الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Natriuretic peptides such as brain natriuretic peptide (BNP), atrial natriuretic peptide (ANP) and pro-BNP are secreted in response to atrial and/or ventricular stretch. Left to right shunts such as in ventricular septal defect (VSD), atrial septal defect (ASD), and patent ductus arteriosus (PDA), are treated medically or surgically. We aimed to evaluate whether the serum level of pro-BNP would be useful to measure the amount of the shunt. Our study was conducted on sixty patients (infants and children) whom had isolated VSD, ASD or PDA with left to right shunt (diagnosed by Echocardiography) from age of 6 months to 18 years old. Twenty four patients were diagnosed with ASD, twenty five patients were diagnosed with VSD & eleven patients were diagnosed with PDA. All patients are subjected to history taking, full clinical examination (general & local cardiac examination), 2D echocardiography for diagnosis of ASD, VSD & PDA, assessment of QP/QS ratio non-invasively by 2D echocardiography, and then blood sample is taken for assessment of serum level of Pro PNB. As regard the age distribution in study population , the mean value was 57.63 ± 62.71 month (mean ± SD) in ASD group , 65.34 ± 66.26 month (mean ± SD) in VSD group and11 patients has 32.45 ± 37.81 month (mean ± SD) in PDA group. As regard the weight distribution in the study population , the mean value was 16.43 ± 11.08kg (mean ± SD)in ASD group , 18.21 ± 10.96kg (mean ± SD)in VSD group and 11.58 ± 6.77kg (mean ± SD) in PDA group. the sample of study which contains 60 patients , 33 patients were females (55%) and 27 patients were males(45%), ASD group has13 females (62.5%)and 9 males(37.5%), VSD group has13 females (52%) and12 males (48%)& PDA group has 5 females (45.5%)and 6 males(54.5%). ASD group contains 14 patients with small size ASD (58.3%), 6 patients with moderate size ASD (25%) and 4 patients with large size ASD (16.7%) , VSD group contains 11 patients with small size VSD (44%), 6 patients with moderate size VSD (24%)& 8 patients with large size VSD (32% ) & PDA group contains 5 patients with small size PDA (45.5 %), 4 patients with moderate size PDA (36.4% ) and 2 patients with large size PDA (18.1% ). In ASD group the mean value of QP/QS ratio was 1.47 ± 0.49 (mean ± SD), In VSD group the mean value of QP/QS ratio was 4.34 ± 1.61(mean ± SD)& In PDA group the mean value of QP/QS ratio was 1.76 ± 1.03 (mean ± SD). ASD group contains 12 patients with QP/QS ratio less than 1.5 (50 %), 9 patients with QP/QS ratio between 1.5-2.0 (37.5 % ) and 3 patients with QP/QS ratio more than 2 (12.5 % ),VSD group contains 15 patients with QP/QS ratio less than 1.5 (60%), 5 patients with QP/QS ratio between 1.5-2.0 (20%) & 5 patients with QP/QS ratio more than 2 (20%)&PDA group contains 6 patient with QP/QS ratio less than 1.5 (54.5 %),1 patient with QP/QS ratio between 1.5-2.0 (9.1% ) and 4 patients with QP/QS ratio more than 2 (36.4% ). In ASD group the mean value of pro BNP was 100.42 ± 43.05pg/ml(mean ± SD) ,In VSD group the mean value of pro BNP was 100.48 ± 55.0 pg/ml (mean ± SD) In PDA group, the main value of pro BNP was 2.0 ± 69.05 pg/ml (mean ± SD) . There is 46 patients of the study population with pro BNP level less than 125 pg /ml about 33 patients (71.7%) of them with Qp/Qs ratio less than 1.5 & 13 patients (28.3 %) of them with Qp/Qs ratio 1.5-2 ,There is 14 patients of the study population with pro BNP ratio≥125 pg/ml , about 12 patients (85.7%) of them with Qp/ Qs ratio more than 2 & 2 patients (14.3%) of them with Qp/Qs ratio 1.5-2 . There was a significant correlation between the Qp/Qs ratio and pro BNP serum level (P=0.001) The mean pro-BNP was related to Qp/Qs<1.5 or Qp/ Qs>1.5 (P = 0.001) in patients with VSD, ASD, and PDA. Therefore pro-BNP can be used as a screening tool for evaluating hemodynamic load in patients with VSD, ASD, and PDA. Based on our study pro-BNP serum level ≥ 125 pg/mL is helpful for detecting the amount of Qp/Qs ratio and the need for more interventions.