Serum level of n terminal prohormone of brain natriuretic peptide and hemodynamically significant ventricular septal defects

Background An isolated VSD occupies more than 20% of all congenital heart diseases. Echocardiography is a useful diagnostic tool in the estimation of left-to-right shunts as VSD, and assessment of serial changes in shunt size. 3D echocardiographic methods provide a unique tool to determine absolute LV volumes and EF without any assumptions. Serum level of Pro BNP is increased in cases of left-to-right shunts such as VSD. Yet, echocardiographic findings are not always sufficient for determining the severity of hemodynamic abnormalities in VSD patients. Purpose We aim of this study is to evaluate whether the serum level of NT-Pro BNP can be used as a marker for determining the amount of the shunt (QP/QS) and the severity of the hemodynamic abnormality in congenital heart diseases with left-to-right shunts as VSD. Methods and Results This was a cross-sectional study that included 2 age and gender matched groups of children with ventricular septal defects (VSDs) over 12 months. First group consisted of patients with non-significant VSD shunts (echocardiographic QP/QS <1.5) while Second group consisted of patients with significant shunts (echocardiographic QP/QS>1.5-2).routine labs were withdrawn from all patients in addition to a Pro BNP sample and all underwent 3D echocardiography for LV volumes and functions assessment. A total of 80 patients with VSDs were included, with the first group mean age 5.4 ± 4.21, mean weight 20.99 ± 11.68, and mean BSA 0.76 ± 0.32, while the second group mean age of 5.69 ± 3.39, a mean weight of 21.69 ± 10.27, and a mean BSA of 0.79 ± 0.28. There was a highly significant difference between the two studied groups regarding Pro BNP (P-value = <0.001). 3D echocardiography data revealed there was no significant difference between the two groups regarding indexed 3D_. LVEDV (P-value = 0.058). Yet there was a highly significant difference between the two groups regarding indexed 3D_. LVESV (P-value = 0.006) and 3D_LV. EF (P-value = <0.001). There was a highly significant positive correlation between Pro BNP and echocardiographic shunt quantification by QP_QS (r = 0.884), indexed LVEDV and (r = 0.398), indexed LVESV by 3D echocardiography (r = 0.369), while there was a significant negative correlation with 3D_LV. EF (r= -0.294) Conclusion This study proves that Pro-BNP level can be used in non-invasive hemodynamic evaluation of children with VSD and can be considered as an indicator of volume overload in infants and children with congenital heart disease, and will thus be useful in clinical pediatric practice.3D LV volumes and functions bar chart correlation between Pro BNP and Qp/Qs