Koch et al. (28) found that the BNP level increased in neonates and children with left to right shunt and was positively correlated with shunt flow, right ventricular systolic pressure, mean pulmonary artery pressure, and pulmonary artery resistance, indicating that the plasma BNP level in neonates with congenital heart disease is closely related to cardiac insufficiency caused by volume load. This evidence concerns the gene NPPB and heart failure.