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J Thorac Cardiovasc Surg 2003;126:1411-1416
© 2003 The American Association for Thoracic Surgery

Surgery for congenital heart disease

Secretion of A-type and B-type natriuretic peptides into the bloodstream and pericardial space in children with congenital heart disease

Yoshio Ootaki, MD, PhDa,*, Masahiro Yamaguchi, MD, PhDa, Naoki Yoshimura, MD, PhDa, Shigeteru Oka, MD, PhDa, Masahiro Yoshida, MDa, Tomomi Hasegawa, MDa

a Department of Cardiothoracic Surgery, Kobe Children's Hospital, Kobe, Hyogo, Japan

Received for publication November 7, 2002; revisions received December 30, 2002; revisions received March 17, 2003; accepted for publication April 11, 2003.

* Address for reprints: Dr Yoshio Ootaki, 1-1-1 Takakuradai, Suma-ku, Kobe, Hyogo 654-0081, Japan
y.ootaki{at}nifty.ne.jp

OBJECTIVE: To determine the secretion of A-type and B-type natriuretic peptides into the bloodstream and pericardial space in children with congenital heart disease.

METHODS: Plasma and pericardial fluid samples were obtained from 77 patients undergoing total correction for congenital heart disease. All patients underwent detailed right-sided and left-sided cardiac catheterization preoperatively.

RESULTS: A-type natriuretic peptide levels in pericardial fluid were lower than those in plasma (33.0 ± 23.1 versus 39.8 ± 33.6 pg/mL, P < .05), and B-type natriuretic peptide levels in pericardial fluid showed marked elevations compared with those in plasma (231.9 ± 305.6 versus 19.8 ± 29.3 pg/mL, P < .0001). The A-type and B-type natriuretic peptide levels in plasma correlated with those in pericardial fluid (R = .522, P < .0001; R = .595, P < .0001). For A-type and B-type natriuretic peptide levels in plasma, the relation with biventricular volume had the highest correlation (R = .669, P < .0001; R = .652, P < .0001). The patients with a pulmonary-to-systemic flow ratio greater than 2 (n = 19) had high levels of natriuretic peptides not only in plasma (58.3 ± 43.2, 40.5 ± 49.4 pg/mL, P < .05) but also in pericardial fluid (44.4 ± 31.5, 287.2 ± 198.5 pg/mL, P < .05), and higher correlation between A-type and B-type natriuretic peptide plasma levels and left ventricular volume (R = .913, P < .0001; R = .787, P < .0001).

CONCLUSIONS: B-type natriuretic peptide is secreted not only into the bloodstream but also into the pericardial space in children with congenital heart disease. Natriuretic peptide levels in plasma correlated well with biventricular volume. The left ventricle was considered to be the main source of secreted natriuretic peptides in the patients with a pulmonary-to-systemic flow ratio greater than 2.




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