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Neurohormonal activation late after cavopulmonary connection
V E Hjortdal1, E V Stenbøg, H B Ravn
1Department of Cardiothoracic Surgery, Aarhus University Hospital, Skejby Section, DK-8200 Aarhus N, Denmark. vibeke.hjortdal@dadlnet.dk
Heart (British Cardiac Society)
|March 18, 2000
Summary
Patients with cavopulmonary connection show elevated neurohormone levels, including angiotensin II and aldosterone, years after surgery. Hormone levels decrease over time, suggesting physiological adaptation post-operation.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Endocrinology
Background:
- Patients with cavopulmonary connection often exhibit altered fluid and electrolyte balance.
- Vasoactive and water-salt regulating hormones play a crucial role in cardiovascular homeostasis.
Purpose of the Study:
- To investigate elevated levels of vasoactive/water-salt regulating hormones in patients post-cavopulmonary connection.
- To determine the relationship between these hormone levels and postoperative hemodynamics and long-term follow-up.
Main Methods:
- A cross-sectional study involving 20 patients (aged 4-22) who underwent total cavopulmonary connection (TCPC) or bidirectional Glenn anastomosis (BDG).
- Cardiac catheterization and blood sampling were performed to measure plasma levels of angiotensin II, renin, aldosterone, vasopressin, atrial natriuretic factor (ANF), and brain natriuretic peptide (BNP).
- Comparison with 33 healthy children.
Main Results:
- Significantly increased plasma levels of all measured neurohormones were observed in both TCPC and BDG patients compared to controls.
- A fourfold increase in angiotensin II, renin, and aldosterone, and a twofold increase in vasopressin, ANF, and BNP were noted.
- No correlation was found between hemodynamic variables and hormone levels, but angiotensin II and renin inversely correlated with time to follow-up. Neurohormonal levels normalized in subjects over 15 years old.
Conclusions:
- Neurohormone levels remain elevated for years after successful cavopulmonary operations.
- Decreasing hormone levels over time suggest physiological adaptation.
- Neurohormonal activation is primarily linked to altered postoperative physiology, with adaptation occurring gradually.