Hemodynamic and humoral effects of atrial natriuretic peptide on pulmonary circulation after cardiac surgery

Morimoto, Keisuke; Taniguchi, Ikuo; Miyasaka, Shigeto; Ishiguro, Shingo; Ohgi, Shigetsugu

doi:10.1007/s00595-007-3649-7

Cited by 2 publications

(2 citation statements)

References 26 publications

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“…Decreased ANP levels are the main cause for acute postoperative fluid retention with pulmonary oedema and symptomatic pleural effusion observed in 12-36% of patients after CMP. On the other hand, higher ANP levels are assumed to improve kidney function and prevent renal insufficiency after cardiac surgery [21], have beneficial impact on pulmonary pressure reduction [22] and protect against ischemia and reperfusion injury [23]. It is believed that amputation of both atrial appendages in the original Cox-maze procedure is a major cause of postoperative ANP decrease [17].…”

Section: Discussionmentioning

confidence: 99%

Impact of epicardial ablation of concomitant atrial fibrillation on atrial natriuretic peptide levels and atrial function in 6 months follow-up: does preoperative ANP level predict outcome of ablation?

Pizon

Friedel

Freundt

et al. 2013

J Cardiothorac Surg

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BackgroundEpicardial ablation concomitant to cardiac surgery is an easy and safe approach to treat atrial fibrillation (AF), but its efficacy in longstanding persistent (LsPe) AF remains intermediate. Although larger left atrial size has been associated with worse outcome after ablation, biochemical predictors of success are not well established. The aim of this study was to evaluate relationship between biochemical marker, echo-characteristic and cardiac rhythm in 6 months follow-up after epicardial ultrasound (HIFU) ablation.MethodsWe included 78 consecutive patients, who underwent elective cardiac surgery. 42 patients with AF (11.9% paroxysmal, 23.8% persistent, 64.3% LsPeAF) underwent concomitant HIFU ablation (AF ablation group), 16 with AF underwent cardiac surgery without ablation (AF control) and 20 had preoperatively normal sinus rhythm (SR control). We measured plasma ANP secretion before, on postoperative day (POD) 1, POD 7 as well as 3 and 6 months after surgery. Moreover, we estimated cardiac rhythm and atrial mechanical function by Atrial Filling Fraction (AFF) and A-wave velocity in follow-up.ResultsBaseline ANP levels were higher in patients with LsPeAF, as compared to the paroxysmal and permanent AF and to the SR control group. Patients with LsPeAF (n = 27) who converted to SR had preoperatively smaller left atrial diameter (LAD) and LA area (p < 0.05) and higher ANP level (p = 0.009) than those who remained in AF at 6 months after ablation. Multivariate regression analysis revealed that only preoperative ANP level was an independent predictor of cardiac rhythm after ablation. Patients with LsPeAF and preoperative ANP >7.5 nmol/l presented with SR in 80%, in contrast to those with ANP <7.5 nmol/l who converted to SR in 20%. We detected gradual increase of AFF and A-velocity at 6 months after ablation (p < 0.05) solely in AF ablation group. ANP levels were increased on POD 1 in ablation group (p < 0.05), without changes in further follow-up.ConclusionOur results indicate that preoperative ANP levels may be a new biochemical predictor of successful epicardial ablation in patients with concomitant LsPeAF. HIFU ablation caused a significant improvement of atrial mechanical function and gradual increase of AFF and did not associate with alteration of atrial endocrine secretion at 6 months follow-up.

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Section: Discussionmentioning

confidence: 99%

Impact of epicardial ablation of concomitant atrial fibrillation on atrial natriuretic peptide levels and atrial function in 6 months follow-up: does preoperative ANP level predict outcome of ablation?

Pizon

Friedel

Freundt

et al. 2013

J Cardiothorac Surg

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“…2 The infusion of human atrial natriuretic peptide after cardiac surgery stimulates the secretion of cyclic guanosine monophosphate from the pulmonary vascular bed and dilates the PA, thereby decreasing the PA pressure. 3 Beta-mimetic agents and phosphodiesterase inhibitors may contribute to further left ventricular dysfunction due to ischemia and arrhythmia-increasing effect. 4 Levosimendan is a positive inotropic agent recommended for short-term use in acute decompensated heart failure.…”

Section: Introductionmentioning

confidence: 99%

Use of levosimendan in patients with ischemic heart disease following mechanical reperfusion

Kurt

2009

Surg Today

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Cardiac failure is among the most significant conditions associated with acute coronary syndrome. In ischemic heart disease, serious hemodynamic problems are reported in patients with left ventricular dysfunction during the acute phase despite mechanical revascularization. Several positive inotropic agents in addition to intra-aortic balloon pump (IABP) are required to support patients with impaired left ventricular pump function during this phase. Intravenous inotropic agents, beta-mimetics, and phosphodiesterase inhibitors lead to increases in the incidence of arrhythmia and myocardial O(2) consumption owing to their effect of increasing intracellular calcium amount, although they produce rapid hemodynamic improvements in cardiac failure. This causes severe problems particularly in cardiac failure of ischemic origin. Recently, levosimendan, a calcium-sensitizing agent with cardioprotective properties, is being used alone or in combination with IABP in cases with severe left ventricular systolic dysfunction during mechanical revascularization procedures (percutaneous coronary interventions, coronary bypass surgery). This review includes studies with levosimendan in cases not recovering due to myocardial stunning in the acute phase despite mechanical approaches applied.

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Hemodynamic and humoral effects of atrial natriuretic peptide on pulmonary circulation after cardiac surgery

Abstract: The infusion of h-ANP after cardiac surgery stimulates the secretion of cGMP from the pulmonary vascular bed and dilates the PA, thereby decreasing the PA pressure.

Cited by 2 publications

References 26 publications

Impact of epicardial ablation of concomitant atrial fibrillation on atrial natriuretic peptide levels and atrial function in 6 months follow-up: does preoperative ANP level predict outcome of ablation?

Impact of epicardial ablation of concomitant atrial fibrillation on atrial natriuretic peptide levels and atrial function in 6 months follow-up: does preoperative ANP level predict outcome of ablation?

Use of levosimendan in patients with ischemic heart disease following mechanical reperfusion

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