Objectives: Fontan type operation is characterized by high central venous pressure and reduced preload for systemic ventricle. It is well known that B-type natriuretic peptide (BNP) has prognostic significance in chronic heart failure. However, it is not well established that clinical implications of BNP levels in the Fontan patients. The aim of this study is to elucidate the clinical implication of BNP in the patients after the Fontan type operation, especially in atrium-pulmonary artery connection(APC).
Methods and Results: BNP levels, in addition to clinical and hemodynamic variables, were evaluated in 112 patients late after Fontan operation. One hundred one patients underwent APC and 13 patients total cavopulmonary connection(TCPC). BNP levels of APC patients were higher than that of TCPC patients (105 vs. 13 pg/ml, p<0.0001). In APC patients, BNP levels of patients in NYHA I were lower than that of patients in NYHA II and III (p=0.03). The patients with arrhythmia had higher value of BNP than patients without arrhythmia (168 vs 103 pg/ml, p=0.02). BNP levels were positively correlated with right atrial volume which obtained by cardiac catheterization (p<0.0001). Kaplan-Meier cardiac event free rate was significantly higher in patients with BNP>200pg/mL compared with patients <200pg/mL (p=0.001).
Conclusions: BNP may be derived from the right atrium, in APC patients, and therefore it may be increased in patients with dilated right atrium. BNP levels can be used to predict cardiac event in patients after APC.