Brain natriuretic peptide and atrial septal defect size in children

Main Article Content

Siti Aizah Lawang
Haryanty Kartini Huntoyungo
Dasril Daud


Background Atrial septal defect (ASD) is one of the most common forms of congenital heart disease (CHD). Brain natriuretic peptide (BNP) is a heart marker released into the circulation during pressure overload, heart volume expansion, and increased stress on +the myocardial wall.

Objective To assess for a possible association between atrial septal defect size and BNP level in pediatric patients.

Methods This cross sectional study on children with ASD was done from March to December 2018 in pediatric outpatients and inpatients at Dr. Wahidin Sudirohusodo Hospital, Makassar, South Sulawesi.  Measurement of ASD defect was conducted using echocardiography and categorized as small defect (<3 mm), medium defect (3-8 mm), and large defect (>8 mm). Brain natriuretic peptide was measured using radioimmunoassay and immunoradiometricassay. Nutritional status was categorized using WHO if the patients aged younger than 5 years and NCHS for patients aged equal or more than 5-year-old.

Results Mean BNP levels were 65.5 pg/mL in the small ASD group, 273.2 pg/mL in the moderate ASD group, and in 654.5 pg/mL in the large ASD group, with significant differences among ASD groups. We found a significant positive correlation between BNP levels and ASD diameter (r=0.829; P=0.001), with Y regression equation of: (BNP level) =2.624 + 0.009X (ASD diameter in mm).

Conclusion Brain natriuretic peptide levels have significant positive correlation with ASD size. Hence, BNP measurements can be used to predict septal defect size in children with ASD. Acyanotic CHD patients with suspected ASD and high BNP levels may have moderate-to-large ASDs.

Article Details

How to Cite
Lawang SA, Huntoyungo H, Daud D. Brain natriuretic peptide and atrial septal defect size in children. PI [Internet]. 17Sep.2020 [cited 27Oct.2020];60(5):277-2. Available from:
Pediatric Cardiology
Received 2020-03-17
Accepted 2020-09-17
Published 2020-09-17


1. Moons P, Sluysmans T, De Wolf D, Massin M, Suys B, Benatar A, et al. Congenital heart disease in 111 225 births in Belgium: birth prevalence, treatment and survival in the 21st century. Acta Paediatr. 2009;98:472–7. doi:10.1111/j.1651-2227.2008.01152.x.
2. Wu MH, Chen HC, Lu CW, Wang JK, Huang SC, Huang SK. Prevalence of congenital heart disease at live birth in Taiwan. J Pediatr. 2010;156:782–5. doi:10.1016/j.jpeds.2009.11.062.
3. Park MK. Pediatric cardiology for practitioners. 4th ed. Philadelphia: Mosby Elsevier; 2014. p.39-55.
4. Gowda SR, Gawde HM, Hyderi A, Savitha MR, Krishnamurthy B, Karat SC, et al. Chromosomal anomalies and congenital heart disease in Mysore, South India. Int J Hum Genet. 2010;10:131–9. doi:10.1080/09723757.2010.11886096.
5. Schiller O, Greene EA, Moak JP, Gierdalski M, Berul CI. The poor performance of RSR’ pattern on electrocardiogram lead V1 for detection of secundum atrial septal defects in children. J Pediatr. 2013;162:308–12. doi:10.1016/j.jpeds.2012.07.017.
6. Sjarief DR, Anggriawan SL, Putra ST, Djer MM. Anthropometric profiles of children with congenital heart disease. Med J Indones. 2011;20:40–5. doi:10.21088/per.2321.1644.5117.5.
7. Uz O, Aparci M, Acar G, Kardesoglu E, Kaplan O, Yiginer O, et al. Association of plasma B-type natriuretic peptide levels with shunt size in young adults with atrial septal defect. Echocardiography. 2011;28:243–7. doi:10.1111/j.1540-8175.2010.01285.x.
8. Radman M, Mack R, Barnoya J, Castañeda A, Rosales M, Azakie A, et al. The effect of preoperative nutritional status on postoperative outcomes in children undergoing surgery for congenital heart defects in San Francisco (UCSF) and Guatemala City (UNICAR). J Thorac Cardiovasc Surg. 2014;147:442–50. doi:10.1016/j.jtcvs.2013.03.023.
9. Jan SL, Fu YC, Hwang B, Lin SJ. B-type natriuretic peptide in children with atrial or ventricular septal defect: a cardiac catheterization study. Biomarkers. 2012;17:166–71. doi:10.3109/1354750X.2011.649494.
10. Eerola A, Jokinen E, Boldt T, Mattila IP, Pihkala JI. Serum levels of natriuretic peptides in children before and after treatment for an atrial septal defect, a patent ductus arteriosus, and a coarctation of the aorta—a prospective study. Int J Pediatr. 2010;2010:674575. doi:10.1155/2010/674575.