Prognostic value of serum B-Type natriuretic peptide in early mortality and morbidity of children with congenital heart disease after open heart surgery

Brain type natriuretic peptide [BNP] is a cardiac hormone that is secreted mainly by the ventricles in response to volume expansion and pressure load. It can predict post-operative complications after heart surgery in adults. We sought to investigate the prognostic value of BNP in children after heart surgery. We measured the BNP serum levels in 96 children with congenital heart diseases before, immediately after, and 12 hours after open heart surgery. We studied the ability of the post-operative BNP serum level variations to predict mortality and morbidity in children. In total, 96 patients, comprising 40 [41.7%] females and 56 [58.3%] males with a mean age of 4.1 years [range: 1 month to 17 years], with various congenital heart diseases were studied. The rise in the serum BNP level 12 hours post surgery was directly related to mortality before discharge from hospital [P value=0.004], congestive heart failure after surgery [P value<0.001], patients' cyanosis [P value=0.045], duration of ICU stay [r=0.342, P value=0.004], and post-operative need for inotropic drugs [P value<0.001]. The rise in the BNP serum level 12 hours after heart surgery is a good marker for predicting mortality, morbidity, and early diagnosis of heart failure in children

Transcatheter closure of fenestration after modified fontan operation in children

Fenestration in the modified Fontan operation allows right-to-left shunting, which reduces the Fontan pathway pressure and improves cardiac output. However, on account of the fact that persistent right-to-left shunting results in cyanosis and paradoxical emboli, fenestration closure is recommended after recovery from the Fontan operation. This study recruited 3 patients who underwent the transcatheter closure of the Fontan fenestration with the ASD-Amplatzer because of severe cyanosis and significant intracardiac shunts. Fenestration closure was performed at a mean age of 8 yr [6-12 yr] and average of 15 months after the Fontan operation. Aortic O[2] saturation increased by an average of 17.6% [9-26%]. During more than a two-year period of follow-up [mean: 27 months], two patients had complete occlusion on echocardiography and the other one had a small residual shunt. One of these patients had atrial flutter during the follow-up. The transcatheter closure of the Fontan fenestration is a safe and feasible technique that is effective in elevating systemic O[2] saturation and well-being and confers acceptable growth and development in children