TY - JOUR

T1 - Neurohormonal activation late after cavopulmonary connection

AU - Hjortdal, V E

AU - Stenbøg, E V

AU - Ravn, H B

AU - Emmertsen, K

AU - Jensen, K T

AU - Pedersen, E B

AU - Olsen, K H

AU - Hansen, O K

AU - Sørensen, K E

PY - 2000/4

Y1 - 2000/4

N2 - OBJECTIVE: To determine whether patients with cavopulmonary connection have higher levels of vasoactive/water-salt regulating hormones and if so, whether hormone levels are related to postoperative haemodynamics and postoperative follow up.DESIGN: Cross sectional study.SETTING: University hospital.PATIENTS: 20 patients (New York Heart Association functional class I-II), mean age 11 years (range 4 to 22), were studied at a mean of 2 years (0.5 to 6) after a total cavopulmonary connection (TCPC, n = 12) or a bidirectional Glenn anastomosis (BDG, n = 8).INTERVENTIONS: Cardiac catheterisation was performed and blood samples were drawn. Control blood samples were drawn from 33 healthy children, mean age 12 years (6 to 16).MAIN OUTCOME MEASURES: Plasma levels of angiotensin II, renin, aldosterone, arginine, vasopressin, atrial natriuretic factor (ANF), brain natriuretic peptide (BNP).RESULTS: All neurohormones were significantly increased in both TCPC and BDG patients (p < 0. 05), with a fourfold increase in angiotensin II, renin, and aldosterone, and a twofold increase in vasopressin, ANF, and BNP (compared with healthy controls). There was no correlation between haemodynamic variables and hormone levels. Angiotensin II and renin were inversely correlated with time to follow up. All subjects over 15 years (n = 5) had normal neurohormonal levels.CONCLUSIONS: Neurohormones were raised for years after successful cavopulmonary operations but lower levels were observed with time on follow up. This supports the hypothesis that neurohormonal activation is primarily related to altered postoperative physiology and that adaptation takes place over time.

AB - OBJECTIVE: To determine whether patients with cavopulmonary connection have higher levels of vasoactive/water-salt regulating hormones and if so, whether hormone levels are related to postoperative haemodynamics and postoperative follow up.DESIGN: Cross sectional study.SETTING: University hospital.PATIENTS: 20 patients (New York Heart Association functional class I-II), mean age 11 years (range 4 to 22), were studied at a mean of 2 years (0.5 to 6) after a total cavopulmonary connection (TCPC, n = 12) or a bidirectional Glenn anastomosis (BDG, n = 8).INTERVENTIONS: Cardiac catheterisation was performed and blood samples were drawn. Control blood samples were drawn from 33 healthy children, mean age 12 years (6 to 16).MAIN OUTCOME MEASURES: Plasma levels of angiotensin II, renin, aldosterone, arginine, vasopressin, atrial natriuretic factor (ANF), brain natriuretic peptide (BNP).RESULTS: All neurohormones were significantly increased in both TCPC and BDG patients (p < 0. 05), with a fourfold increase in angiotensin II, renin, and aldosterone, and a twofold increase in vasopressin, ANF, and BNP (compared with healthy controls). There was no correlation between haemodynamic variables and hormone levels. Angiotensin II and renin were inversely correlated with time to follow up. All subjects over 15 years (n = 5) had normal neurohormonal levels.CONCLUSIONS: Neurohormones were raised for years after successful cavopulmonary operations but lower levels were observed with time on follow up. This supports the hypothesis that neurohormonal activation is primarily related to altered postoperative physiology and that adaptation takes place over time.

KW - Adolescent

KW - Adult

KW - Aldosterone/blood

KW - Angiotensin II/blood

KW - Arginine Vasopressin/blood

KW - Atrial Natriuretic Factor/blood

KW - Biomarkers/blood

KW - Child

KW - Child, Preschool

KW - Cross-Sectional Studies

KW - Follow-Up Studies

KW - Heart Bypass, Right

KW - Heart Defects, Congenital/surgery

KW - Hemodynamics

KW - Hormones/blood

KW - Humans

KW - Natriuretic Peptide, Brain/blood

KW - Neurosecretory Systems/physiopathology

KW - Postoperative Period

KW - Renin/blood

U2 - 10.1136/heart.83.4.439

DO - 10.1136/heart.83.4.439

M3 - Journal article

C2 - 10722548

VL - 83

SP - 439

EP - 443

JO - Heart

JF - Heart

SN - 1355-6037

IS - 4

ER -