B-type natriuretic peptide levels in patients with functionally univentricular hearts after total cavopulmonary connection.

AIMS: To assess plasma B-type natriuretic peptide (BNP) levels in patients with univentricular hearts late after volume unloading by total cavopulmonary connection (TCPC).

METHODS

Plasma BNP was measured by sandwich immunoassay in 67 patients after a modified Fontan procedure. BNP levels were compared with age and sex-specific normal values, clinical and echocardiographic data, and results of exercise testing.

RESULTS

BNP had a wide range of 5-290 pg/ml, but was normal in 81% of patients, and median BNP was only 13 pg/ml. There was no difference between males and females, between patients with left or right ventricular morphology, and no correlation was found between BNP and age, post-operative follow-up period, maximum exercise capability, peak oxygen uptake, or blood oxygen saturation. New York Heart Association class I patients had lower BNP than class II patients (p=0.04). Plasma BNP concentration was positively correlated to the number of specific sequelae (r=0.59, p<0.001), and to severity of atrioventricular regurgitation (r=0.38, p=0.002). 5/13 patients with elevated BNP died during follow-up.

CONCLUSION

BNP plasma concentration was normal in the majority of patients up to 15 years after TCPC. Elevated and increasing BNP levels were associated with increased morbidity and late mortality.