NDLI: Cardiopulmonary bypass and serum thyroid hormone profile in pediatric patients with congenital heart disease.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Talwar, Sachin Khadgawat, Rajesh Sandeep, Jandardhan Alamanda Sreenivas, Vishnubhatla Choudhary, Shiv Kumar Gupta, Nandita Airan, Balram
Description	Country affiliation: India Author Affiliation: Talwar S ( Departments of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India. sachintalwar@hotmail.com)
Abstract	OBJECTIVE: To study the effect of cardiopulmonary bypass (CPB) on serum thyroid hormone profile in children undergoing open-heart surgery. DESIGN: Prospective cross-sectional study. SETTING: Multispecialty tertiary level referral center. PATIENTS: One hundred consecutive patients (age 15.9 ± 14.6 months, weight 6.7 ± 2.5 kg) undergoing open-heart surgery under CPB. INTERVENTIONS: None. OUTCOME MEASURES: Levels and trends of serum total thyroxine (TT4), free thyroxine (FT4), total tri-iodothyronine (TT3), free tri-iodothyronine (FT3) and thyroid stimulating hormone (TSH), survival, inotropic score, duration of mechanical ventilation, postoperative complications. RESULTS: TT4 levels were 9.08 ± 3.6, 6.4 ± 2.5, 6.24 ± 2.1, 6.43 ± 2.4, 7.20 ± 3.0 µg/dL at baseline and at 1, 24, 48 and 72 hours; FT4 levels were 1.82 ± 0.5, 1.49 ± 0.3, 1.29 ± 0.3, 1.32 ± 0.4, and 1.43 ± 0.5 ng/dL; TT3 levels were 1.81 ± 0.4, 1.31 ± 0.3, 0.99 ± 0.2, 1.0 ± 0.37, and 1.17 ± 0.48 ng/ml; FT3 levels were 4.09 ± 1.0, 3.02 ± 0.8, 2.21 ± 0.6, 2.22 ± 0.7, and 2.66 ± 1.05 pg/ml; TSH levels were 5.40 ± 3.8, 2.0 ± 3.1, 1.24 ± 1.1, 2.90 ± 3.3, and 4.03 ± 3.4 mIU/L. There was significant fall (29.1% for FT4, 32.1% for TT4, 77% for TSH, 46% for FT3 and 45% for TT3, p < 0.0001). When area under curve (AUC) TT4 was compared between survivors (n = 87) and nonsurvivors (n = 12), significantly larger AUC was seen in survivors (492.81 ± 158.6) than nonsurvivors (360.75 ± 179.6 p = 0.0125). In survivors >72 hours, AUC TT4 was larger in patients with uneventful postoperative course versus those with postoperative complications (516.48 ± 18.6 vs. 394.78 ± 29.9, p = 0.001). AUC TT4 showed significant inverse correlation with inotropic score and borderline inverse correlation with duration of mechanical ventilation. CONCLUSION: Children undergoing surgery under CPB showed significant fall in thyroid hormones. Because TT4 level is modifiable, prophylactic administration of TT4 for improving outcomes needs to be studied further.
File Format	HTM / HTML
ISSN	1747079X
Issue Number	5
Volume Number	7
e-ISSN	17470803
Journal	Congenital Heart Disease
Language	English
Publisher	Wiley-Blackwell
Publisher Date	2012-09-01
Publisher Place	United States
Access Restriction	Subscribed
Subject Keyword	Discipline Cardiology Cardiac Surgical Procedures Cardiopulmonary Bypass Heart Defects, Congenital Surgery Thyroid Hormones Blood Area Under Curve Biological Markers Adverse Effects Mortality Cardiotonic Agents Therapeutic Use Child Child, Preschool Cross-sectional Studies Down-regulation Female Humans Infant Infant, Newborn Linear Models Male Postoperative Complications Etiology Therapy Prospective Studies Respiration, Artificial Tertiary Care Centers Thyrotropin Thyroxine Time Factors Treatment Outcome Triiodothyronine Journal Article
Content Type	Text
Resource Type	Article
Subject	Radiology, Nuclear Medicine and Imaging Surgery Pediatrics, Perinatology and Child Health Cardiology and Cardiovascular Medicine

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