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Plasma Atrial Natriuretic Peptide Concentrations of the Pulmonary artery, Aorta and Veins in Children with Cardiac Disease

Journal of the Korean Pediatric Society 1994;37(4):481-493.
Published online April 15, 1994.
Plasma Atrial Natriuretic Peptide Concentrations of the Pulmonary artery, Aorta and Veins in Children with Cardiac Disease
Kang Il Lee, Nam Geun Heo, Myung Chul Hyun, Sang Bum Lee, Eun Kyoung Yang, Won Jung Lee
Department of Pediatrics, School of Medicine, Kyung-pook National University, Taegu, Korea
소아 심장질환 환자에서의 혈중 Atrial Natriuretic Peptide농도
이강일, 허남근, 현명철, 이상범, 양은경, 이원정
경북대학교 의과대학 소아과학교실
Abstract
To study the site of release and factors affecting the releases of the atrial natriuretic peptide (ANP) in the pediatric patients, we measured the plasma ANP concentrations in 23 normal healthy children, 19 patients with congestive heart failure and 16 patients with cardiac disease undergoing diagnostic cardiac catheterization. The following results were obtained. 1) The plasma ANP concentrations of the vein (226.3¡¾74.9 pg/ml) in patients with congestive heart failure were significantly higher than those (p<0.01) of the normal healthy children (13.4¡¾7.9 pg/ml) and those (43.3¡¾40.7 pg/ml) in patients undergoing cardiac catheterization. The plasma ANP concentrations of the femoral vein in patients undergonig cardiac catheterization were also significantly higher than that of the peripheral vein in the normal healthy children (p<0.01) 2) The plasma ANP concentrations of the pulmonary artery (110.9¡¾80.7 pg/ml) were 2 to 3 times higher than that of the femoral vein (43.3¡¾40.3 pg/ml, p<0.01). However there were no significant differences of the plasma ANP concentrations between pulmonary artery and aorta (65.4¡¾36.1 pg/ml), and between aorta and femoral vein. 3) There was a significant correlations of the plasma ANP concentrations between pulmonary artery and femoral vein, and pulmonary artery and aorta, but no correlation of those between femoral vein and aorta. 4) The plasma ANP concentrations of the vein were over 3 times more higher in cases of left atrial area over 20 cm2/M2 measured by 2-dimensional echocardiography (213.2¡¾292.9 pg/ml) than those in cases of left atrial area under 20 (65.0¡¾66.9 pg/ml, p<0.05). The plasma ANP concentrations of the pulmonary artery were 2 times more higher in cases of left atrial area over 14 cm2/M2 (88.6¡¾19.1 pg/ml) than those in cases of left atrial area under 14 (57.1¡¾39.5 pg/ml, p<0.05), and in cases of the sum of both atrial mean pressure over 11mmHg (189.5¡¾42.8 pg/ml) than those in cases of the sum under 11 (79.3¡¾52.3 pg/ml, p<0.01). The plasma ANP concentrations of the aorta were significantly higher in cases of left atrial area over 14cm2/M2 (88.6¡¾19.1 pg/ml) than those in cases of left atrial area under 14 (57.1¡¾39.5 pg/ml, p<0.05), in cases of the sum of both atrial area over 25cm2/M2 (93.9¡¾21.7 pg/ml) than those in cases of the sum under 25 (46.6¡¾33.8 pg/ml, p<0.01), in cases of mean atrial pressure over 11 mmHg (90.5¡¾30.3 pg/ml) than those in cases of undr 11 (53.8¡¾24.6 pg/ml, p<0.05), in cases of the sum under 190 (57.5¡¾26.4 pg/ml, p<0.01), and also in cases of pulmonary artery mean pressure over 20mmHg (83.3¡¾18.2 pg/ml) than those in cases of pulmonary artery under 20 (47.8¡¾39.8 pg/ml, p<0.05). In conclusion, the plasma ANP concentrations of the pulmonary artery were significantly higher than those of the femoral vein and the aorta, which indicates that the ANP is predominantly secreted via coronary sinus into the right atrium. The plasma ANP concentrations of the peripheral and femoral vein, the pulmonary artery and the aorta, especially that of the aorta, correlated well with the atrial pressure, the area and the wall stress. This suggests the arterial blood may be the most appropriate sample for measurement of the ANP.
Key Words: Atrial Natriuretic Peptide, Pulmonary artery, Aorta, Veins


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