Περίληψη:
Introduction: Inflammation and neurohormonal activation are considered to be involved in the development of earlier and/or later complications in congenital heart disease patients, even after a successful repair of the lesion. It is not yet clarified what is the role of the therapeutic interventions in the occurrence of such a response and how it could be associated with possible postoperative complications. Aim: We sought to assess the inflammatory and neurohormonal response to transcatheter closure of secundum type atrial septal defects (ASD) over a six-month follow-up period. We also evaluated the association between the respective markers and catheterization data as well as echocardiographic measurements. Methods: Plasma concentrations of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), interleukin-10 (IL-10), N-terminal-proatrial natriuretic peptide (NT-proANP) and N-terminal-probrain natriuretic peptide (NT-proBNP) were assessed and echocardiographic measurements were performed in twenty-eight patients with atrial septal defect prior to, and at the first, second and sixth months post transcatheter closure. Thirty-three age-matched healthy volunteers were also enrolled. Results: IL-6 plasma levels, although higher preoperatively, [physical logarithm (ln) IL-6: 3.37. ±. 0.66 vs 2.92. ±. 0.44. pg/ml, . p=. 0.015], reached control levels postoperatively, at the end of the third month, whereas TNF-α and IL-10 were not influenced by the procedure. NT-proANP levels were elevated preoperatively compared to the control group (ln NT-proANP 3.78. ±. 0.572 vs 3.48. ±. 0.30, . p=. 0.031), with a further significant increase during the 1st month (ln NT-proANP 3.78. ±. 0.572 vs 4.2. ±. 0.42, . p=. 0.006), following the pattern of the left atrial volume enlargement, and remained high even 6. months after the procedure .On the other hand, the initially normal concentrations of NT-proBNP, after a transient significant increase during the first month postoperatively (ln NT-proBNP 3.56. ±. 0.94 vs 4.58. ±. 0.91, . p<. 0.0001) returned to the controls' levels at the end of the third month. Preoperative concentrations of NT-proANP positively correlated with NT-proBNP concentrations and pulmonary to systemic flow ratio (Qp/Qs). Conclusions: Transcatheter closure could improve, on a mid- term basis, the inflammatory process but natriuretic peptides' secretion continues in parallel with left atrial volume increase. Further follow up is required to determine the long-term progress of the inflammatory and neurohormonal response to the procedure. © 2011 Elsevier Ltd.
Συγγραφείς:
Chamakou, A.C.
Dede, E.
Moutafi, A.
Thanopoulos, V.
Chryssanthopoulos, S.
Loukopoulou, S.
Pitsavos, C.
Stefanadis, C.
Davos, C.H.
Λέξεις-κλειδιά:
amino terminal pro atrial natriuretic peptide; amino terminal pro brain natriuretic peptide; interleukin 10; interleukin 6; natriuretic factor; tumor necrosis factor alpha; unclassified drug, adult; article; blood level; clinical article; concentration response; controlled study; echocardiography; enzyme linked immunosorbent assay; female; follow up; heart atrium septum defect; heart catheterization; heart left atrium volume; heart surgery; heart volume; human; lung blood flow; male; medical assessment; postoperative period; preoperative evaluation; priority journal; systemic circulation; treatment outcome, Case-Control Studies; Cytokines; Echocardiography; Female; Heart Atria; Heart Catheterization; Heart Septal Defects, Atrial; Hemodynamics; Humans; Male; Natriuretic Peptides; Neurotransmitter Agents; Organ Size; Young Adult
