Doppler velocities and time intervals were measured. Creatinine kinase (CK), CKMB, troponin-I and NT pro-brain natriuretic peptide (NT pro-BNP) were measured. Patients were divided into four groups: (A) PTS but no IAC (n = 32); (B) PTS and IAC (n = 23); (C) VSD but no IAC (n = 16); and (D) VSD and IAC (n = 19). Group A had more frequent mitral regurgitation (p = 0.041), larger mitral annulus (1.80 vs. 1.30 cm, p < 0.0001) and larger LV systolic and diastolic dimensions (2.01 vs. 1.40 and 3.28 vs. 2.35 cm, p < 0.001) than group B. The E-wave deceleration time tended to be longer in group A (121.0 vs. 106.8 ms, p = 0.06). By tissue Doppler, group A had E'- and S-waves significantly taller (15.51 vs. 13.14 and 7.69 vs. 6.72 cm, p = 0.04 and p = 0.005, respectively) than group B. Also, NT pro-BNP was significantly higher in group A (1116.15 vs. 458.73 pg/ml, p = 0.028). Group C had significant larger mitral z-score values (1.2 vs. 0.01, p < 0.001), larger LV diameter z-score (p = 0.001) and higher NT pro-BNP level (1477.37 vs. 451.66 pg/ml, p = 0.001) than group D. There was no significant difference in the clinical status between the groups. In children with PTS, the presence of IAC could be beneficial. Their echocardiographic parameters and biomarker show better systolic and diastolic LV performance.

Topics: Biomarkers; Child, Preschool; Ductus Arteriosus, Patent; Echocardiography, Doppler; Female; Heart Septal Defects, Ventricular; Heart Ventricles; Humans; Infant; Male; Mitral Valve; Mitral Valve Insufficiency; Myocardial Contraction; Natriuretic Peptide, Brain; Peptide Fragments; ROC Curve; Tricuspid Valve

Few prospective data are available regarding long-term outcomes after surgical closure of a ventricular septal defect (VSD).. The objective of this study was to investigate clinical outcomes>30 years after surgical VSD closure.. Patients who underwent surgical VSD closure during childhood between 1968 and 1980 were reexamined every 10 years. In 2012, we invited eligible patients to undergo another examination, which included electrocardiography, Holter monitoring, echocardiography, bicycle ergometry, measurement of N-terminal pro-B-type natriuretic peptide, and subjective health assessment.. Cumulative survival was 86% at 40 years. Causes of mortality were arrhythmia, heart failure, endocarditis, during valvular surgery, pulmonary hypertension, noncardiac causes, and unknown causes. Cumulative event-free survival after surgery was 72% at 40 years. Symptomatic arrhythmias occurred in 13% of patients and surgical or catheter-based reinterventions in 12%. Prevalence of impaired right ventricular systolic function increased from 1% in 2001 to 17% in 2012 (p=0.001). Left ventricular systolic function was impaired but stable in 21% of patients. Aortic regurgitation occurred more often in the last 20 years (p=0.039), and mean exercise capacity decreased (p=0.003). N-terminal pro-B-type natriuretic peptide (median: 11.6 pmol/l [interquartile range: 7.0 to 19.8 pmol/l]) was elevated (>14 pmol/l) in 38% of patients. A concomitant cardiac lesion, for example, patent ductus arteriosus, and aortic cross-clamp time were determinants of late events (hazard ratio: 2.84 [95% confidence interval: 1.23 to 6.53] and hazard ratio: 1.47 per 10 min [95% confidence interval: 1.22 to 1.99], respectively). Patients rated their subjective health status significantly better than a reference population.. Survival up to 40 years after successful surgical VSD closure is slightly lower than in the general Dutch population. Morbidity is not negligible, especially in patients with a concomitant cardiac lesion.

Topics: Adult; Aortic Valve Insufficiency; Arrhythmias, Cardiac; Echocardiography; Exercise Tolerance; Female; Health Status; Heart Septal Defects, Ventricular; Humans; Longitudinal Studies; Male; Natriuretic Peptide, Brain; Patient Outcome Assessment; Peptide Fragments; Prospective Studies; Self Report; Ventricular Dysfunction

In this study, we investigated the relationship between plasma B-type natriuretic peptide (BNP) levels and hemodynamics from cardiac catheterization in pediatric patients with atrial or ventricular septal defect. A total of 59 patients were studied including 80% of patients had Qp/Qs > 1.5 and 25% of patients had pulmonary hypertension. The mean BNP value and BNP z-score were 10.9 ± 11.2 pg/mL and -0.28 ± 1.7 (-2.85 to 3.29), respectively. There was a statistically significant linear correlation between BNP value and the size of defects (r = 0.303, p = 0.002) and a trend toward to positive correlation between BNP value and Qp/Qs ratio (r = 0.183, p = 0.166) among all patients. To identify patients with a Qp/Qs ratio >1.5, the sensitivity and specificity were 28%, 100% in all patients at a plasma BNP cut-off point of 15 pg/mL. We concluded that a BNP > 15 pg/mL would help identify patients who need further intervention.

Topics: Adolescent; Biomarkers; Cardiac Catheterization; Child; Child, Preschool; Female; Heart Atria; Heart Septal Defects, Atrial; Heart Septal Defects, Ventricular; Hemodynamics; Humans; Hypertension, Pulmonary; Infant; Male; Natriuretic Peptide, Brain; Sensitivity and Specificity

Left atrioventricular valve (LAVV) regurgitation usually follows surgical repair of partial atrioventricular canal (PAVC). Although measurements of B-type natriuretic peptide (BNP) levels are useful for the monitoring and prediction of outcomes in chronic mitral regurgitation, no data are available on the role of BNP measurements in the assessment of LAVV regurgitation in patients after surgical correction of PAVC.. To determine the role of plasma BNP determination in the assessment of LAVV regurgitation in patients after surgical repair of PAVC.. We evaluated 41 patients who had undergone surgery for PAVC between 1968 and 2005 with preserved left ventricular ejection fraction (LVEF, mean age at follow-up: 39.2 ± 14.0 years, mean age at the time of surgery: 31.3 ± 15.6 years, 32 females) and 13 healthy controls (mean age: 38.9 ± 13.2 years, 9 females). All the subjects had undergone transthoracic echocardiography and had their plasma BNP levels determined. LAVV regurgitation was assessed qualitatively on 1+ to 4+ grading scale and quantitatively by calculating the effective regurgitant orifice area (EROA).. LAVV regurgitation was present in 40 (97.6%) patients. Compared to patients with mild-to-moderate LAVV regurgitation (grade 1+ to 2+/EROA 〈 0.4 cm²) evaluated qualitatively and quantitatively, the group with severe regurgitation (grade 3+ to 4+/EROA ≥ 0.4 cm²) had higher values of left atrial volume (LAvol) and right ventricular (RV) systolic pressure, although there was no significant difference in plasma BNP levels. There were significant correlations between BNP levels and LAvol (r = 0.54, p = 0.0001), age at follow-up (r = 0.61, p=0.0001), age at the time of surgery (r = 0.58, p = 0.0001), RV diastolic diameter (r = 0.38, p = 0.02) and RV systolic pressure (r = 0.48, p = 0.002). Multivariate logistic regression analysis showed that only LAvol and age at the time of surgery but not the degree of LAVV regurgitation were independently associated with elevated plasma BNP levels.. In patients late after surgical repair of the PAVC with preserved LVEF, plasma BNP levels reflect the consequences of the shunt at atrial level and LAVV regurgitation expressed by LAvol but it does not allow to estimate the severity of regurgitation.

Topics: Adolescent; Adult; Age Factors; Aged; Biomarkers; Cardiovascular Surgical Procedures; Child; Child, Preschool; Female; Heart Septal Defects, Ventricular; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Natriuretic Peptide, Brain; Postoperative Complications; Time Factors; Ventricular Function, Left; Young Adult

Topics: Female; Heart Septal Defects, Ventricular; Humans; Male; Mitral Valve Insufficiency; Natriuretic Peptide, Brain; Postoperative Complications

To explore the implication of the dynamic changes of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) level and Tei index of left ventricle (LV) in children with ventricular septal defect (VSD) treated by transcatheter closure.. Sixty children with VSD treated by transcatheter closure with VSD occluder (Group VSD) and 30 healthy children (Group C) were included in this study. The plasma concentration of NT-proBNP, Tei index of LV and left ventricle ejection fraction (LVEF) were measured in Group C and at before, 5th minute, 4th hour, 1st month, 3rd month and 6th month after VSD closure in Group VSD.. (1) The concentration of plasma NT-proBNP was significantly increased in children with VSD before transcatheter closure compared with Group C [(229.45 ± 57.75) ng/L vs. (99.21 ± 46.86) ng/L, P < 0.01], significantly increased at 5th minute and 24th hour after transcatheter closure [(356.27 ± 96.78) ng/L and (356.38 ± 91.95) ng/L vs. (229.45 ± 57.75) ng/L, all P < 0.01], and significantly decreased at 1st month, 3rd months and 6th months after transcatheter closure [(131.33 ± 34.79) ng/L, (96.56 ± 31.55) ng/L and (93.39 ± 29.46) ng/L vs. (229.45 ± 57.75) ng/L, P < 0.05 or P < 0.01]. (2) The Tei indexes of LV in Group VSD before transcatheter closure were significantly higher than in Group C (0.45 ± 0.05 vs. 0.33 ± 0.08, P < 0.01) and Tei index was significantly increased at 24th hour, 1st month after transcatheter closure (P < 0.01) while significantly decreased at 3rd and 6th month compared with those before transcatheter closure (0.34 ± 0.07 and 0.34 ± 0.06 vs. 0.45 ± 0.05, all P < 0.01). (3) There is a positive correlation between the changes of the plasma concentration of NT-proBNP and the change of Tei index of LV before and after transcatheter closure (r = 0.653, P < 0.05).. Tei index of LV and NT-proBNP can monitor cardiac function changes in children with VSD before and after transcatheter closure.

Topics: Adolescent; Cardiac Catheterization; Case-Control Studies; Child; Child, Preschool; Female; Heart Septal Defects, Ventricular; Heart Ventricles; Humans; Male; Natriuretic Peptide, Brain; Peptide Fragments

In adults without congenital heart disease, B-type natriuretic peptide (BNP) has been shown to be a very sensitive and specific marker of heart failure. The utility of BNP as a marker of clinical heart failure in children with a ventricular septal defect (VSD) has yet to be determined. A prospective, observational study evaluated BNP levels and other measures of heart failure. Eligible patients were <2 years old, scheduled to undergo surgical repair of a VSD, and without other significant structural heart disease. Data collected before and after surgical repair included echocardiographic measurements, electrocardiographic (ECG) findings, Ross score, BNP measurements, and weight gain. A total of 21 patients were enrolled and 14 patients had complete postoperative follow-up data. For patients with complete data, mean BNP decreased by 94 pg/ml (118 pre vs. 24 post; paired t-test, p = 0.041), mean left ventricular end-diastolic dimension z-score decreased by 1.75 (+0.86 vs. -0.89; paired t-test, p = 0.013), mean weight z-score change per month increased by 0.35 (-0.25 vs. +0.10; Wilcoxon test, p = 0.013), and the incidence of biventricular hypertrophy on ECG decreased (46% vs. 0%; McNemar test, p = 0.031). The change in BNP showed a trend toward a negative correlation with weight z-score change per month (r = -0.531, p = 0.075). In conclusion, BNP, along with other measures of heart failure, decreased following VSD repair, and the change in BNP was most closely correlated with improved weight gain.

Topics: Biomarkers; Disease Progression; Female; Health Status Indicators; Heart Failure; Heart Septal Defects, Ventricular; Humans; Infant; Infant, Newborn; Male; Natriuretic Peptide, Brain; Pilot Projects; Prognosis; Prospective Studies; Statistics as Topic; Ultrasonography; Weight Gain

Topics: Child; Coronary Circulation; Heart Defects, Congenital; Heart Septal Defects, Atrial; Heart Septal Defects, Ventricular; Humans; Infant; Lactates; Natriuretic Peptide, Brain; Postoperative Period

Topics: Child; Coronary Circulation; Heart Bypass, Right; Heart Defects, Congenital; Heart Septal Defects, Ventricular; Humans; Infant; Natriuretic Peptide, Brain; Postoperative Period; Tetralogy of Fallot

B-type natriuretic peptide (BNP) reflects volume overload on left ventricle and pulmonary hypertension (PH) in patients with ventricular septal defect (VSD). Pulmonary vascular resistance (PVR) has been reported to correlate positively with BNP in VSD patients with various degrees of PH. We aimed to investigate the relationship between PVR and BNP in VSD patients with severe PH. We examined 24 subjects with VSD concomitant severe PH aged from 2 months to 17 years (median: 4 months). The ratio of pulmonary to systemic pressure (Pp/Ps), the ratio of pulmonary to systemic flow (Qp/Qs), the ratio of pulmonary to systemic resistance (Rp/Rs), and PVR were determined by cardiac catheterization. PVR and Rp/Rs ranged from 1.6 to 15.5 (mean: 5.7 +/- 3.9) Wood unit . m(2) and 0.1 to 0.8 (mean: 0.4 +/- 0.2), respectively. BNP ranged from 5.5 to 69 (mean: 31 +/- 19) pg/ml. Negative correlations were observed between BNP and PVR (r = -0.56, p = 0.004) and BNP and Rp/Rs (r = -0.51, p = 0.01). BNP was significantly lower (<10 pg/ml) in VSD patients with Eisenmenger physiology as compared with the others (p = 0.003). We should draw attention to evaluate BNP values in VSD patients with severe PH.

Topics: Adolescent; Cardiac Catheterization; Child; Child, Preschool; Comorbidity; Echocardiography, Doppler; Eisenmenger Complex; Female; Heart Septal Defects, Ventricular; Hemodynamics; Humans; Hypertension, Pulmonary; Infant; Male; Natriuretic Peptide, Brain; Vascular Resistance

There are limited data regarding whether the ratio of the peak transmitral flow velocity during early diastole (E) to the peak mitral annular velocity during early diastole (Ea) obtained by tissue Doppler imaging (TDI) and the plasma levels of the B-type natriuretic peptide (BNP) are useful for evaluating the left ventricular end-diastolic pressure (LVEDP) in children with ventricular septal defects (VSD). We investigated the validity of noninvasive estimation of the LVEDP in VSD infants.. We studied 48 patients (mean age, 9 +/- 6 months). Using pulsed-wave Doppler echocardiography and TDI, E and Ea were measured to calculate the E/Ea ratio. The LVEDP and the ratio of pulmonary to systemic blood flow (Qp/Qs) were determined invasively.. There were significant positive correlations between E and both the LVEDP value and the Qp/Qs ratio. In contrast, Ea showed significant negative correlations with the LVEDP value and Qp/Qs ratio. The E/Ea ratio correlated significantly with the LVEDP value and Qp/Qs ratio. The plasma BNP levels correlated significantly with the Qp/Qs ratio, although they did not show a significant correlation with the LVEDP. An E/Ea ratio of >9.8 indicated patients with a LVEDP of >10 mmHg with a sensitivity of 92% and specificity of 80%.. TDI combined with pulsed-wave Doppler echocardiography predicted the LVEDP of VSD infants, whereas the plasma BNP value did not have a significant association with the LVEDP.

Topics: Biomarkers; Blood Flow Velocity; Cardiac Catheterization; Echocardiography, Doppler; Echocardiography, Doppler, Pulsed; Female; Heart Septal Defects, Ventricular; Humans; Infant; Male; Mitral Valve; Natriuretic Peptide, Brain; Reproducibility of Results; Ventricular Function, Left; Ventricular Pressure

Brain natriuretic peptide is a relatively recently discovered circulating mediator that has been correlated with the degree of heart failure in adults. This study evaluated the preoperative and postoperative brain natriuretic peptide levels in infants and children undergoing ventricular septal defect repair.. The study enrolled 18 infants and children (ages 2 months to 15.6 years) scheduled for surgical repair of their ventricular septal defects. Brain natriuretic peptide levels were drawn preoperatively and then postoperatively at 1, 24, 48, and 72 hours. The amount of shunt (the ratio of pulmonary blood flow [Q(p)]/systemic blood flow [Q(s)]) through the ventricular septal defect was determined by saturation levels performed in the catheterization laboratory or intraoperatively.. The preoperative brain natriuretic peptide levels (pg/mL) averaged 78 +/- 57, and the postoperative levels were 168 +/- 241 at 1 hour, 418 +/- 330 at 24 hours, 405 +/- 364 at 48 hours, and 391 +/- 397 at 72 hours. These differences were significant for each postoperative time point compared with preoperative values. Preoperative brain natriuretic peptide and the Q(p)/Q(s) were significantly correlated (age-adjusted R(2) = 0.33, p < 0.001).. Brain natriuretic peptide levels have a close correlation with the physiologic volume load caused by ventricular septal defects. The preoperative brain natriuretic peptide levels were also found to be predictive for the postoperative time course of brain natriuretic peptide level changes. These results suggest that brain natriuretic peptide levels may be a useful clinical marker in infants and children with ventricular septal defects.

Topics: Adolescent; Child; Child, Preschool; Female; Heart Septal Defects, Ventricular; Humans; Infant; Male; Natriuretic Peptide, Brain

The value of plasma brain natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) can reflect cardiac function and therefore can be used for diagnosing congestive heart failure (CHF) and evaluating cardiac function. There are few reports, however, on the value of BNP and NT-proBNP in pediatric cases of congenital heart defect. The aim of this study was to assess the value of plasma NT-proBNP in the diagnosis of CHF and evaluation of cardiac function in pediatric patients with ventricular septal defect (VSD).. Fifty-one patients with VSD aged from 2 months to 2 years old (mean 7.9 months) were enrolled. According to the modified Ross Score, the patients were divided into three groups, no CHF group (20 patients), mild CHF group (18 patients) and moderate to severe CHF group (13 patients). Fifteen age-matched normal children were used as controls. Plasma NT-proBNP was measured using enzyme immunoassay. All patients had complete echocardiographic study, including measurement of left ventricular end diastolic volume index (LVEDVI), left ventricular end systolic wall stress (LVSEWS), heart rate corrected mean velocity of circumferential fiber shortening (mVcFc), left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS), and contractility index (Con). The correlation between plasma NT-proBNP level and modified Ross Score and echocardiographic cardiac functional indexes was determined. The sensitivity, specificity and ROC curve of plasma NT-proBNP for diagnosing CHF was studied.. Plasma NT-proBNP was positively correlated with modified Ross Score (r = 0.75, P < 0.01). Plasma NT-proBNP concentration in moderate to severe CHF group (2061 +/- 908) fmol/ml was significantly higher than that of mild CHF group (810 +/- 335) fmol/ml, and Plasma NT-proBNP concentration in mild CHF group was higher than that in no CHF group (309 +/- 68) fmol/ml. 97.14% of normal controls and subjects in no CHF group had their plasma NT-proBNP below 400 fmol/ml. 83.3% of children in mild CHF group had their plasma NT-proBNP between (400-1400) fmol/ml while in moderate and severe CHF group 84.6% of children had their plasma NT-proBNP beyond 1400 fmol/ml. Plasma NT-proBNP was also positively correlated with LVEDVI and LVSEWS. There was no correlation among mVcFc, LVEF, LVFS, Con and plasma NT-proBNP concentration. Using plasma NT-proBNP concentration > or = 400 fmol/ml as cut-point for diagnosing CHF, the sensitivity was 89.3%, the specificity was 91.2%, and the area under the ROC curve was 0.944.. Plasma NT-proBNP level could be used to assess cardiac function and diagnose CHF in pediatric patients with VSD.

Topics: Echocardiography; Female; Heart Failure; Heart Septal Defects, Ventricular; Humans; Infant; Male; Natriuretic Peptide, Brain; Peptide Fragments; Ventricular Function, Left

There is little information available concerning plasma concentrations of B-type natriuretic peptide (BNP) in children with a ventricular septal defect. The aim of the present study was to determine hemodynamic factors that control plasma concentrations of BNP and the clinical implications of BNP compared with atrial natriuretic peptide (ANP) in children with ventricular septal defect.. Fifty-nine patients with ventricular septal defect (28 boys and 31 girls) without pulmonary vascular disease were enrolled. The patients' ages ranged from 3 months to 13 years (mean 3.1 years). Plasma BNP and ANP were determined by immunoradiometric assay. Hemodynamic variables derived from cardiac catheterization were analyzed in terms of correlation with BNP and ANP.. It was found that plasma BNP significantly positively correlated with ANP (ANP = 2.1 x BNP + 25 pg/mL; r = 0.81, P < 0.0001) and BNP never exceeded ANP in the present patient series. Plasma BNP as well as ANP significantly positively correlated with pulmonary to systemic flow ratio (r = 0.65 and r = 0.59, respectively) and mean pulmonary artery pressure (r = 0.72 and r = 0.68, respectively). In addition, plasma BNP of > or =20 pg/mL and ANP of > or =50 pg/mL identified children with mean pulmonary artery pressure of > or =20 mmHg with a sensitivity of 82% and 97%, respectively, and a specificity of 89% and 84%, respectively.. Plasma BNP and ANP reflect pressure and volume loads to the pulmonary artery and right ventricle and may help to identify children with ventricular septal defect complicated by pulmonary hypertension that demands early intervention.

Topics: Adolescent; Atrial Natriuretic Factor; Blood Pressure; Child; Child, Preschool; Female; Heart Failure; Heart Septal Defects, Ventricular; Hemodynamics; Humans; Infant; Male; Natriuretic Peptide, Brain; Pulmonary Circulation; Vascular Resistance