The Utility of B-type Natriuretic Peptide (BNP) for Evaluating Left to Right Shunts Effects in Pediatric Patients

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Background: Congenital heart disease (CHD) with left-to-right shunts, including atrial septal defect (ASD), ventricular septal defect (VSD), and patent ductus arteriosus (PDA), is a leading cause of pediatric morbidity. Echocardiography remains the diagnostic standard for defining anatomy and shunt magnitude, yet repeated imaging can be resource-intensive. B-type natriuretic peptide (BNP), a ventricular stress biomarker, has emerged as a potential adjunct for assessing shunt severity, guiding management, and monitoring outcomes in infants and children. This review aims to synthesize current evidence on the prognostic and diagnostic value of BNP in pediatric left-to-right shunts.Methods: PubMed, Scopus, and Web of Science databases were searched without language restriction, focusing on studies evaluating BNP or NT-proBNP in VSD, ASD, and PDA. Key outcomes of interest included correlations with shunt fraction (Qp/Qs), chamber enlargement, hemodynamic significance, and changes following pharmacological or interventional closure. Additional literature on neonatal BNP physiology and confounding factors was also examined to contextualize biomarker interpretation.Conclusion: Evidence consistently demonstrates that BNP levels rise with increasing shunt burden, particularly in hemodynamically significant PDA, and decline following closure, highlighting its role as a dynamic marker of ventricular volume overload. BNP offers practical advantages as a bedside, minimally invasive tool to complement echocardiography in diagnosis and follow-up. However, age-dependent reference ranges, assay variability, and non-specific elevations (e.g., renal dysfunction, cardiomyopathy) limit its standalone use. Future studies are needed to establish standardized pediatric cut-offs and to integrate BNP into multimodal diagnostic algorithms for CHD.

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