Correlation of plasma B-type natriuretic peptide with shunt severity in patients with atrial or ventricular septal defect

The goal of this study was to test the utility of bedside plasma concentration of B-type natriuretic peptide (BNP) assay as a screen for large shunts in pediatric patients with atrial septal defects (ASDs) and ventricular septal defects (VSDs). Thirty-five children at a mean age of 70 +/- 129 weeks with ASD or VSD were included in the study. Nine patients had VSD and 26 had ASD. Plasma BNP values were compared with the Q(p)/Q(s) ratios derived from quantitative Doppler flow measurements. Mean BNP was 29 +/- 42 pg/ml, with a range between < 5 pg/ml and 208 pg/ml. Sixteen patients had Q(p)/Q(s) values > 1.5 and 19 had values < 1.5. The difference of mean BNP in these patient groups was statistically significant (45 +/- 56 vs 14 +/- 17, p = 0.03). BNP was positively correlated with shunt significance. Receiver operating characteristic curve analysis revealed a sensitivity of 69% and a specificity of 79% at a plasma BNP cut-off level of >= 20 pg/ml. Bedside measurement of BNP correlates with magnitude of ASD and VSD in children. BNP can provide information for the management of children with ASD or VSD. It can be used as part of the evaluation of a child with a preliminary diagnosis of a congenital defect.