During treatment protocol for univentricular heart serum levels of natriuretic peptides decrease☆☆☆

Abstract

In children treated for univentricular heart (UVH), prospective evaluation of serum levels of N-terminal proatriopeptide (ANPN) and N-terminal pro-brain natriuretic peptide (NT-proBNP) was performed. Serum samples were analysed in 19 children before the first operation, before the bi-directional Glenn (BDG) operation, at age 1 year and before total cavopulmonary connection (TCPC). In addition, we performed cross-sectional measurement of peptide levels in 32 children: 22 hypoplastic left ventricle (LV), 10 hypoplastic right ventricle (RV) before; and in 12 children: nine hypoplastic LV, three hypoplastic RV, 2 (range: 0.5-5.3) years after the TCPC operation. Controls comprised 12 children aged less than 6 months and 41 children aged from 6 months to 7 years. Between the first and second operations, peptide levels decreased. Before TCPC, further decreases had occurred. Throughout follow-up, peptide levels were higher than in controls. In the cross-sectional study, before TCPC, median ANPN concentration measured 0.37 (range: 0.18-1.00) nmol l(-1) (P=0.059, compared with controls) and NT-proBNP 155 (range: 13-718) ng l(-1) (P<0.001). After TCPC, median ANPN concentration measured 0.39 (range: 0.09-0.98) nmol l(-1) (P=ns) and NT-proBNP 201 (range: 76-1406) ng l(-1) (P<0.001). Before TCPC, levels of NT-proBNP were higher in patients with RV than with LV morphology. Natriuretic peptide levels decreased during treatment protocol for UVH, but NT-proBNP levels remained higher than in controls. These reflect reduction of volume overload of the single ventricle and can prove useful for haemodynamic monitoring.