Friday January 9, 2009
(Pediatrics pearl)

Does N-terminal pro-brain natriuretic peptide (N-proBNP) and troponin I (TnI) profile following mitral and/or aortic valve surgery in children correlate with echocardiography measures and outcome criteria?

In a prospective cross-controlled study in twenty children with acquired valvular disease requiring valvular surgery N-proBNP 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.

Conclusion: 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. BNP could be used as marker of heart failure in conjunction with other measures such as echocardiographic finding and clinical severity of illness while explaining parents about short term outcome after surgery such as length of intensive care, need for inotrope support etc.


Reference:

Value of brain natriuretic peptide in the perioperative follow-up of children with valvular disease.- Intensive Care Med. 2008 Jun;34(6):1109-13.