Evaluation of NT-ProBNP levels in infants with left to right shunt congenital heart disease before and after decongestive therapy

Evaluation of NT-proBNP Levels in Infants with Left to Right Shunt Congenital Heart Disease Before and After Decongestive TherapyAim: In first six months of life, most common causes of congestive heart failure in children are congenital heart diseases with left to right shunt that cause volume overload as patent ductus arteriosus or ventricular septal defect. BNP is a polypeptide that is secreted from cardiac myocytes in response to increased volume and pressure loads and induce vasodilation, natriuresis and diuresis.The goal of our study is to investigate the relationship between patients? Ross scores, echocardiographic findings and NT-proBNP levels before decongestive therapy and at the 10th and 30th days of therapy in infants, having the symptoms and signs of heart failure, with left to right shunt congenital heart disease and to display if BNP can be used as a biological marker in the follow-up of decongestive therapy.Materials and Methods: 46 infants having congenital heart diseases with left to right shunt were studied prospectively. Patients older than 21 days of age who required decongestive therapy due to untreated heart failure were included the study. Physical examination, modified Ross scoring, electrocardiography, telecardiography and echocardiography were performed and NT-proBNP levels were measured for all patients. Furosemide and captopril as decongestive therapy were given to all patients. In 10th and 30th day of therapy, patients were revaluated and all studies were repeated.Results: Of the patients that were included the study, 17 (37%) were male and 29 (63%) were female. The most common primary diagnosis was ventricular septal defect (74%). NT-proBNP levels of patients with ventricular septal defect were statistically higher than patients with atrial septal defect. The mean value of basal Ross scores was 5,37 (± 2,13) and the mean value of basal NT-proBNP levels was 4983,4 (± 6326) pg/ml. Although both the Ross scores of patients and the NT-proBNP levels declined due to decongestive therapy, statistical relationship could only be shown at the 30th day of therapy. Positive correlations between basal NT-proBNP levels and the basal z scores of left ventricule diastolic and systolic diameters and also left ventricule mass indexes were detected.Conclusions: NT-proBNP is considered as a rapid and non-invasive biological marker that can be used for the diagnosis of congestive heart failure, the detection of the severity of congenital heart diseases and for monitoring the response to decongestive therapy in children. But in early infancy, although NT-proBNP levels are significantly high in congestive heart failure patients with left to right shunt heart lesions, clinical evaluation seems to be more important in the assessment of the severity of congestive heart failure.