Department of Pediatrics, University of California, San Francisco, CA 94143, USA.
J Thorac Cardiovasc Surg. 2013 May;145(5):1279-87. doi: 10.1016/j.jtcvs.2012.07.067. Epub 2012 Aug 20.
B-type natriuretic peptide is used in the diagnosis, risk stratification, and management of adult patients with cardiac disease. However, its use in infants with congenital heart disease has been limited, particularly in the perioperative period. Our objective was to determine the alterations in perioperative B-type natriuretic peptide levels and their predictive value on postoperative outcomes, in infants undergoing congenital heart surgery.
We prospectively enrolled 115 patients: 24 with univentricular heart disease undergoing a modified Norwood procedure, 11 with d-transposition of the great arteries, 55 with hemodynamically important left-to-right shunt, and 25 with tetralogy of Fallot undergoing primary repair. Clinical data and B-type natriuretic peptide samples were collected before and 2, 12, and 24 hours after cardiopulmonary bypass. Univariate analysis and multivariate linear regression analysis were performed.
The perioperative B-type natriuretic peptide levels were lesion specific. Patients with d-transposition of the great arteries and univentricular heart disease had high preoperative B-type natriuretic peptide levels that decreased postoperatively, and those with hemodynamically important left-to-right shunts and tetralogy of Fallot had lower preoperative levels that increased during the first 12 hours postoperatively. The patients with univentricular heart disease with an adverse outcome had a significantly greater 24-hour B-type natriuretic peptide level than those without (P < .05). Those with hemodynamically important left to right shunts and an adverse outcome had a greater 12-hour B-type natriuretic peptide level than those without (P < .05). A 12-hour postoperative/preoperative ratio greater than 45 was 100% sensitive and 82% specific for an adverse outcome in the patients with tetralogy of Fallot.
The perioperative changes in B-type natriuretic peptide levels and their ability to predict outcomes are lesion-specific. Characterization of these changes might be useful in caring for infants after congenital heart surgery.
B 型利钠肽用于诊断、危险分层和成年心脏病患者的管理。然而，其在先天性心脏病婴儿中的应用受到限制，特别是在围手术期。我们的目的是确定围手术期 B 型利钠肽水平的变化及其对先天性心脏病婴儿术后结果的预测价值。
我们前瞻性地纳入了 115 例患者：24 例单心室心脏病患者行改良的 Norwood 手术，11 例大动脉转位患者，55 例左向右分流有血流动力学意义的患者，25 例法洛四联症患者行一期修复术。在体外循环前、后 2、12 和 24 小时收集临床数据和 B 型利钠肽样本。进行单因素分析和多变量线性回归分析。
围手术期 B 型利钠肽水平与病变有关。大动脉转位和单心室心脏病患者术前 B 型利钠肽水平较高，术后降低，左向右分流有血流动力学意义和法洛四联症患者术前水平较低，术后 12 小时内升高。有不良预后的单心室心脏病患者的 24 小时 B 型利钠肽水平明显高于无不良预后者（P<.05）。有不良预后的左向右分流有血流动力学意义的患者的 12 小时 B 型利钠肽水平明显高于无不良预后者（P<.05）。法洛四联症患者术后 12 小时/术前比值大于 45 对不良预后的敏感性为 100%，特异性为 82%。
B 型利钠肽水平的围手术期变化及其预测结局的能力与病变有关。这些变化的特征可能对先天性心脏病婴儿的术后护理有用。
