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A Journal on Cardiac, Vascular and Thoracic Surgery

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The Journal of Cardiovascular Surgery 1999 December;40(6):781-5

language: English

Hemodynamic ­effects of α-­human atri­al nat­riu­ret­ic poly­pep­tide on ­patients under­go­ing ­open-­heart sur­gery

Ohki S., Ishikawa S., Ohtaki A., Takahashi T., Kpyano T., Otani Y., Muramaki J., Mohara J., Isa Y.*, Kunimoto F.*, Morishita Y.

From the Second Department of Surgery
*Intensive Care Unit Gunma University School of Medicine, Maebashi, Japan


Background. A car­diac hor­mone, α-­human atri­al nat­riu­ret­ic poly­pep­tide (α-hANP), ­acts as a vaso­di­la­tor and a diu­ret­ic by acti­vat­ing ­cyclic GMP for­ma­tion. We stud­ied the hemo­dy­nam­ic ­effects of con­tin­u­ous intra­ve­nous infu­sion of α-hANP on ­patients under­go­ing ­open-­heart sur­gery.
Methods. A total­ of 15 ­patients, includ­ing 7 ­with ­CABG, 4 ­with AVR, 2 ­with ­CABG ­plus AVR, and 2 ­with AVR ­plus MVR ­were ­involved in the ­study. They under­went ­open-­heart sur­gery in our insti­tute ­between July 1996 and April 1997. The ­mean age of ­patients was 68 ­years, rang­ing ­from 63 to 77. A dos­age of 0.05 µg/kg/min of α-hANP was admin­is­tered to all ­patients on post­op­er­a­tive day 1. Hemodynamics and ­blood and ­urine sam­ples ­were meas­ured at the fol­low­ing ­times: 2 ­hours ­before con­tin­u­ous intra­ve­nous infu­sion of α-hANP, 0, 1, 2, 3, 6, 12 and 24 ­hours ­after con­tin­u­ous intra­ve­nous infu­sion. We con­com­i­tant­ly meas­ured ­urine vol­ume and the plas­ma con­cen­tra­tion of α-hANP.
Results. The plas­ma con­cen­tra­tion of α-hANP ­increased suf­fi­cient­ly ­after the begin­ning of con­tin­u­ous intra­ve­nous infu­sion with­out any ­side ­effects, and the ­urine vol­ume ­increased too. The admin­is­tra­tion of α-hANP ­induced a ­decrease in cen­tral ­venous pres­sure, pul­mo­nary cap­il­lary ­wedged pres­sure and the pul­mo­nary vas­cu­lar resis­tance ­index. Systemic vas­cu­lar resis­tance ­index and car­diac out­put ­remained ­unchanged.
Conclusions. It is use­ful for the man­age­ment of ­patients ­with asso­ciat­ed vol­ume over­load fol­low­ing ­open-­heart sur­gery ­because the admin­is­tra­tion of α-hANP decreas­es pre­load and facil­i­tates sat­is­fac­to­ry uri­na­tion.

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