BNP response during Berlin Heart^® support in child: a case report

A five-year-old boy is presented to Necker hospital for a dilated hypertrophic cardiomyopathy. The implantation of the Berlin Heart Excor^® ventricular assist device was performed. This pediatric-sized Berlin Heart^® device provides mechanical support for young infants and children of all ages to sustain the failing cardiac circulation over several months, until either recovery of myocardial function or heart transplantation. It remains difficult to identify patients with sufficient recovery and the right time for explantation of the Berlin Heart^®. Currently, the decision as to whether a patient should be weaned from the system is mainly based on echocardiographic data. Humoral biomarker, associated to echocardiographic features, would be helpful to identify children who might recover without heart transplantation. We observed that our young patient presented highly elevated BNP plasma levels before mechanical support, and a significant decrease during Berlin Heart^® support. Monitoring levels of BNP can be helpful to detect appropriate unloading of the heart as a precondition for recovery. During pump-stop maneuvers, BNP should be regarded in combination with clinical and hemodynamic status of the patients, associated with echocardiographic data.