Attenuation of atrial natriuretic peptide response to sodium loading after cardiac operation

To evaluate the role of cardiac operation and the atrial appendage in secretion of atrial natriuretic peptide in response to sodium loading, we studied 44 patients who underwent heart operations with (28 patients; group I) or without (16 patients; group II) right atrial appendectomy and 16 patients who underwent lobectomy (group III). Before and after operation 1 ml/kg of 10% NaCl was infused for 15 minutes. Blood samples were taken before NaCl infusion and immediately after infusion and at 60 minutes after infusion. There were no significant changes in hemodynamics or hematocrit level throughout the study. Plasma and urine sodium levels and the fractional excretion of sodium were significantly increased by sodium loading. Before operation, plasma mean atrial natriuretic peptide levels increased markedly in response to sodium infusion in all groups. After operation, this atrial natriuretic peptide response disappeared in groups I and II, but remained present in group III. Elution profiles of plasma atrial natriuretic peptide showed that the major peak coincided with alpha-atrial natriuretic peptide before sodium loading, whereas a beta-atrial natriuretic peptide peak appeared 60 minutes after sodium loading in all groups both before and after operation. The mean plasma arginine vasopressin levels were significantly increased by sodium loading both before and after operation in all groups. Sodium loading decreased the mean plasma aldosterone levels in all groups before operation, but did not after operation in groups I and II. Plasma renin activity and angiotensin II concentrations were not changed by sodium loading. We conclude that atrial natriuretic peptide response to sodium loading is attenuated by cardiac operation irrespective of right appendectomy, but not by lobectomy. Sodium loading augments secretion of beta-atrial natriuretic peptide even in reduced atrial natriuretic peptide response states after heart operations.