Angiotensin II blockade diminished plasma BNP levels in surgically corrected tetralogy of Fallot patients with moderate-to-severe pulmonary regurgitation

  • Dr Yuichi Ishikawa, Pediatric cardiology division, Fukuoka Children's Hospital, Japan
  • Dr Shirou Ishikawa, Pediatric cardiology division, Fukuoka Children’s Hospital, Japan
  • Dr Kouichi Sagawa, Pediatric cardiology division, Fukuoka Children’s Hospital, Japan
  • Dr Hiroya Ushinohama, Pediatric cardiology division, Fukuoka Children's Hospital, Japan
  • Dr Makoto Nakamura, Pediatric cardiology division, Fukuoka Children's Hospital, Japan
  • Dr Naoki Fusazaki, Neonatal cardiology division, Fukuoka Children's Hospital, Japan

    • Objective: In patients (pts) with tetralogy of Fallot (TOF) after surgical correction, pulmonary regurgitation (PR) is one of major risk factors of the poor prognosis. Up to now, there is no effective treatment for the PR expect pulmonary valve replacement (PVR). The aim of the study is to evaluate the effects of an angiotensin II receptor blocker (ARB) olmesartan on the postoperative PR in pts with TOF.
    Methods: Forty-three pts of TOF and others after surgery with moderate-to-severe PR (12.2±6.8 years; 9.5±5.7 years after surgery; New York Heart Association functional class I) were enrolled. Forty-one pts were orally given olmesartan (0.2 mg/kg, orally, once daily) and 38 had tolerated for 6 months and more. We examined alterations on the systolic and diastolic blood pressures (SBP and DBP, respectively), the cardio thoracic ratio (CTR) of a chest X-ray film, and plasma natriuretic peptide type A and type B levels(ANP and BNP, respectively) before and after the treatment of olmesartan.
    Results: Olmesartan decreased the SBP significantly (97±16 to 87±17 mmHg), and also showed a tendency of the decrease in DBP (61±8 to 56±12mmHg, p=0.11). Furthermore, olmesartan decreased the CTR (57±4 to 56±4 %) and the plasma BNP levels (59± 52 to 41±23 pg/mL) significantly. It also showed a tendency of the decrease in plasma ANP levels (57±42 to 48±27 pg/mL, p=0.17).
    Conclusions: The present small cohort study suggested that olmesartan might attenuate the development of cardiac remodeling by PR to postpone the PVR in pts with TOF after surgery.