Abstract
The objective of this study was to determine the effects of transient aortic valve occlusion (balloon valvuloplasty) on vasoactive hormones in patients with heart failure. Plasma atrial natriuretic peptide, vasopressin, aldosterone, adrenocorticotropic hormone (ACTH), and plasma renin activity were measured before, immediately after, and 30 minutes and 18 to 24 hours following balloon inflation in 18 patients. Mean right atrial and pulmonary wedge pressures were 6 and 18 mm Hg before inflations, respectively, and were unchanged after balloon inflations (5 and 13 mm Hg, respectively). Systemic systolic/diastolic pressures were 139 ± 8 65 ± 4 mm Hg before occlusion, decreased to 47 ± 5 34 ± 3 mm Hg during occlusion, and returned to baseline after occlusions. Baseline atrial natriuretic peptide levels were 267 ± 43 pg/ml and increased to 513 ± 71 pg/ml after balloon inflations. Vasopressin levels before occlusion were 9.1 ± 2.2 pg/ml and increased to 21.4 ± 4.8 pg/ml after balloon inflations. Plasma renin activity was 5.4 ± 1.4 ng/ml/hr before inflations and was not significantly changed after balloon inflations. No clinically significant changes in plasma sodium, potassium, creatinine, and osmolality were observed after the procedure. Aldosterone increased from 23 ± 4 to 40 ± 7 ng/dl 10 minutes after the last inflation. Plasma ACTH measured in seven patients with increased aldosterone was 28 ± 8 pg/ml before and increased to 295 ± 157 pg/ml 10 minutes after balloon inflations. The increases in natriuretic peptide and vasopressin were likely due to elevated intracardiac and decreased arterial pressures, respectively; they persisted in spite of no clinically significant changes in filling pressures 12 to 24 hours after the procedure. Increased aldosterone secretion with no change in renin was likely due to elevated ACTH levels and may have attenuated the hyponatremic effects of atrial natriuretic peptide and vasopressin.
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