Suppression of the secretion of atrial and brain natriuretic peptide aftertotal cavopulmonary connection

Objectives: Among the modifications of the Fontan operation currently being used, total cavopulmonary connection offers the greatest potential for opt imizing early and long-term postoperative outcomes. Although studies have e stablished that abrupt increases in right atrial pressure elevate the plasm a atrial natriuretic peptide level after the Fontan procedure, changes in p lasma natriuretic peptide levels after total cavopulmonary connection have not been clarified. Our hypothesis is that secretion of atrial natriuretic peptide may be suppressed in patients undergoing total cavopulmonary connec tion because the atrium continues to function at low pressure in those pati ents, In this study, we measured plasma levels of atrial and brain natriure tic peptide before and during the postoperative period in patients undergoi ng total cavopulmonary connection. Methods: We evaluated 60 patients: 30 patients underwent total cavopulmonar y connection and 30 patients underwent definitive repair for Fallot's tetra logy. Blood samples for measurement of atrial and brain natriuretic peptide were obtained before the operation and in the postoperative period. Results: Plasma levels of atrial and brain natriuretic peptide were signifi cantly lower during the early postoperative period in patients undergoing t otal cavopulmonary connection than in patients undergoing definitive repair for Fallot's tetralogy. No correlations were identified between the atrial natriuretic peptide levels and central venous pressure after total cavopul monary connection. Conclusion: These results suggest that total cavopulmonary connection atten uates the secretion of atrial and brain natriuretic peptide in the early po stoperative period. The suppressed release of atrial and brain natriuretic peptide after total cavopulmonary connection may have clinical importance.