, Volume 34, Issue 6, pp 1109-1113
Date: 19 Feb 2008

Value of brain natriuretic peptide in the perioperative follow-up of children with valvular disease

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Abstract

Objective

To characterize N-terminal pro-brain natriuretic peptide (N-proBNP) and troponin I (TnI) profile following mitral and/or aortic valve surgery and to evaluate correlations with echocardiography measures and outcome criteria.

Design and setting

Prospective cross-controlled study in a university children's hospital.

Patients

Twenty children with acquired valvular disease requiring valvular surgery.

Interventions

We prospectively studied clinical, biochemical, and echocardiographic characteristics at baseline and 6, 12, 24 h and 3–4 weeks postoperatively.

Results

TnI peaked 6 h after surgery and remained elevated during the first 24 h. N-proBNP was significantly lower 3–4 weeks after surgery than during the perioperative period. Overall, N-proBNP was correlated with the Pediatric Heart Failure Index, left ventricle shortening fraction, left atrium to aorta ratio, left ventricle mass index, end-systolic wall stress, and with outcome measures such as inotropic score, duration of inotropic support, and ICU length of stay. Preoperative N-proBNP was significantly more elevated in patients with complicated outcome than in patients with uneventful postoperative course.

Conclusions

In pediatric valvular patients, perioperative N-proBNP is a promising risk stratification predicting factor. It is correlated with evolutive echocardiographic measures, need for inotropic support, and ICU length of stay.

P.T. was supported by research grants from the Roche Research Foundation (131-2002) and the University Hospitals of Geneva Research Fund (PRD-03-I-18).