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Clinical Investigations: CARDIOVASCULAR SURGERY |

Elevated Plasma Atrial Natriuretic Peptide Levels After Occlusion of the Thoracic Aorta*

Haim Berkenstadt, MD; Talma Rosenthal, MD; Edna Peleg, PhD; Eran Segal, MD; Allan Hackshaw, MSc; Gur Ben-Ari, MD; Azriel Perel, MD
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*From the Departments of Anesthesiology and Intensive Care (Drs. Berkenstadt, Segal, and Perel), Surgical Oncology (Dr. Ben-Ari), and Chorley Institute for Hypertension Research (Drs. Rosenthal and Peleg), Chaim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel; and The Wolfson Institute of Preventive Medicine, St. Bartholomew’s and the Royal School of Medicine (Mr. Hackshaw), London.



Chest. 1999;115(1):130-134. doi:10.1378/chest.115.1.130
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Study objective: The influence of occlusion of the thoracic aorta by an intraluminal balloon on plasma atrial natriuretic peptide (ANP) levels was evaluated in humans.

Methods: The changes in plasma ANP and plasma norepinephrine levels, and hemodynamic parameters were measured in 10 patients under general anesthesia undergoing regional chemotherapy treatment involving the 15-min inflation and subsequent deflation of an intra-aortic balloon.

Results: The hemodynamic changes observed were similar to those seen during aortic clamping and declamping in patients undergoing vascular surgery. Plasma ANP levels (median ± SD) measured 1 min after inflation (146 ± 117 pg/mL) and 1 min after deflation (168 ± 189 pg/mL) of the aortic balloon were significantly higher than baseline values (83 ± 55 pg/mL), with a mean increase, respectively, of 92% and 97% (95% confidence intervals [CI], 50 to 147% and 53 to 152%). Plasma ANP levels were still elevated 30 min after deflation (121 ± 94 pg/mL), a 56% increase (95% CI, 21 to 100%), although the hemodynamic parameters had already returned to their baseline levels. There was no evidence that the hemodynamic variables were associated with changes in plasma ANP levels (all p values > 0.30). In addition, there was no evidence of an association between plasma ANP and plasma norepinephrine levels at any of the four individual sampling points (p > 0.17). Thirty minutes after deflation, however, norepinephrine levels were higher than baseline values.

Conclusions: The changes in plasma ANP levels after aortic occlusion and reinstitution of blood flow may be dependent on parameters other than atrial stretch and pressure.

Abbreviations: ANOVA = analysis of variance; ANP = atrial natriuretic peptide; CI = confidence interval; CO = cardiac output; CVP = central venous pressure; MAP = mean arterial pressure; PAP = pulmonary arterial pressure; PCWP = pulmonary capillary wedge pressure; SVR = systemic vascular resistance

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