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J Thorac Cardiovasc Surg 2005;129:1104-1110
© 2005 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Dysfunction of atrial and B-type natriuretic peptides in congenital univentricular defects

Lena S. Sun, MDa,b,*, Carmen Dominguez, MDa, Navin A. Mallavaram, MDa, Jan M. Quaegebeur, MD, PhDc

a Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, New York, NY
b Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY
c Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY

Received for publication June 8, 2004; revisions received August 3, 2004; accepted for publication August 6, 2004.

* Address for reprints: Lena S. Sun, MD, Columbia University, College of Physicians and Surgeons, BH 4-440 North, 630 W 168th St, New York, NY 10032 (E-mail: Iss4{at}columbia.edu).

OBJECTIVE: To examine whether children with univentricular defects have intrinsic dysfunction in the natriuretic peptide system.

METHODS: We compared plasma levels of the fluid-regulating hormone vasopressin (antidiuretic hormone), aldosterone, atrial natriuretic peptide, and brain natriuretic peptide in children with congenital univentricular and biventricular defects. We enrolled 27 patients with univentricular defects and 27 patients with biventricular cardiac defects. Children who underwent Fontan and Glenn procedures were considered as patients with univentricular cardiac defects; children who underwent repair of tetralogy of Fallot or subaortic stenosis were considered as controls with biventricular defects.

RESULTS: Preoperative plasma atrial natriuretic peptide, brain natriuretic peptide, antidiuretic hormone, and aldosterone were comparable in both groups. Although plasma cyclic guanosine monophosphate levels were comparable between groups, there was a significant correlation between molar concentrations of plasma cyclic guanosine monophosphate and plasma atrial natriuretic peptide (r = 0.42) and brain natriuretic peptide (r = 0.44) in the biventricular group, but not in the univentricular group (r = 0.19 for atrial natriuretic peptide; r = 0.13 for brain natriuretic peptide). All patients had a significant postoperative increase in plasma antidiuretic hormone. A significant postoperative increase in plasma brain natriuretic peptide was found in the patients with biventricular, but not univentricular, defects. In contrast, a significant increase in plasma aldosterone was observed only in the patients with univentricular defects.

CONCLUSIONS: There were distinct differences between univentricular and biventricular groups in their perioperative plasma fluid-regulating hormone responses. Specifically, patients with univentricular defects may have abnormal natriuretic peptide secretion and function. The natriuretic dysfunction may be on the basis of hypoplastic ventricular development.




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