Pediatric Cardiology

, Volume 33, Issue 2, pp 264–271 | Cite as

The Cause of B-Type Natriuretic Peptide Elevation and the Dose-Dependent Effect of Angiotensin-Converting Enzyme Inhibitor on Patients Late After Tetralogy of Fallot Repair

  • Takuo FurukawaEmail author
  • Tomoaki Murakami
  • Michihiko Ueno
  • Atsuhito Takeda
  • Satoshi Yakuwa
  • Hirokuni Yamazawa
Original Article


Patients after surgical repair of tetralogy of Fallot (TOF) may experience various complications that result in neurohormonal activation, including plasma B-type natriuretic peptide (BNP) elevation. Right ventricular (RV) dilation is a frequent complication, and few treatments are available. This study aimed to identify the factor or factors leading to BNP elevation and to clarify the effects of angiotensin-converting enzyme inhibitor (ACE-I) on changes in BNP levels in patients with repaired TOF. Plasma BNP levels and hemodynamic data derived from cardiac catheterization were analyzed. In addition, longitudinal BNP levels and ACE-I dosages were analyzed for patients administered ACE-I. For 31 patients with repaired TOF, who mainly had RV dilation, log BNP levels were significantly correlated with the RV end-diastolic volume index (P = 0.02) as well as ventricular volume and pressure (P < 0.01). For 11 patients medicated with ACE-I, BNP levels were significantly lower at the time of maximal ACE-I dosage than at the time of minimal dosage (P < 0.01). Furthermore, BNP levels decreased as the ACE-I dosage per body weight increased (P < 0.01). In conclusion, elevation of BNP in patients after TOF repair could reflect volume and pressure load in the RV end-diastolic phase, and ACE-I may reduce BNP levels in a dose-dependent manner.


ACE-I Angiotensin-converting enzyme inhibitor B-type natriuretic peptide Tetralogy of Fallot 


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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Takuo Furukawa
    • 1
    Email author
  • Tomoaki Murakami
    • 2
  • Michihiko Ueno
    • 1
  • Atsuhito Takeda
    • 1
  • Satoshi Yakuwa
    • 3
  • Hirokuni Yamazawa
    • 1
  1. 1.Department of PediatricsHokkaido University HospitalSapporo CityJapan
  2. 2.Department of Pediatrics and Adult Congenital Heart DiseaseChiba Cardiovascular CenterIchihara CityJapan
  3. 3.Department of PediatricsObihiro Kousei General HospitalObihiro CityJapan

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