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J Thorac Cardiovasc Surg 2000;120:604-608
© 2000 The American Association for Thoracic Surgery

Surgery for Congenital Heart Disease

Triiodothyronine repletion in infants during cardiopulmonary bypass for congenital heart disease

From the Division of Cardiology, Department of Pediatrics (M.A.P., C.F., X.H., G.L.R.), and Division of Cardiothoracic Surgery (B.W.D., F.M.L), Department of Surgery, University of Washington and Children's Hospital and Regional Medical Center, Seattle, Wash.

Funded in part by grant R01-HL60666 awarded to M.A.P.

Address for reprints: Michael A. Portman, MD, Cardiology–CH-11, Children's Hospital and Regional Medical Center, 4800 Sand Point Way NE, Seattle, WA 98105 (E-mail: Mportm{at}chmc.org ).

Objective: Cardiopulmonary bypass suppresses circulating thyroid hormone levels. Although acute triiodothyronine repletion has been evaluated in adult patients after cardiopulmonary bypass, triiodothyronine pharmacokinetics and effects have not previously been studied in infants undergoing operations for congenital heart disease. We hypothesized that triiodothyronine deficiency in the developing heart after bypass may adversely affect cardiac function reserve postoperatively.
Methods: Infants less than 1 year old undergoing ventricular septal defect or tetralogy of Fallot repair were randomized into 2 groups. Group T (n = 7) received triiodothyronine (0.4 µg/kg) immediately before the start of cardiopulmonary bypass and again with myocardial reperfusion. Control (NT, n = 7) patients received saline solution placebo or no treatment.
Results: These groups underwent similar ischemic and bypass times and received similar quantities of inotropic agents after the operation. The NT group demonstrated significant depression in circulating levels, compared with prebypass levels, for free triiodothyronine and total triiodothyronine at 1, 24, and 72 hours after bypass. Group T demonstrated similar low thyroxine values, but free and total triiodothyronine levels were maintained at prebypass levels for 24 hours and remained elevated over those of group NT (P < .05) at 72 hours. Heart rate was transiently elevated in group T compared with group NT (P < .05), and peak systolic pressure-rate product increased after 6 hours.
Conclusion: These data imply that (1) triiodothyronine in the prescribed dose prevents circulating triiodothyronine deficiencies and (2) triiodothyronine repletion promotes elevation in heart rate without concomitant decrease in systemic blood pressure. Elevation of peak systolic pressure-rate product implies that triiodothyronine repletion improves myocardial oxygen consumption and may enhance cardiac function reserve after cardiopulmonary bypass in infants.

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